Osteosarcoma is a type of bone cancer. The most common sites are the distal femur, proximal tibia and proximal humerus.
Osteosarcoma is most common in adolescents, but it also occurs in young adults. The typical age range at presentation is 10-25 years.
Presentation
The key presenting feature is persistent bone pain. Other symptoms that may be present include bone swelling, a palpable mass and restricted joint movements.
TOM TIP: The bone pain associated with osteosarcoma can be present at any time of day. However, pain that wakes the child or young person at night is a particular red flag symptom.
Referral
The NICE guidelines on suspected cancer (updated April 2026) recommend for children and young people:
- Very urgent x-ray (within 48 hours) for unexplained bone swelling or pain
- Very urgent referral to be seen within 48 hours if an x-ray suggests bone sarcoma
Persistent bone pain is also a presenting feature of leukaemia in children. NICE recommend a very urgent full blood count (within 48 hours) in this scenario.
Diagnosis
X-ray is the initial investigation of choice for suspected osteosarcoma. Possible x-ray findings include:
- Mixed lytic (destructive) and sclerotic (hardening) areas
- Cortical destruction (breakdown of the outer layer of bone)
- Periosteal reaction (new bone formation caused by irritation of the periosteum)
- Sunburst appearance (fine spikes radiate from the lesion)
- Codman triangle (a triangular area of new bone at the edge of the lesion)
Blood tests may show a raised alkaline phosphatase (ALP).
Further investigations include:
- MRI for local staging
- CT chest for lung metastases
- Bone scan or PET scan for skeletal metastases
- Bone biopsy for histology
Management
Management involves surgical resection of the lesion. The aim is to achieve adequate margins to ensure the entire lesion is removed, while preserving the limb and its function. However, in some cases amputation may be required.
Chemotherapy is typically used before and after surgery to improve outcomes.
Patients will require support and input from the specialist sarcoma multidisciplinary team, including specialist oncologists, orthopaedic oncology surgeon, specialist nurses, occupational therapists and psychologists.
Complications
Complications include:
- Local recurrence
- Metastases (particularly to the lungs)
- Pathological bone fractures
- Chemotherapy toxicity
- Surgical complications
- Functional impairment
Last updated July 2026
Now, head over to members.zerotofinals.com and test your knowledge of this content. Testing yourself helps identify what you missed and strengthens your understanding and retention.
