Question 1

My 14-year-old son was just diagnosed with osteosarcoma in his knee—I'm devastated and terrified. What is his realistic chance of surviving this, and will he lose his leg?

Accepted Answer

I understand this is every parent's worst nightmare, but there is genuine reason for hope—osteosarcoma, while serious, is a curable cancer with modern treatment. Here's realistic information: SURVIVAL: For localized osteosarcoma (tumor confined to bone and nearby soft tissue, no metastases to lungs)—65-70% 5-year survival with current treatment protocols. This means 2 out of 3 children are cured and alive 5+ years after diagnosis. For metastatic disease (if lung metastases present at diagnosis, occurs in 15-20%)—30-40% 5-year survival. Still significant chance of cure even with metastases. FACTORS AFFECTING SURVIVAL: Tumor response to chemotherapy is MOST IMPORTANT predictor. After initial chemotherapy (8-12 weeks before surgery), pathologist examines surgical specimen to see how much tumor was killed. Good responders (90%+ tumor killed)—80-85% long-term survival. Poor responders (less than 90% killed)—45-55% survival. Unfortunately can't predict response in advance, must treat and see. Complete surgical resection with adequate margins—critical for cure. Modern surgical techniques achieve good margins in 95%+ of cases. LIMB SALVAGE: Your son will almost certainly keep his leg. In modern era, 90-95% of osteosarcomas are treated with limb salvage (removing tumor while preserving limb). Amputation only needed if tumor involves major nerves/blood vessels that can't be reconstructed (5-10% of cases). Surgeons are remarkably skilled at removing large tumors around knee while preserving limb function. After tumor removed, bone gap reconstructed with metal prosthesis or donor bone. Your son will walk, likely run, and participate in most activities (avoid high-impact contact sports long-term). TREATMENT JOURNEY: 9-12 months total treatment: chemotherapy before surgery (8-12 weeks), surgery, then more chemotherapy (6-8 months). Intensive and difficult, but most teenagers tolerate it and return to school/activities. Side effects manageable with modern supportive care. WHAT NOW: Find experienced pediatric orthopedic oncology center (children's hospitals in major cities—Sydney, Melbourne, Brisbane, Perth all have excellent programs). Ensure biopsy done properly by orthopedic oncologist (not general surgeon—biopsy technique affects limb salvage success). Trust the treatment protocol—MAP chemotherapy (methotrexate, doxorubicin, cisplatin) has been refined over decades. Your son has good chance of cure, keeping his leg, and returning to normal life. Focus on getting through treatment one step at a time.

Question 2

My daughter finished osteosarcoma treatment 8 months ago and just had her 3-month follow-up chest CT—they found a small lung nodule and we're terrified the cancer has come back. What does this mean and what happens now?

Accepted Answer

Finding a lung nodule on surveillance CT is frightening, but it's important to remember: not all lung nodules are cancer recurrence. Here's what happens next and realistic outcomes: LUNG NODULE WORKUP: Chest CT finds small nodules (less than 5mm) in many people—most are benign (scar tissue, infection, inflammation). For osteosarcoma patient, oncologist carefully reviews CT: Size—nodules less than 3-4mm often watched with repeat CT in 6-8 weeks. Nodules 5mm+ concerning for metastasis. Number—single nodule vs multiple nodules (multiple suggests metastatic disease). Growth—if repeat CT shows growth, highly suspicious for metastasis. PET scan may be ordered—osteosarcoma metastases usually PET-avid (light up on scan), benign nodules don't. IF METASTASIS CONFIRMED: Unfortunately, lung metastases develop in 30-40% of osteosarcoma patients despite treatment (micrometastases present at diagnosis that didn't respond to chemotherapy, or new metastases developing). This is serious but NOT hopeless. Pulmonary metastasectomy (surgery to remove lung nodules) is standard treatment if: Small number of nodules (1-5), all nodules resectable (can be cut out), no other sites of disease. Surgery performed by thoracic surgeon—VATS (minimally invasive) or open thoracotomy depending on nodule location. 30-40% of patients with resected lung metastases achieve long-term survival (5+ years). Second-line chemotherapy often added after metastasectomy (different drugs than initial treatment—ifosfamide, etoposide). PROGNOSTIC FACTORS: Good prognosis for lung metastases: long interval from initial treatment to recurrence (more than 1 year better than less than 1 year), small number of nodules (1-3 better than 5+), completely resectable disease. Poor prognosis: multiple unresectable nodules, recurrence within 6 months of completing treatment, other sites of disease (bone metastases, local recurrence). REALISTIC EXPECTATIONS: If small solitary lung nodule that can be resected—30-40% chance of cure with metastasectomy + chemotherapy. If multiple lung nodules or unresectable disease—focus shifts to disease control, prolonging quality life. Some patients live months-years with metastatic disease controlled by repeated surgeries and chemotherapy. WHAT TO DO NOW: Wait for formal workup (repeat CT, PET scan, possible biopsy if diagnosis unclear). If metastasis confirmed, discuss options with oncology team. Strongly consider second opinion at specialized sarcoma center (Peter MacCallum Cancer Centre in Melbourne, Chris O'Brien Lifehouse in Sydney). Not all lung nodules are metastases—don't lose hope until confirmed. Even if metastasis, treatment options exist with possibility of cure.

Medical Disclaimer

Bone Cancer in Children and Young Adults (Osteosarcoma)

📖What is Bone Cancer in Children and Young Adults (Osteosarcoma)?

🔬What Causes It?

⚠️Risk Factors

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🛡️Prevention