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Also called: pediatric osteosarcoma

What is osteosarcoma?

Osteosarcoma is a type of cancer of the bones:

  • Osteosarcoma is the most common type of bone cancer in children and teens.
  • This cancer arises most often in the wide ends of long bones, such as the femur and tibia in the upper and lower leg, and the humerus in the upper arm.
  • It can also occur in flat bones that support and protect vital organs, including the bones of the pelvis and the skull.
  • In about 15 to 20% of patients, osteosarcoma has spread by the time it is diagnosed. It typically spreads to the lungs but sometimes to other bones (beyond the initial site).
Osteosarcoma cells

How common is osteosarcoma?

  • Osteosarcoma occurs most often in children and young adults, typically after age 10.
  • It occurs slightly more often in males than females.
  • African-American children have a higher risk of developing osteosarcoma than Caucasians.
  • Each year in the United States, about 400 children and teens younger than age 20 are diagnosed.
  • Osteosarcoma is the third most common cancer in teens, after lymphomas and brain tumors.
  • It is extremely rare in children before age 5.
  • Osteosarcoma has been found in long-term survivors of other cancers who were treated with radiation therapy.
  • Genetics can play a role in whether a person develops osteosarcoma. About 3 to 4% of children with osteosarcoma carry mutations (changes) in certain genes. Some related factors include the following:
    • An eye cancer called retinoblastoma
    • A history of multiple cancers
    • A strong family history of cancer including breast cancer, leukemia, brain tumors and tumors of the bones or soft tissues

What are the symptoms of osteosarcoma?

Symptoms of osteosarcoma may appear weeks to months before the diagnosis is made. A diagnosis may not be made right away because the symptoms are common to other health problems.

The following symptoms may be present at the tumor site:

  • Pain
  • Swelling
  • Decreased joint motion
  • Fracture (broken bone), less common

How is osteosarcoma diagnosed?

Work-up for a suspected osteosarcoma includes the following:

  • Blood tests
  • X-rays and magnetic resonance imaging (MRI) of the involved bone
  • Computerized tomography (CT) of the chest
  • Whole-body imaging to look for other areas of the body where tumor may have spread
  • A biopsy (removing a tissue sample to examine in the lab) is always required to make the diagnosis. Sometimes this can be done with a core-needle biopsy, but often an open biopsy is needed to obtain enough tissue to make the diagnosis.

How is osteosarcoma treated?

Osteosarcoma treatment includes surgery and chemotherapy.

  • Surgery — is used to remove osteosarcoma.
    • The entire cancer must be removed to prevent it from returning. A small amount of normal tissue around the tumor is also removed to ensure no cancer is left behind.
    • Before the 1970s, surgery to amputate the affected limb was the only treatment available. Today, if the osteosarcoma has not spread, 95% of patients may be able to have limb-saving surgery.
  • Chemotherapy (“chemo”) — is also given to help treat and prevent the return of the cancer. Chemo uses powerful medicines to kill cancer cells or stop them from growing and dividing to make more cancer cells.
    • Most chemo is injected into the bloodstream, so that it can travel throughout the body.
    • Some chemo may be given by mouth.
    • Combination therapy uses more than one type of chemo at a time and is commonly used for the treatment of osteosarcoma.
    • Chemo is critical for treating osteosarcoma. In patients who had their tumor removed by surgery but did not receive chemotherapy, 80% developed new disease in the lungs and other bones.

What are the survival rates for osteosarcoma?

  • If the disease is localized (has not spread to other areas of the body), the long-term survival rate is 70 to 75%.
  • If osteosarcoma has already spread to the lungs or other bones at diagnosis, the long-term survival rate is about 30%.

Why choose St. Jude for your child’s osteosarcoma treatment?

  • St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • St. Jude has been a pioneer in limb-sparing surgical techniques. Our surgeons continue to explore new limb-sparing techniques to improve survival and help children live normal lives after treatment.
  • Your child will have access to a closely knit team of pediatric oncologists (cancer doctors), surgeons, radiation treatment specialists, rehabilitation specialists and pediatric nurses who work together for the best outcomes.
  • Laboratory studies at St. Jude help scientists better understand the biology and behavior of osteosarcoma, both in tumor cell lines and in animal models such as mice. These studies help scientists find risk factors and develop treatments using new agents.
  • Clinicians work closely with laboratory researchers to bring new treatments from the laboratory to the clinic.

Associated Clinical Trials

AOST2032: Cabozantinib with Chemotherapy for Osteosarcoma

A Feasibility and Randomized Phase 2/3 Study of the VEGFR2/MET Inhibitor Cabozantinib in Combination with Cytotoxic Chemotherapy for Newly Diagnosed Osteosarcoma

Diseases Treated:



  • Less than 40 years old
  • A new diagnosis of high-grade osteosarcoma
  • Must be able to swallow tablets
  • The current phase is only open to patients with metastatic disease
  • View Trial

    PAINBDY1: Treating Pain in Children with Cancer: Pain Buddy

    Treating Pain in Children with Cancer: A 21st Century Innovative Approach (Pain Buddy)

    Diseases Treated:

    Endocrine Tumors
    Ewing Sarcoma


    This is a research study open only to St. Jude patients and their caregivers.

    • 8 to 18 years old
    • Within 16 weeks of initial cancer diagnosis
    • Receiving outpatient chemotherapy treatment for cancer
    • Can speak, read and write English. Parents who can speak, read, and write in English and Spanish
    • Have Internet access
    View Trial

    PEPN2111: Study of CBL0137 in Patients with Relapsed or Refractory Solid Tumors and Lymphoma

    A Phase 1/2 Trial of CBL0137 in Patients with Relapsed or Refractory Solid Tumors including CNS Tumors and Lymphoma

    Diseases Treated:

    Solid Tumor


    Brain Tumor


    • 12 months to 21 years old with diagnosis of:
      • Relapsed or refractory solid tumor or lymphoma (including CNS tumors) OR
      • Progressive or recurrent DIPG or other H3 K27M-mutant diffuse midline gliomas previously treated with radiation therapy
    • 12 months to 30 years old with diagnosis of relapsed or refractory osteosarcoma
    View Trial

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