Paediatric haematology and oncology consultant Dr Yap Tsiao Yi said primary malignant bone tumours account for 3-5% of cancers in children and adolescents.
“Osteosarcoma (OS) is the most diagnosed bone tumour, accounting for 20-40% of all bone cancers, while Ewing tumours or sarcomas make up 1% of all childhood cancers,” she said.
According to Yap, OS – which usually appears around the knee, shoulder, ankle or pelvic bone – is the most common bone tumour in childhood, occurring during puberty.
Ewing’s sarcoma, which can affect both bones and soft tissues, commonly occurs in the extremities, pelvic bone, and sometimes the spine. It can affect teenagers and even younger children.
Both types of cancer are notably aggressive and progress rapidly. In Malaysia, over 55% of bone cancer cases were in stage 4, which requires intensive chemotherapy, surgery, and sometimes radiotherapy. As such, early detection would significantly improve survival rates, she said.
“The most common symptoms of osteosarcoma and Ewing’s disease is pain in the knees, shoulders and extremities that is persistent and may wake children up from sleep. In addition, a swelling or lump could be indicative of something more serious.
“Parents are urged to take persistent pain in the knees, shoulders and extremities seriously and seek medical advice promptly,” she said, adding that imaging tests are the main diagnostic tool for suspected cancer.
“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.”
Yap cautioned that treatment, which usually involves a combination of surgery, chemotherapy and radiotherapy, can last from six months to a year. As such, it can be physically and emotionally taxing, 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,” she noted. “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.”
She cited visible changes, such as hair loss from chemotherapy or walking with a limp due to prostheses, as issues that make reintegration into normal life difficult.
Despite these challenges, Yap stressed that children are generally resilient and are more capable of enduring treatment. “This is why our approach to treatment for childhood cancers ensures the child has the best possible chance of a long life,” she concluded.