Small but Mighty Heroes: Children Battling Bone Cancer
- Penny Pratt
- Apr 11
- 4 min read
Updated: Sep 5
Parents dream of watching their children grow healthy and strong. For some families, however, an unexpected diagnosis of bone cancer changes everything, replacing those dreams with doctor visits, treatments, and fear. Although rare, bone cancer in children is serious, often developing during critical stages of growth. Persistent pain, swelling, or fractures could be early warning signs of a more serious problem. Early detection, expert care, and unshakable hope are essential in this fight.
What Is Bone Cancer?
Bone cancer is a rare disease where bone cells grow uncontrollably, typically beginning in the bones as primary bone cancer or sarcoma. Although all bone cancers are rare, primary bone cancer is among the least common, often requiring specialized treatment.
Bone Cancers Affecting Children
In the United States, doctors diagnose approximately 700 children under 20 with bone cancer each year, accounting for 6% of childhood cancers. The most common types are osteosarcoma (56%) and Ewing sarcoma (34%). Although pediatricians rarely see these cancers, 60% of patients with bone cancer first visit their primary doctor. Diagnosis is often delayed for weeks or months because many teenagers and young adults mistake the pain for a minor injury or sports-related trauma. Recognizing symptoms, exploring treatment options, and understanding outcomes can help families navigate this difficult journey.
Osteosarcoma
The most common bone cancer in children and teens, typically affecting those aged 10-20 years.
Accounts for 5% of all childhood cancers.
Affects long bones such as the humerus, femur, and tibia, particularly around the knee.
Develops from osteoblasts, cells that help build new bone tissue.
Symptoms: Persistent bone pain, swelling, and fractures without a clear history of trauma or injury.
Treatment: Chemotherapy, limb-sparing surgery (removal of cancerous bone while preserving the limb), or, in some cases, amputation.
Survival rate: Approximately 60% of patients achieve long-term, disease-free survival.
Ewing Sarcoma
The second most common bone cancer in children and young adults, typically affecting those aged 10 to 25 years.
Accounts for 4% of all childhood cancers.
Can occur in bones or soft tissue (most often the pelvis, ribs, spine, or femur).
Caused by a genetic change (EWSR1 gene fusion), which makes cells grow abnormally and results in cancer.
Symptoms: Persistent pain, fever, swelling, fatigue, and unexplained weight loss, which can easily be mistaken for noncancerous conditions or illnesses.
Treatment: Chemotherapy, radiation, and surgery.
Survival rate: Approximately 60% of patients achieve long-term, disease-free survival.
Chondrosarcoma
Cancer of cartilage-producing cells.
Extremely rare in children but can occasionally affect older adolescents.
Typically found in the pelvis, ribs, or femur.
Symptoms: Dull pain, swelling, and difficulty moving the affected joint or area, especially if near a joint.
Treatment: Surgery (chondrosarcoma is often resistant to chemotherapy and radiation).
Chordoma
Slow-growing tumor in the spine or base of the skull.
Arises from leftover tissue from early development (notochordal remnants).
Symptoms: Neurological issues, persistent back pain, and difficulty swallowing.
Treatment: Surgery and, in some cases, targeted therapy to more precisely attack cancer cells.
Fibrosarcoma & Malignant Fibrous Histiocytoma (MFH)
Soft tissue sarcomas that sometimes spread to bone, especially in legs, arms, or jaw.
Symptoms: Hard lump, pain, and limited range of motion.
Treatment: Surgery, chemotherapy, and radiation.
Adamantinoma
Slow-growing tumor that mainly affects the tibia (shin bone).
Believed to arise from epithelial cells in bone.
Symptoms: Swelling, pain, and possible fractures.
Treatment: Surgical removal.
Diagnosis
Imaging tests and biopsies help diagnose bone cancer by identifying abnormal growths and determining severity. Imaging tests create detailed pictures of the bone, assisting doctors in identifying abnormal growths, measuring their size, and determining if the cancer has spread. However, the only way to confirm if bone growth is cancerous is through a biopsy, where a small tissue sample is removed and examined under a microscope.
Imaging tests
X-ray: Provides a basic image of the bone to identify abnormal growths.
Magnetic resonance imaging (MRI): Uses powerful magnets and radio waves to produce detailed images of bones and soft tissues.
Computerized tomography (CT) scan: Combines X-rays from different angles to create a cross-sectional image of the bone.
Positron emission tomography (PET) scan: Uses a small amount of radioactive sugar to detect cancerous activity in the body.
Bone scan: Helps identify bone abnormalities, including cancer, by highlighting areas of increased bone activity.
Biopsy
Needle biopsy: A healthcare professional inserts a thin needle through the skin to collect small tissue samples from the tumor.
Surgical biopsy: A surgeon makes an incision in the skin to remove a tumor sample for testing.
Treatment
Bone cancer treatment options include surgery, chemotherapy, and radiation therapy. Treatment plans depend on cancer type, location, and stage, along with the patient’s overall health and preferences.
Surgery
Surgery removes cancerous tissue and may require bone grafts or artificial materials to repair the bone. In rare cases, if the cancer is particularly large or in a difficult location, it may be necessary to remove a limb. If this occurs, an artificial limb may be an option. With time and training, adapting to daily activities is possible.
Chemotherapy
Chemotherapy targets cancer cells and is usually administered through a vein or in pill form. Chemotherapy is used before or after surgery to shrink tumors and prevent recurrence.
Radiation therapy
Radiation therapy uses powerful energy beams, such as X-rays or protons, to treat cancer. During treatment, the patient lies on a table while a machine targets radiation to specific areas of the body. Doctors may use radiation after surgery to destroy any remaining cancer cells or, when surgery isn’t an option, to help control the cancer.
Although diagnosis and treatment present overwhelming challenges, advances in care, early detection, and strong community support bring hope. With the best available treatment and resources, many children overcome bone cancer and go on to live long, healthy, and active lives.
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