Sarcoma & Bone Cancer In Children: Look Out For These Symptoms, Treatment Options

In India, an estimated 38 to 124 cases of childhood cancer are reported per million children each year, leading to over 50,000 new diagnoses annually. Unlike adult cancers, pediatric cancers are primarily driven by genetic mutations or cellular changes during early development, often due to ionising radiation exposure. These causes differ from adult cancers, which are largely influenced by lifestyle and environmental factors. As a result, the treatment of childhood cancer presents unique challenges, requiring specialised care that addresses the complexities of treating a developing body.

Sarcomas are rare forms of cancers that form in bones and soft tissues such as fat, muscles, blood vessels, nerves, deep skin tissues, and fibrous tissues. Bone cancers are sarcomas that start in bones, while soft tissue sarcomas originate in muscle, fat, blood vessels, nerves, tendons, and joint linings. Bone cancers make up to 6 per cent of cancers in children. These include:

Osteosarcoma: This commonly develops in the long bones of the upper and lower limbs. 

Ewing Sarcoma: This can develop in either the bones or the surrounding soft tissue. Typically affects the lower limbs, pelvic bones, and chest wall ribs, also referred to as ASKIN tumour.

Symptoms

It can be challenging to recognise the signs of bone cancers as they are often similar to certain injuries or pains. For instance, the signs and symptoms of bone cancer are similar to those of other conditions like osteoporosis, arthritis, and bone injuries. However, there are certain symptoms that require attention and must therefore not be ignored if they persist. Osteosarcoma and Ewing Sarcoma usually have similar symptoms though they may affect different parts of the bones. These symptoms include:

• Pain in the bones: Persistent bone pain is one of the earliest and most frequent symptoms. Even though growing pains are typical in kids, the discomfort from bone cancer typically escalates gradually, particularly at night or during physical activities

• Swelling and sensitivity: Another important sign is the presence of a noticeable swelling or bump on the affected bone. Whether or not this swelling is painful, it should be evaluated by a healthcare provider if it continues to grow or persist

• Fractures: Bones afflicted by cancer are at a higher risk of fracturing. Children who have sarcoma may suffer from breaks or fractures following minor falls or injuries that wouldn't usually result in such harm

• Fatigue: Unexplained exhaustion, lack of energy, and unintentional weight loss can also indicate a possible cancer

• Fever and overall discomfort: While not unique to bone cancer, it's important to keep an eye on recurring fevers and a general feeling of being unwell, particularly if they are accompanied by other symptoms such as bone pain or swelling

Treatment options

The treatment processes have been transformed by the recent advancements in surgical techniques and radiotherapy with limb-saving surgeries now possible in the majority of cases

• Surgery is commonly considered the primary treatment for bone cancer. Limb-sparing surgery is typically done to eliminate the tumour and save the affected limb

• Chemotherapy is commonly used alongside surgery, either preoperatively (neoadjuvant) to reduce the size of the tumour or postoperatively (adjuvant) to eradicate any residual cancer cells. It is a common aspect of therapy for osteosarcoma and Ewing sarcoma.

• Radiation therapy is used to focus on the tumour region and eliminate cancer cells, frequently alongside surgery and chemotherapy

• New treatments are created to specifically target the genetic mutations fueling the cancer. Immunotherapy, which utilises the body's immune system to combat cancer, is currently being researched for pediatric sarcomas 

With a combination of surgery, chemotherapy, and radiation, many children have been able to overcome this disease and lead healthy lives. Ongoing research into targeted therapies and immunotherapy holds promise for even better outcomes in the future.

Dr. Somesh Virmani

Guest Author Associate Director & Head - Paediatric Orthopaedics, Sarvodaya Hospital, Faridabad