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What is osteosarcoma?

This information has been written for patients, their families and friends, and the general public to help them
understand more about chondrosarcoma: what it is and the different types. This information is produced in accordance
with BCRT's information policy.
Osteosarcoma is a 'primary bone cancer'
Osteosarcoma is the most common type of primary bone cancer in children and young people, and the second most
common overall after chondrosarcoma.
Osteosarcoma starts when one bone cell becomes abnormal and grows out of control to form a lump of cancerous
tissue known as a tumour. The cells in the tumour still act like bone, in that they try to create new bone as they grow and
divide. If a pathologist can see bone in atumour sample under the microscope, this helps to confirm a diagnosis of
Osteo comes from an ancient Greek word for bone and a sarcoma is the name given to cancers that start
in connective or supporting tissues, such as bone, fat, cartilage, blood vessels and muscle.
The majority of osteosarcomas arise from a single place within the area of a long bone known as the metaphysis
(meta-FEE-siss). The metaphysis contains the area of the bone where cells are growing and dividing, this is called the
epiphyseal (epi-FEE-see-al) plate.
The long bones of the skeleton are those bones that are very much longer than they are wide. The best examples
being the bones of the limbs, for example, the thigh bone (femur) or the upper arm bone (humerus). Figure 1 shows what is
inside a long bone, and where osteosarcoma can arise.

Figure 1: What is inside a bone?
(Image by Hannah Thompson)
The three areas most often affected by osteosarcoma are:
The lower thigh bone nearest to the knee (distal femur)
The upper shin bone nearest to the knee (proximal tibia)
The upper arm bone nearest to the shoulder (proximal humerus)
Other bones can be affected such as the jaw, spine and the pelvis, these are shown in figure 2. Tumours found in the
bones of the face, skull and spine are more common in older osteosarcoma patients than younger osteosarcoma patients.

Figure 2: Where in the skeleton does osteosarcoma most often occur?
(Image by Hannah Thompson)
Very rarely, osteosarcoma can start in more than one bone at the same time; this is calledmulti-focal osteosarcoma.
Osteosarcoma behaves in an aggressive manner, which means it can spread in the bloodstream from or through the
bone and into other places in the body. The most common place for it to spread to is the lungs.
Osteosarcoma can also spread to other places in the body including other bones. Because osteosarcoma can spread to
other parts of the body quickly, patients need treatment to the whole body; this is called systemic treatment.

There are different types of osteosarcoma (subtypes)
When looked at under the microscope, all osteosarcomas can be seen to consist of abnormal cells that are 'trying' to
make bone. By looking closely at what kind of cells are in the tumour, doctors can class each patients osteosarcoma as one of
five main subtypes of osteosarcoma.
Usually, the cancer cells look like bone forming cells. These cells are calledosteoblasts and so this
type of osteosarcoma is known as 'osteoblastic osteosarcoma.'
Sometimes, the cells look different under the microscope. If the cancer is trying to make cartilage as
well as bone then the tumour is called 'chondroblastic (KON-dro-blast-ick) osteosarcoma.' Cartilage is tissue that covers
and cushions the ends of bones, see figure 1.
If there is only a small amount of bone being made by the cancerous cells then thetumour may be
called 'fibroblastic osteosarcoma.'
If there are lots of abnormal blood vessels in the tumour as well as bone forming cells then
the tumour is called 'telangiectatic (teh-LAN-jee-ek-TAT-ick) osteosarcoma.'
Some osteosarcomas contain small round cells and are called 'small cell osteosarcoma.' These can
sometimes be difficult to tell from other tumours, which contain small round cells.
These five subtypes above account for about 90% of osteosarcomas and all five are treated in the same way.
Mostly these osteosarcomas start inside the bone and are called high grade. High grademeans that when the cells of
the tumour are looked at under a microscope, many cells are in the process of dividing. This means the tumour behaves in
an aggressive manner, meaning that the cancer cells can invade surrounding healthy tissues and spread to other organs. As a
result, the cells can spread to other sites in the body at an early disease stage.
Sometimes, osteosarcoma can start either on or close to the surface of bone. Some of thesetumours have the same
high grade appearance (cells are dividing rapidly) as the common subtypes above and are treated in the same way with a
combination of surgery andchemotherapy drugs.
Other types can be less aggressive (low grade) and may require surgery alone. These may be called 'parosteal' (pa-
ROSS-tee-al) or 'periosteal' (peh-RIH -oss-TEE-al) osteosarcoma.'
Very rarely tumours, which appear identical to osteosarcoma, can arise outside of the bone in unusual places. This is
known as 'extraosseous (extra-OSSY-os) osteosarcoma.' These are treated in the same way as conventional osteosarcoma; with a
combination of surgery andchemotherapy if the tumour is of a high grade.
The authors and reviewers of this information are committed to producing reliable, accurate and up to date content
reflecting the best available research evidence, and best clinical practice. We aim to provide unbiased information free from
any commercial conflicts of interest. This article is for information only and should not be used for the diagnosis or treatment
of medical conditions. BCRT can answer questions about primary bone cancers, including treatments and research but we are
unable to offer specific advice about individual patients. If you are worried about any symptoms please consult your doctor.
Version 2 produced January 2013
Information will be reviewed in January 2015