Metastatic Osteosarcoma

Metastatic osteosarcoma is when bone cancer spreads from its original location to other parts of the body, most commonly the lungs. This advanced form of bone cancer presents significant treatment challenges and has a less favorable outlook than cancer that remains in one place.

Table of contents

• What is metastatic osteosarcoma?
• How common is it?
• Where does osteosarcoma spread?
• Symptoms
• Prognosis and survival
• Treatment options
• Coping with metastatic osteosarcoma

What is metastatic osteosarcoma?

Metastatic osteosarcoma refers to osteosarcoma that has spread beyond the bone where it started to other parts of the body. Osteosarcoma is the most common type of bone cancer in children and adolescents, where cells that should form healthy bone instead create cancerous tumors^[1].

Metastasis is the process by which cancer cells leave the original tumor and travel through the bloodstream to other locations in the body^[9]. When cancer spreads in this way, it becomes much more difficult to treat. While the cancer may now be in the lungs or other organs, it is still called osteosarcoma, not lung cancer or another type of cancer.

Metastatic osteosarcoma can present in different ways. Some patients have visible metastases (areas where cancer has spread) at the time they are first diagnosed. Others develop metastatic disease during treatment or shortly after completing it. In some cases, metastases appear months or even years after the initial treatment has ended^[5].

How common is it?

Approximately one-fourth of all osteosarcoma patients have metastases when they are first diagnosed^[13]. This is sometimes called metastatic disease at presentation. Even among patients whose cancer appears to be only in one location at diagnosis, many actually have microscopic cancer cells already circulating in their body that cannot yet be detected^[11].

The high likelihood that osteosarcoma will spread is why treatment includes both surgery to remove the visible tumor and chemotherapy (drugs that kill cancer cells throughout the body). Before chemotherapy became standard treatment in the 1970s, more than 80 percent of patients developed metastases after surgery, even when the primary tumor was completely removed^[11].

Where does osteosarcoma spread?

The lungs are by far the most common site for osteosarcoma metastases^[5]. This is because cancer cells from the bone tumor enter the bloodstream and are carried to the lungs, where they can settle and begin growing. About 20 percent of osteosarcoma cases involve lung metastases^[9].

Besides the lungs, osteosarcoma can also spread to other bones in the body and, less commonly, to soft tissues in various locations^[5]. When cancer spreads to multiple locations, it becomes even more challenging to treat.

Symptoms

The symptoms of metastatic osteosarcoma depend on where the cancer has spread. Many symptoms are similar to those of osteosarcoma that has not spread, but additional symptoms may develop based on the affected organs.

Common symptoms of osteosarcoma include^[4][6]:

• Bone pain or tenderness that may come and go at first but often worsens, especially at night
• Limited movement in a joint near the affected bone
• Swelling around the bone or a visible lump
• Unexplained broken bones from minor injuries
• Unexplained fever
• Limping if the cancer is in leg bones

When osteosarcoma has spread to the lungs, additional symptoms may include difficulty breathing, chest pain, or persistent cough. Symptoms related to bone metastases in new locations may cause pain in those areas.

Prognosis and survival

The presence of metastatic disease significantly affects survival outcomes. The statistics reveal a stark difference between patients with and without metastases. Patients who have metastatic osteosarcoma at diagnosis achieve cures only about 30 percent of the time. In contrast, patients whose cancer has not spread achieve cures approximately 70 percent of the time^[9].

However, the outlook is not the same for all patients with metastatic disease. The most important factor for survival is whether doctors can surgically remove all visible cancer. Patients who can have complete surgical removal of both the primary tumor and all metastatic sites have a much better chance of long-term survival^[5][13].

The number of metastases and their locations also matter. Patients with only lung metastases generally do better than those with bone metastases or cancer in multiple organ systems^[13].

Treatment options

Treating metastatic osteosarcoma requires a combination of approaches. The standard treatment includes chemotherapy, surgery, and sometimes radiation therapy, though the specific plan must be tailored to each patient’s unique situation^[13].

Chemotherapy remains the backbone of treatment for metastatic osteosarcoma. The standard drugs used are high-dose methotrexate, doxorubicin, and cisplatin, often called the MAP regimen. Another drug called ifosfamide may also be added^[13]. Chemotherapy may be given before surgery to shrink tumors or after surgery to eliminate remaining cancer cells.

Surgery plays a critical role because complete surgical removal of all cancer sites is essential for the best chance of survival^[5][13]. This means surgeons must remove the primary bone tumor and, if possible, all metastatic lesions. For lung metastases, this involves surgically removing the affected portions of the lung.

The timing of surgery can vary. Some doctors recommend early surgical removal of the primary tumor if the cancer is not responding well to initial chemotherapy, followed by removal of metastases after completing additional chemotherapy^[13].

Radiation therapy is not commonly used for osteosarcoma because this type of cancer does not respond particularly well to it^[11]. However, radiation may be helpful in certain situations, such as when surgery cannot remove all the cancer or to relieve pain from metastases.

Researchers are actively working to find better treatments for metastatic osteosarcoma. Clinical trials (research studies testing new treatments) are exploring immunotherapies, targeted drugs that attack specific features of cancer cells, and other novel approaches^[10].

Coping with metastatic osteosarcoma

Living with metastatic osteosarcoma brings emotional, physical, and practical challenges. Many patients experience a range of feelings including shock, fear, anger, sadness, and uncertainty^[19]. These reactions are completely normal and may come and go over time.

Talking with family, friends, and healthcare providers about your feelings can help. Some people find it helpful to connect with other patients who understand what they are going through. Support groups, whether in person or online, provide opportunities to share experiences and coping strategies^[19].

Staying positive and believing in your ability to cope can make a difference. Some patients focus on living day to day and finding joy in everyday moments^[16]. Setting small, achievable goals and planning enjoyable activities can help maintain quality of life.

Practical steps that may help include:

• Making lists of questions before doctor appointments
• Bringing someone with you to appointments to help remember information
• Asking your medical team to explain anything you don’t understand
• Taking information at your own pace—you don’t have to learn everything at once
• Keeping a calendar with all your appointments
• Asking for help when you need it

Managing pain and other physical symptoms is an important part of coping with metastatic osteosarcoma. Work closely with your healthcare team to develop a plan that addresses bone pain, side effects from treatment, and any other symptoms you experience. Palliative care specialists can provide additional support focused on improving comfort and quality of life.

Remember that everyone’s journey with metastatic osteosarcoma is different. What works for one person may not work for another. Be patient with yourself and focus on what you can control each day.