Can osteosarcoma be seen on an X-ray?

Written by Guan Jing Tao
Orthopedics
Updated on May 12, 2025
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Osteosarcoma can be detected through characteristic changes in X-ray imaging, such as the Codman's triangle, which usually occurs around the joints at the metaphyseal ends of the long tubular bones in the limbs. This leads to the destruction of the trabeculae and increased density of the tumor tissue, which can break through the cortical bone. The tumor can lift the periosteum to form the characteristic Codman's triangle. Therefore, orthopedic doctors can preliminarily diagnose it as a bone tumor or osteosarcoma based on the appearance in this X-ray. Additionally, diagnosis should be correlated with clinical symptoms such as the presence of a noticeable mass, pain, tenderness in the localized area, and general symptoms of cachexia, such as weight loss, anemia, fever, and malaise.

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Can late-stage osteosarcoma be cured?

For osteosarcoma in its late stages, it often metastasizes to other organs, with the majority of cases involving lung metastasis. In such cases, conservative treatment can be applied. However, if surgery is an option, it is the best approach as it can be complemented with postoperative chemotherapy and radiotherapy to extend the patient’s survival time. If there is distant metastasis and the body is in poor condition, unable to withstand surgery, then only conservative treatment and nutritional support are viable, along with the use of painkillers. In late stages, when the patient cannot tolerate surgery, only conservative treatment is available with no other alternatives. Typically, the conditions are divided into three stages. By stage three, there is usually lung metastasis. This stage often involves T which signifies intracompartmental or extracompartmental growth—T2 indicating extracompartmental, typically a marker of an aggressive tumor. Then M represents metastasis, with 0 for none and 1 for presence. So, in cases where distant metastasis occurs, it generally corresponds to stage three, phase B, which involves extracompartmental invasive metastasis. In such cases, even surgery provides poor outcomes. Early detection and treatment are best. If it progresses to later or final stages, treatment is often deemed unnecessary, limited to conservative management, as surgical outcomes are poor, and metastasis may occur elsewhere.

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Written by Na Hong Wei
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Is osteosarcoma sensitive to chemotherapy?

Osteosarcoma is relatively sensitive to chemotherapy. Currently, the treatment of malignant tumors is primarily a comprehensive approach centered around surgery. However, the treatment of osteosarcoma should start with neoadjuvant chemotherapy, which involves administering a certain number of chemotherapy sessions, generally around six, before surgery. After chemotherapy, the tumor itself shrinks in size, pain is reduced, and the patient's cachexia also improves. At this point, choosing an optimal surgical method based on the tumor’s location and size becomes feasible, whether it involves amputation, limb-salvage, or other treatment methods such as the implantation of prosthetics. Postoperative chemotherapy is then administered. With this approach, there is a significant improvement in the five-year survival rate. Therefore, the treatment of osteosarcoma is inseparable from chemotherapy, requiring both preoperative and postoperative chemotherapy, making osteosarcoma quite sensitive to chemotherapy overall.

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Does osteosarcoma spread through blood?

As far as we know, osteosarcoma is not transmitted through blood or infectious. If osteosarcoma had such infectious characteristics, it would be transmitted in the same way as AIDS or other sexually transmitted diseases and would be classified as a contagious disease. However, there has been no notification or relevant guidelines to date indicating that osteosarcoma can be transmitted through blood. Therefore, normal contact with patients with osteosarcoma, or caring for patients with osteosarcoma, including sharing the same food or coming into contact with their blood, generally does not lead to the transmission or contraction of osteosarcoma.

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Written by Wang Cheng Lin
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Can osteosarcoma be detected by ultrasound?

Osteosarcomas are generally difficult to diagnose through ultrasound. The diagnosis of osteosarcoma mainly relies on the following methods. The first method is X-rays. X-rays can reveal a typical Codman's triangle appearing in the bone. The second method involves using CT and MRI to detect the extent of the tumor and to see if there is extensive infiltration around it. The third method is nuclear bone scanning. The main significance of nuclear bone scanning is to detect bone tumors early and to distinguish whether there has been any metastasis in the later stages. The fourth method is the gold standard, which is to perform a biopsy. However, this test is invasive, requiring the cutting of tissue from the osteosarcoma for pathological examination. Of course, this method provides the highest accuracy and positive rate.

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Does osteosarcoma require amputation?

Do osteosarcomas require amputation? In the past, the likelihood of amputation for treating osteosarcoma was very high. However, currently, the rate of amputation is very low, and the limb-salvage rate is very high. This is due to a new chemotherapy protocol in medical practice, which involves initial chemotherapy followed by surgery, and then continued chemotherapy post-operatively. The limb-salvage rate with this treatment plan can reach about 75% to 80%. Therefore, currently, most osteosarcoma patients do not require amputation. Unlike the past, where amputation rates were very high, today's medical approach is very advanced, generally resulting in a very high rate of limb preservation for osteosarcoma patients.