Oncology (General Cancer)/osteosarcoma

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QUESTION: My 10 year old sons doctor suspects that he may have osteosarcoma. He has a lump on his knee as well as leg pain. My son has also been suffering from reoccurring abdominal pain, vomiting and diarrhea episodes. They have done a scope and ultrasound but found nothing. If he does have osteosarcoma could it have spread and be causing his episodes? I have also attached a picture of his lump. If you could give me your opinion I would greatly appreciate it! The lump is hard like a bone but the xray showed no bone, more like an empty sack. He complains about knee and leg pain when walking/running. It does not hurt if you touch it. The strange coloring on his leg in the pic is a port wine stain.

ANSWER: I would be very concerned that this is osteosarcoma, and the best advice is that it shouldn't be biopsied, it should be treated with radical surgery by a specialist.  Try to locate a pediatric orthopedic oncologist (try the local universities).  As for the other symptoms, he should have more than an ultrasound and scope; he needs a thorough work up for metastatic disease, including a PET scan and and MRI.  There has been a lot of progress in the management of these tumors so be optimistic.  OTher possibilities include Ewings sarcoma, giant cell tumors, and several other rare tumors.  Often a specialist can diagnose the type from the x-ray.  Would get moving on this as quickly as you can.  

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QUESTION: Thank you. His orthopedic ordered a mri but does not seem concerned. He has an appointment for his stomach problems with a GI. Is there anything else I can do? Is there anyway I can get them to listen?! They say it's a cyst and IBS but I really don't think so. I see him in pain. He complains about leg pain just from walking 15 feet to the bus stop. He screams in agony and begs me to kill him when he gets the stomach pains. I know somethings wrong but they won't listen!!

ANSWER: Has your orthopedist seen the MRI yet?  And when is the GI appointment?  Unfortunately, other than going to different specialists, I can't think of anything I would do right now. By the way, how does your son sleep, and is he losing weight?  Does he run a fever?  This information would be helpful.  

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QUESTION: He's getting an mri tomorrow May7. We get the results Tuesday May 12 and he's also seeing the GI Tuesday. No fevers and he's not losing weight which is strange because he barely eats. He only eats a little at dinner and says he's full. He sleeps alright as far as I know, he never says anything.

Answer
If he's not losing weight and he sleeps alright, the stomach problems may be psychosomatic caused by his worry and stress.  In any event keep me posted as to the results.  (I had the same thing when I was about 11, severe stomach pains which seemed to come on whenever my parents had serious fights.)

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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