“A common story in osteosarcoma is of a child having been seen for pain by a healthcare provider who did not consider it to be serious. The pain continued and ultimately worsened until the parents brought the child back once, twice, or more before a diagnosis is made,” says Dr. Helman.
Dr. Helman says:
The most important thing a parent can do is to listen to their child. If a child’s pain is worsening or continuing, and especially if there is associated swelling in the absence of trauma or if the swelling increases after minor trauma, take your child back to a doctor. If a child is ill, or limping, or avoiding activities, take your child back. If you are dissatisfied with the consultation, consider seeing an orthopedist or rheumatologist as a second opinion.
The Symptoms of Osteosarcoma
By far, pain or swelling (or both) are the most common symptoms of osteosarcoma, says Dr. Helman. “This is really how the vast majority of osteosarcoma patients present — usually pain before swelling.” While osteosarcoma can occur in any bone or joint, including the skull, tailbone, and jaw, the two most common areas of osteosarcoma are in the knee and shoulder, says Dr. Helman, with pain specifically presenting in those areas.
Osteosarcoma pain can feel dull and continuous or sharp and shooting. “I have heard it described both ways, but sharp pain is less common,” says Dr. Helman. “The pain of osteosarcoma is generally persistent, whether in a joint or elsewhere, and it is usually one-sided. Nighttime pain that persists until morning should be of concern.” If pain is solely in a joint, or swelling does not resolve rapidly after an injury or increases in size, families should be concerned.
He adds that parents should pay close attention and investigate further if their child seems to be unwell — not eating or growing normally, or limping or avoiding activities.
When to See a Doctor for Bone Pain
Experiencing some pain can be a normal part of growing up for kids, so how can parents determine when it is time to see a doctor?
“We all get pain. Most of the time it just goes away,” says Dr. Helman. Since adolescents and young adults are typically physically active, often the pain can be associated with mild injury that occurred while engaged in some physical activity. If the pain does not go away, a doctor may initially suggest rest and non-steroidal [anti-inflammatory] pain medications.
“What I advise doctors or families is that if a child has symptoms that are persistent or especially if they are increasing after several visits, strong consideration should be given to getting a radiologic image of the area, or you may ask your primary care physician to refer you to a bone or joint specialist,” says Dr. Helman. Even then, the pain is unlikely to be osteosarcoma, but it still needs to be diagnosed and treated.
What to Expect at the Doctor’s Office
Most patients will want to start with their pediatrician or family doctor for an exam. Often, it is not until a repeat visit that a physician considers an X-ray, which may lead to a diagnosis. Dr. Helman says, however, that “Osteosarcoma can be missed on a simple X-ray, and additional imaging studies should be obtained for ongoing pain without a diagnosis.”
Ultimately, Dr. Helman encourages families and patients to keep pushing for answers and seeking out specialists if the pain is not improving. While the diagnosis may not turn out to be osteosarcoma, serious, persistent pain is worthy of close medical attention.
Please note: This article is not a substitute for an actual assessment by a specialist. If you or a loved one is experiencing ongoing pain, please contact a qualified medical professional and seek a diagnosis.
