Care pathway for osteosarcoma

Osteosarcoma, or bone sarcoma, is a malignant tumor that originates in the bone. The most common symptoms of osteosarcoma and Ewing’s sarcoma are increasing pain, swelling and limitation of movement in the joint, and palpable lumps or nodules.  

Sometimes a patient seeking treatment may have a minor sports injury that does not heal in the expected time. The injury itself is not related to the onset of cancer, but the affected bone becomes painful more easily. A bone fracture may also be a symptom.

Ewing’s sarcoma is a malignant tumor mainly found in children and young adults, primarily in the skeleton. Ewing’s sarcoma may also include general symptoms such as fever and weight loss. 

Some patients are diagnosed with metastases already at the stage of diagnosis. These are most commonly located in the lungs, causing symptoms such as coughing and shortness of breath. 

The first additional examination performed in primary care is usually a native X-ray. If the imaging results reveal signs of a skeletal tumor, a referral will be made to specialized medical care for further examinations.  

If osteosarcoma is suspected, the physician will refer you to the HUS bone tumor unit. 

A physician will review your situation, plan the required additional examinations, and give a treatment recommendation. 

We usually begin the examination of bone tumors with an X-ray. Other additional examinations include computed tomography, magnetic resonance imaging and nuclear imaging (PET-CT or bone scintigraphy) of the entire body. With the help of computed tomography, we look for visible cancer metastases, which are usually found in the lungs. If there is a suspicion of a bone tumor, we take a biopsy to confirm the diagnosis.

At the appointments with the physician and nurse, we will review your examination results, overall situation, and treatment plan. At the nurse’s appointment, you will receive more information about the practical implementation of treatment and its adverse effects, and possible supportive therapies. 

We plan the treatment of osteosarcoma in a multi-professional treatment meeting according to the extent and characteristics of the tumor.

In osteosarcomas of low malignancy, surgical treatment is sufficient. In highly malignant osteosarcomas, surgery is supplemented with chemotherapy or radiation therapy, or a combination of both. 

We draw up a follow-up plan for each patient individually. At the end of your treatments, we will monitor your condition every 2–3 months for the next two years and then every six months until five years have passed since your treatment. After this, follow-up usually ends, since most recurrences of osteosarcomas occur within the first two years.

The follow-up regarding the functionality of prostheses can take longer, sometimes for the rest of your life. In the follow-up, we use X-ray, magnetic resonance or computed tomography imaging. 

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or a hospital-at-home unit in your area.

In general, your follow-up at HUS does not continue after the five-year follow-up period. The follow-up regarding the functionality of prostheses can take longer, sometimes for the rest of your life.