KUALA LUMPUR, Nov 22 – Bone cancer in children, particularly osteosarcoma and Ewing’s sarcoma, presents unique challenges in diagnosis and treatment.
With primary malignant bone tumours accounting for 3 to 5 per cent of cancers in children and adolescents, osteosarcoma (OS) is the most diagnosed bone tumour, accounting for 20 to 40 per cent of all bone cancers while Ewing tumours (Ewing sarcomas) consists of 1 per cent of all childhood cancers.
Dr Yap Tsiao Yi, consultant paediatrician (haematology and oncology) at Sunway Medical Centre, has shed some light on this aggressive disease, emphasising the importance of early detection and comprehensive care.
The Basics Of Osteosarcoma And Ewing’s Sarcoma
Both osteosarcoma and Ewing’s sarcoma primarily affect children, teens, and young adults. “Osteosarcoma is derived from osteoclasts, the bone-forming cells. It is the most common bone tumour in childhood, typically occurring during puberty,” explained Dr Yap.
Osteosarcoma usually appears around the knee, shoulder, ankle, or pelvic bone. Ewing’s sarcoma can affect both bones and soft tissues, commonly occurring in the extremities, pelvic bone, and sometimes the spine.
“The age range for Ewing’s sarcoma is broader than that of osteosarcoma. It can affect teenagers and sometimes younger children,” noted Dr Yap.
Rapid Progression Of Sarcoma And Bone Cancer In Children
Both osteosarcoma and Ewing’s sarcoma are notably aggressive and progress rapidly. In Malaysia, over 55 per cent of bone cancer cases were in stage 4.
“These diseases progress quickly, requiring intensive chemotherapy, surgery, and sometimes radiotherapy,” said Dr Yap.
Early detection significantly improves survival rates. “Localised disease has a much better survival rate compared to metastatic disease, where the survival rate can drop to 25 per cent compared to 75 per cent for localised disease,” she explained.
Symptoms Of Osteosarcoma And Bone Cancer In Children And Its Challenges
Early symptoms of bone cancers can be misleading, often resembling less severe conditions. Common symptoms include persistent pain in the knees, shoulders, and extremities, which may wake children from sleep, along with swelling or a lump.
“The most common symptoms of osteosarcoma and Ewing’s disease is pain in the knees, shoulders, and extremities that is persistent, does not go away and may wake children up from sleep as well as swelling or a lump and could be indicative of something more serious,” added Dr Yap.
Due to the aggressive nature of osteosarcoma and Ewing’s disease, early diagnosis is crucial. Dr Yap emphasises the importance of recognising early symptoms.
“Some parents may delay seeking medical attention, sometimes opting for alternative therapies first.
“By the time they consult a doctor, the tumour may have grown and metastasised which diminishes the survival rate of the disease significantly.”
Diagnostics And Treatment
When a tumour is suspected, imaging tests is the main diagnostic tool. For osteosarcoma, which often spreads to the lungs, a CT scan of the lungs is performed.
Ewing’s sarcoma, being more unpredictable, may require a PET scan and bone marrow aspiration to assess the disease extent.
“Most doctors will start with an X-ray to detect a bone tumour. For soft tissue involvement, a CT scan or MRI might be necessary,” elaborated Dr Yap.
Dr Yap also emphasises that treatment typically involves a combination of surgery, chemotherapy, and radiotherapy.
“Treatment for sarcoma typically involves a combination of surgery, chemotherapy, and radiotherapy for tumours that cannot be resected surgically,” she explained.
“We use chemotherapy neoadjuvantly to shrink the tumour before surgery and adjuvantly to eliminate remaining cancer cells post-surgery.
“This combined approach improves the chances of a successful outcome and reduces the risk of recurrence.”
Surgery is also a critical component of treatment, aiming to remove the tumour and surrounding tissues. In some cases, limb-salvage surgery is possible, where the affected bone is replaced with a prosthesis.
“Children are growing, so choosing the right prosthesis, which can be lengthened as they grow, is complex,” explained Dr Yap.
Impact On Children And Families
Treatment can be physically and emotionally taxing, lasting six months to a year, and impacting children and their families.
“Children are often out of school and isolated due to the side effects of chemotherapy, surgeries, and prolonged hospital stays.
“They may also experience depression, especially if they face rejection from peers upon returning to school or from the sense of loss of their childhood.
“Adjusting to the new normal can also bring challenges to their families as well,” Dr Yap pointed out.
The visible changes, such as hair loss from chemotherapy or walking with a limp due to prostheses, can also make reintegration into normal life difficult.
Despite these challenges, she highlights children’s resilience, noting, “Unlike adults, children haven’t faced lifestyle health damage, making them more capable of enduring treatment compared to adults.
“This is why our approach to treatment for childhood cancers to ensure the child has the best possible chance of a long life.”
Importance Of Awareness And Timely Intervention
Early detection and a multidisciplinary approach to treatment offer hope for better outcomes.
Dr Yap emphasises the importance of awareness and timely medical intervention to improve survival rates and quality of life for affected children.
“Parents are urged to take persistent pain in the knees, shoulders, and extremities seriously and seek medical advice promptly.
As we advance in medical technology and therapeutic techniques, the goal remains to provide these young patients with the best possible chance for a healthy future,” added Dr Yap.
