Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment (PDQ�)
General Information About Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Osteosarcoma and malignant fibrous histiocytoma (MFH) of the bone are diseases in which malignant (cancer) cells form in bone.
Osteosarcoma is the most common type of
Having past treatment with radiation can increase the risk of osteosarcoma.
Anything that increases your risk of getting a disease is called a
Past treatment with
Past treatment with anticancer
drugscalled alkylating agents.
Having a certain change in the
Having certain conditions such as
Hereditaryretinoblastoma. Paget disease. Diamond-Blackfan anemia. Li-Fraumeni syndrome. Rothmund-Thomson syndrome. Bloom syndrome. Werner syndrome.
Possible signs of osteosarcoma and MFH include pain and swelling over a bone or a bony part of the body.
These and other
Swelling over a bone or bony part of the body.
Pain in a bone or
A bone that breaks for no known reason.
Imaging tests are used to detect (find) osteosarcoma and MFH.
Physical examand history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient?s health habits and past illnesses and treatments will also be taken. X-ray: An x-ray of the organs and bones inside the body. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dyemay be injectedinto a veinor swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
A biopsy is done to diagnose osteosarcoma.
Cells and tissues are removed during a biopsy so they can be viewed under a
The type of biopsy that is done will be based on the size of the tumor and where it is in the body. There are three types of biopsy that may be used:
Fine-needle aspiration(FNA) biopsy: The removal of tissue or fluidusing a thin needle. Core biopsy: The removal of tissue using a wide needle. Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn't look normal. Excisional biopsy: The removal of an entire lump or area of tissue that doesn?t look normal.
The following tests may be done on the tissue that is removed:
Lightand electron microscopy: A laboratory testin which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells. Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
Immunocytochemistry study: A laboratory test in which a substance such as an
antibody, dye, or radioisotopeis added to a sample of cancer cells to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis of untreated osteosarcoma and MFH depends on the following:
Where the tumor is in the body and whether tumors formed in more than one bone.
The size of the tumor.
Whether the cancer has spread to other parts of the body and where it has spread.
The type of tumor (based on how the cancer cells look under a microscope).
Whether the patient has certain
After osteosarcoma or MFH is treated, prognosis also depends on the following:
How much of the cancer was killed by
How much of the tumor was taken out by surgery.
Whether chemotherapy is delayed for more than 3 weeks after surgery takes place.
Treatment options for osteosarcoma and MFH depend on the following:
Where the tumor is in the body.
The size of the tumor.
stageof the cancer.
Whether the bones are still growing.
The patient's age and general health.
The desire of the patient and family for the patient to be able to participate in activities such as sports or have a certain appearance.
Whether the cancer is newly diagnosed or has
recurred(come back) after treatment.
Stages of Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
After osteosarcoma or malignant fibrous histiocytoma (MFH) has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
The process used to find out if
X-ray: An x-ray of the organsand bones inside the body. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. X-rays will be taken of the chest and the area where the tumorformed. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injectedinto a veinor swallowed to help the organsor tissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Pictures will be taken of the chest and the area where the tumor formed. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactivematerial is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner. PET scan(positron emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactive glucose(sugar) is injected into a vein. The PET scannerrotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
Through tissue. Cancer invades the surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veins and capillariesand travels through the blood to other places in the body.
When cancer cells break away from the
Osteosarcoma and MFH are described as either localized or metastatic.
Localizedosteosarcoma or MFH has not spread out of the bone where the cancer started. There may be one or more areas of cancer in the bone that can be removed during surgery.
Metastatic osteosarcoma or MFH has spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs. It may also spread to other bones.
Recurrent Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Treatment Option Overview
There are different types of treatment for patients with osteosarcoma or malignant fibrous histiocytoma (MFH) of bone.
Different types of treatment are available for children with
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with osteosarcoma or MFH should have their treatment planned by a team of health care providers with expertise in treating cancer in children.
Treatment will be overseen by a
surgeon. Radiation oncologist. Rehabilitation specialist. Pediatric nurse specialist. Social worker. Psychologist.
Some cancer treatments cause side effects months or years after treatment has ended.
Changes in mood, feelings, thinking, learning, or memory.
Second cancers(new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the
Four types of standard treatment are used:
The following types of surgery may be done:
Wide local excision: Surgery to remove the cancer and some healthy tissue around it. Limb-sparing surgery: Removal of the tumor in a limb (arm or leg) without amputation, so the use and appearance of the limb is saved. Most patients with osteosarcoma in a limb can be treated with limb-sparing surgery. The tumor is removed by wide local excision. Tissue and bone that are removed may be replaced with a graftusing tissue and bone taken from another part of the patient's body, or with an implantsuch as artificial bone. If a fracture is found at diagnosisor during chemotherapy before surgery, limb-sparing surgery may still be possible in some cases. If the surgeon is not able to remove all of the tumor and enough healthy tissue around it, an amputation may be done.
Amputation: Surgery to remove part or all of an arm or leg. This may be done when it is not possible to remove all of the tumor in limb-sparing surgery. The patient may be fitted with a
prosthesis(artificial limb) after amputation. Rotationplasty: Surgery to remove the tumor and the knee joint. The part of the leg that remains below the knee is then attached to the part of the leg that remains above the knee, with the foot facing backward and the ankle acting as a knee. A prosthesis may then be attached to the foot.
Studies have shown that
Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients are also given chemotherapy after surgery to kill any cancer
Chemotherapy is a cancer treatment that uses
In the treatment of osteosarcoma and malignant fibrous histiocytosis of bone, chemotherapy is usually given before and after surgery to remove the
See Drugs Approved for Bone Cancer for more information.
Osteosarcoma and MFH cells are not killed easily by radiation therapy. It may be used when a small amount of cancer is left after surgery or used together with other treatments.
Treatment with samarium may be followed by
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
One kind of targeted therapy being studied to treat
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed.
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options for Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
A link to a list of current
Localized Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Treatment may include the following:
Surgery. Chemotherapyis usually given before and after surgery.
Surgery followed by
radiation therapywhen the tumorcannot be completely removed by surgery.
clinical trialof surgery and a new anticancer drug.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized osteosarcoma and localized childhood malignant fibrous histiocytoma of bone. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Metastatic Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Bone Metastasis or Bone with Lung Metastasis
Osteosarcoma and malignant fibrous histiocytoma may spread to a distant bone and/or the lung. Treatment may include the following:
Chemotherapy followed by surgery to remove the primary tumor and the cancer that has spread to other parts of the body. More chemotherapy is given after surgery.
Surgery to remove the primary tumor followed by chemotherapy and surgery to remove cancer that has spread to other parts of the body.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic osteosarcoma and metastatic childhood malignant fibrous histiocytoma of bone. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Recurrent Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Surgeryto remove the tumorwith or without chemotherapy. Samariumwith or without stem cell transplantusing the patient's own stem cells, as palliative treatmentto relieve pain and improve the quality of life.
clinical trialof new types of treatment for patients whose cancercannot be removed by surgery. These may include targeted therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent osteosarcoma and recurrent childhood malignant fibrous histiocytoma of bone. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
For more information from the
Bone Cancer Home Page
Drugs Approved for Bone Cancer
Understanding Cancer Series: Targeted Therapies (Advances in Targeted Therapies)
Targeted Cancer Therapies
Bone Cancer: Questions and Answers
For more childhood
What You Need to Know About? Cancer
CureSearch for Children's Cancer
Late Effects of Treatment for Childhood Cancer
Adolescents and Young Adults with Cancer
Young People with Cancer: A Handbook for Parents
Care for Children and Adolescents with Cancer
Understanding Cancer Series: Cancer
Coping with Cancer: Supportive and Palliative Care
Information for Survivors/Caregivers/Advocates
Get More Information From NCI
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp� online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
NCI Public Inquiries Office
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Changes to This Summary (12/09/2011)
Changes were made to this summary to match those made to the health professional version.
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).