Most Common Primary Malignant Bone Tumor in Children and Adolescents
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. 1
Epidemiology of Primary Bone Tumors
- Osteosarcoma has the highest incidence among primary bone cancers, with 0.2-0.3/100,000/year in the general population
- The incidence increases significantly in adolescents to 0.8-1.1/100,000/year at ages 15-19, where it accounts for >10% of all solid cancers 1
- There is a male predominance with a male:female ratio of 1.4:1 1
- Ewing sarcoma is the third most common primary malignant bone-associated sarcoma, also occurring frequently in children and adolescents with a median age at diagnosis of 15 years 1
- Chondrosarcoma is more common in adults, with typical age at diagnosis between 30-60 years 1
- Rhabdomyosarcoma is primarily a soft tissue sarcoma, not a primary bone tumor
Distinguishing Features of Bone Tumors by Age
- Before age 5: Destructive bone lesions are most commonly metastatic neuroblastoma or eosinophilic granuloma 1
- Above age 5: Primary bone sarcomas (particularly osteosarcoma) become more common 1
- After age 40: Metastatic disease or myeloma are more likely than primary bone tumors 1
Clinical Presentation and Diagnosis
- Persistent non-mechanical bone pain lasting several weeks is the most common presenting symptom
- Swelling appears only when the tumor has progressed through the cortex and distended the periosteum 1
- All patients with suspected primary malignant bone tumors should be referred to a bone sarcoma reference center before biopsy 1
Treatment Approach for Osteosarcoma
- Standard treatment involves multimodal therapy with chemotherapy and surgery 2
- MAP chemotherapy regimen (methotrexate, doxorubicin, cisplatin) is the standard first-line treatment for patients under 40 years 2
- Modern multimodal treatment has improved survival rates from 10-20% (with surgery alone) to >60% 2
Common Pitfalls in Diagnosis and Management
- Malignant bone tumors are frequently difficult to recognize by clinicians, radiologists, and pathologists 1
- Delayed referral to specialized centers can negatively impact outcomes 2
- Bone sarcomas in children may be confused with benign tumors, which are more common 1
In conclusion, when considering the options presented in the question, osteosarcoma (option B) is definitively the most common primary malignant bone tumor in children and adolescents, as consistently reported in clinical guidelines.