Osteosarcoma in children is the most common primary bone neoplasm at that age. These are primary bone tumors, that is, they originate in the tissue itself. They are rare, but despite their rarity they pose a latent danger.
The diagnostic peak is between the ages of 13 and 16, at which time the diagnosis occurs. growth of adolescence. Furthermore, a higher occurrence was observed in boys than in girls. Its feature is production of immature bone by malignant cells.
Presentation of osteosarcoma in children
The most common site of occurrence of osteosarcoma in children is the long bones, especially in the distal femur (in the thigh, near the knee), proximal tibia (in the leg, also near the knee), and proximal humerus (in the arm, near the shoulder). The epidemiological distribution is as follows:
- Femur: 42% of osteosarcoma diagnoses.
- Tibia: 19%.
- Homer: 10%.
- Skull and jaw: 8%.
- Pelvis: 8%.
At the time of diagnosis, it is assumed that most patients have metastatic disease, i.e. tumors elsewhere in the body, outside of the bones. These would be small, asymptomatic, called micrometastases. The most common localization site for this complication is the lungs.
Symptoms of osteosarcoma in children
Most children with osteosarcoma have Localized pain lasting several months which can be related to activity or movement. It often starts after an injury and can increase or decrease with the course of time. Sometimes fractures occur as the first manifestation.
The most important finding on physical examination is a soft tissue mass. which is often large and tender to palpation. It can even be hot.
The most common areas are those described above, i.e. on the thigh, leg or arm. But they can also appear in other bones of the body.
There are rarely fever, weight loss and malaise. It is important to consult promptly before any type of pain mentioned, whether associated with movement or at rest, even if there has been no trauma to justify it.
Laboratory evaluation is generally normal, except for alterations in some parameters such as alkaline phosphatase, lactate dehydrogenase (LDH), and erythrocyte sedimentation rate. In most patients they are within the normal range.
Causes
In children, most osteosarcomas are sporadic. This means that the hereditary predisposition represents a minority of patients. From what is known so far, this type of tumors they occur at a time when long bones are in a growth spurtbut the root cause is still unknown.
Treatments for osteosarcoma in children
As a rule, imaging studies will be performed on patients suspected of having osteosarcoma.. These include a simple X-ray of the affected area and an MRI scan. In addition, a biopsy of the bone lesion, a lung CT scan for metastases, and other imaging of all bones will be done.
With all this information, the so-called tumor stratification, which will allow you to plan the best treatment to perform on the patient. In general terms, HeTO Surgery and systemic chemotherapy are the mainstays of the approach for children with nonmetastatic osteosarcoma..
Surgery
Surgical treatment has evolved over the past few decades. Its main goal remains to achieve a complete extraction of the tumorbut with an emphasis on more conservative surgery to maintain function of the affected limb.
Chemotherapy
Chemotherapy is considered a standard component of osteosarcoma treatment, in both children and adults. It improves patient survival, which would be related to the micrometastases we mentioned earlier.
It is used before and after surgery.. It can sometimes have undesirable effects on different organs, such as the bladder, liver and ears. Therefore, periodic monitoring is carried out.
Radiotherapy
In very specific cases, radiotherapy associated with the treatment is also used, since tumor response is suboptimal.
Treatment for side effects
The specific surgical procedure to be performed in each patient is dictated by the location of the osteosarcoma and the extent of the tumor. For this reason, not all patients will be candidates for more conservative surgery which allows the functionality of the affected member to be maintained.
Most children with osteosarcoma will require reconstructive surgical procedures to restore structural integrity at the site where the tumor was removed. This is to preserve functionality. Sometimes they will be used joint replacements or grafts.
Osteosarcoma in children and its prognosis
In conclusion, we can say that the prognosis of children diagnosed with osteosarcoma is significantly improved and also their chances of leading a normal life after treatment.
Early diagnosis and specialized referral will allow for better results. Likewise, long-term follow-up is important in order to prevent future complications.
THE survival of patients have improved over the past 30 years, largely due to advances in chemotherapy, as many patients are known to have microscopic metastases at diagnosis. Chemotherapy is used to eradicate them.
Furthermore, surgeries performed today tend to be more conservative. But of course, we have to clarify that the choice of the treatment is quite complex and is supported by the stratification that is carried out.
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