If teenagers have unexplained bone pain, be alert to osteosarcoma!

Author: Yu Shengji, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

Reviewer: Ge Yuping, deputy chief physician, Peking Union Medical College Hospital

Osteosarcoma is a type of bone tumor and the most common malignant tumor occurring in the bones of adolescents.

However, its incidence is not high, with only 3-5 people getting sick every year in a population of one million. But for an individual, once they get sick, they have to fight this malignant disease in a real way.

1. Where does osteosarcoma occur most often? What causes it?

Osteosarcoma often occurs in the epiphysis of the limbs, which is the bones around the joints of the limbs.

Among them, the most common sites are the distal end of the femur and the proximal end of the tibia. About 80% of osteosarcomas occur in the epiphysis around the knee joint.

Figure 1 Original copyright image, no permission to reprint

In addition, osteosarcoma may also occur in the elbow joints, shoulder joints, and even the pelvis and spine, but the incidence rate is relatively lower.

However, the specific cause of osteosarcoma is still unclear. Past studies have found that there are several etiological theories:

First, the rapid growth theory. When children's bones grow rapidly, cells are prone to division. If they are affected by external factors, such as inflammation, radiation, etc., these factors can induce normal bone cells to become cancerous, which will lead to the occurrence of osteosarcoma.

Second, the genetic theory. Studies have found that the genetic genes of some osteosarcoma patients may change, which may also cause some cells to become cancerous.

These are just some theories. Scientists are working hard to explore the exact causes of the disease and hope to clarify them as soon as possible so that they can target the causes and take better preventive measures.

2. Which age group is most likely to develop osteosarcoma?

Osteosarcoma usually occurs in teenagers and young adults. In addition, some middle-aged and elderly people may also develop the disease. For example, some benign bone lesions may turn into malignant osteosarcoma after a period of change. However, the most common group of people who are prone to osteosarcoma is still teenagers.

Therefore, if teenagers experience unexplained pain in the limbs, or pain in a certain part of the body, this is when they should pay attention.

Pain caused by osteosarcoma has the following characteristics:

First, there is no pattern. At the beginning, there is no pattern. It may be sporadic and intermittent. As the disease progresses, the pain will become continuous and even gradually worsen to nighttime pain, which may wake the child up during sleep. Sometimes it is called resting pain, which means that the pain is worse when the child is quiet, and the pain is not so severe during class or exercise during the day.

Second, it gradually gets worse. After a period of time, the pain not only gets worse, but also some lumps appear in the corresponding parts. At this time, the possibility of osteosarcoma should be considered.

Third, it causes lameness. The tumor invades and destroys the bones, causing some nerves in the bones to be stimulated and cause pain. In some patients, the tumor grows from the inside of the bone to the outside of the bone, forming a soft tissue mass, which will also compress some surrounding soft tissues and nerves. This child will take a protective measure, which is to reduce exercise. For example, compared with the healthy side, the steps of the affected leg are shortened, and even flexion deformity may occur for protection. At the same time, due to the nature of the lesion itself, after the bone is destroyed, the bone's load-bearing capacity will be weakened, causing lameness.

Figure 2 Original copyright image, no permission to reprint

3. What is the difference between the pain caused by osteosarcoma and growing pains?

Many patients with bone tumors are already in the late or mid-late stages when they come to see a doctor. This is because a considerable number of children initially think they are suffering from growing pains. Their parents and teachers also think they are just growing taller.

Although both osteosarcoma and growing pains occur in adolescents, there is actually a big difference between growing pains and the pain caused by osteosarcoma during the growth stage.

Growing pains occur at the fulcrum of muscles or tendons, which are basically at the epiphyseal line. For example, the patellar ligament in front of the tibia is repeatedly pulled when the knee joint moves continuously, and the fulcrum of the tendon is prone to pain. This pain often becomes significantly worse after exercise, and it will not hurt after resting at night, and lumps rarely appear.

Of course, this part may be a bit special, because if you touch it from the surface of the body, you can feel a bulge in this place, but after this place is repeatedly pulled, tibial tubercle epiphysiitis will also occur, which is somewhat different from growing pains.

In summary, compared with osteosarcoma, growing pains have three different characteristics: First, they are not continuous but sporadic. Second, they can be relieved or even disappear after rest. Third, there will be no lumps, and the skin and muscles are normal.

Therefore, when teenagers experience bone pain, parents must not assume that it is growing pains. They must seek the help of a doctor to determine the cause of the pain to avoid delaying the condition.