Osteosarcoma is a type of bone cancer. This usually presents in adolescents and younger adults aged 10 – 20 years. The most common bone to be affected is the femur. Other common sites are the tibia and humerus.



The main presenting feature is persistent bone pain, particularly worse at night time. This may disturb or wake them from sleep.

Other symptoms that may be present include bone swelling, a palpable mass and restricted joint movements.



NICE guidelines recommend a very urgent direct access xray within 48 hours for children presenting with unexplained bone pain or swelling. If the xray suggests a possible sarcoma they need very urgent specialist assessment within 48 hours.

Xrays show a poorly defined lesion in the bone, with destruction of the normal bone and a “fluffy” appearance. There will be a periosteal reaction (irritation of the lining of the bone) that is classically described as a “sun-burst” appearance. There can an associated soft tissue mass.

Blood tests may show a raised alkaline phosphatase (ALP).

Further investigations is used to better define the lesion and stage the cancer:

  • CT scan
  • MRI scan
  • Bone scan
  • PET scan
  • Bone biopsy



Management involves surgical resection of the lesion, often with a limb amputation. Adjuvant chemotherapy is used alongside surgery to improve outcomes.

They will require support and input from the multidisciplinary team in addition to treatment of the tumour:

  • Paediatric oncologists and surgeons
  • Specialist nurses
  • Physiotherapy
  • Occupational therapy
  • Psychology
  • Dietician
  • Prosthetics and orthotics
  • Social services

The main complications are pathological bone fractures and metastasis.


Last updated January 2020