Bone Cancer

Until recently, bone cancer was a devastating malignancy that rarely responded to treatment. Today, however, the combination of anticancer drugs, radiation therapy and surgery has boosted the five-year survival rate to 80 percent. The most common forms of bone cancer in children are osteosarcoma and Ewing's sarcoma. Osteosarcoma affects about five children in a million each year and is more common in whites than in blacks. Ewing's sarcoma occurs less frequently and is hardly ever seen in blacks. Bone cancer is most likely to occur during adolescence—particularly in boys as they undergo the adolescent growth spurt. With early detection, the odds of a child surviving bone cancer are good.

WHEN SHOULD I SUSPECT A CHILD HAS BONE CANCER?
The first signs of bone cancer are persistent bone pain and swelling at the site of the tumor. At first, the parent may assume that the pain is due to a bump or bruise, but it lasts beyond the few days usually required for healing. Closer examination of the area may reveal a tender lump. After several weeks, the child begins to limit motion of the affected limb, and gait and coordination may change. Eventually, bone fractures may occur.

HOW DOES BONE CANCER DEVELOP?
Bone cancer most often develops in the bones of the arm or the leg (particularly the femur), but it may also occur in the knee, shoulder or hip, or in several bones at once. Bone cancer commonly progresses to the lungs, but it does not produce symptoms there for some time. The bones are also common sites for the spread of other tumors. When a lump or growth is found in a bone, it may be the first sign of cancer elsewhere in the body.

HOW CAN A DOCTOR TELL IF A CHILD HAS BONE CANCER?
Bone tumors usually can be detected on an X-ray examination. Many bone tumors are benign, however, so the doctor may order a biopsy, in which a small sample of bone tissue is removed for laboratory examination, to confirm the diagnosis. Other diagnostic measures include other radiologic studies, such as bone scans and CT (computed tomography) scans to assess the size of the tumor and to deterine if the cancer has spread.

WHAT TREATMENTS ARE AVAILABLE?
Osteosarcoma is treated by surgical removal of the cancerous bone tissue and usually requires the amputation of the affected limb. If the bone tumor is localized, however, sometimes the limb can be saved by removing only the cancerous portion of the bone and reconstructing the arm or the leg with a bone graft or bone transplant. After surgery, treatment with anti-cancer drugs (chemotherapy) is given for many months to destroy any cancer cells that may have migrated to other parts of the body.

Ewing's sarcoma does not require surgical removal of the tumor. Instead, these tumors are treated with intensive irradiation of the involved bone (radiotherapy) followed by an extensive course of chemotherapy.

GETTING HELP
Call your doctor if your child:

• Has persistent bone pain with no sign of a bruise

• Has a lump, redness or swelling at the site of bone pain

• Gradually begins to limp or limit the motion of an arm or leg

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.