Follow-up after treatment for childhood bone cancer
Follow-up after treatment is an important part of cancer care. Follow-up for childhood bone cancer is often shared by a team of healthcare professionals such as cancer doctors, audiologists, speech-language pathologists, dentists, eye doctors, nurses and psychologists. This team will work with you to decide on follow-up care to meet your child's needs.
Follow-up is important because there is a chance the cancer can come back (recur) and late side effects from treatment can develop. Initial follow-up focuses on checking to see if cancer has come back and making sure that the child has recovered from treatment. If your child has any new symptoms or symptoms that don't go way, don't wait until the next scheduled appointment to report them. Tell the healthcare team if your child has:
- swelling or a lump
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The healthcare team will follow all children treated for bone cancer to make sure they are growing and developing normally. The chance of childhood bone cancer recurring is greatest within 18 months of completing treatment for osteosarcoma and within 2 years of completing treatment for Ewing sarcoma. Close follow-up is usually done for the first 5 years after completing treatment.
Children who have limb-sparing surgery need careful orthopedic follow-up. They will also need to see a rehabilitation medicine specialist, physiotherapist and occupational therapist.
Children who have limb-sparing surgery or amputation often need lifelong follow-up with an orthopedic surgeon.
Follow-up visits with the healthcare team are usually scheduled:
- every 3 months for the first 2 years after treatment
- every 6 months for the next 3 years
- every year for the next 5 years
- every 2 to 3 years once 10 years have passed since treatment
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During a follow-up visit, the healthcare team will usually ask questions about the side effects of treatment and how the child is coping. The doctor may do a complete physical exam, including:
- feeling the lymph nodes
- examining the area where the primary tumour was
- checking that the child is growing normally
- checking that the child's sexual development is normal
Tests are often part of follow-up care. Your child may have:
- blood tests to check organ function
- bone scan
- a CT scan or MRI of the primary tumour site
- an x-ray or a CT scan of the chest
- an echocardiogram to check heart function
Children who have limb-sparing surgery need to have yearly x-rays to check:
if limbs are different lengths
- grafts or implants to find out if they are healing properly or not (called non-union)
- grafts for breaks, or fractures
- implants to make sure they are not loose (a loose implant is called stem loosening)
If a recurrence or other problems are found during follow-up visits, the healthcare team will assess your child to determine the best treatment options. Some children may be referred to an endocrinologist if there are any problems with their sexual development.
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In the long term, follow-up focuses on watching for late effects. People who had a childhood cancer may be followed in aftercare programs for life.
The Children's Oncology Group (COG) provides long-term follow-up guidelines for childhood cancer survivors. Some centres across Canada have transition clinics set up to follow the survivors of childhood cancer. These clinics help prepare survivors who are reaching early adulthood to successfully manage their own healthcare. Find out more about long-term survivorship.
Questions to ask about follow-up @(Model.HeadingTag)>
Abha Gupta, MD, MSc, FRCPC
Raveena Ramphal, MBChB, FRACP
American Cancer Society. Living as an Osteosarcoma Survivor. 2020: https://www.cancer.org/cancer/osteosarcoma/treating.html.
American Cancer Society. Living as a Ewing Tumor Survivor. 2018: https://www.cancer.org/cancer/ewing-tumor/follow-up.html.
Hendershot, E . Ewing's Sarcoma Family of Tumors. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.3: pp. 37-41.
Hendershot, E . Osteosarcoma. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.4: pp. 41-44.
Macmillan Cancer Support. Ewing's Sarcoma in Children. Macmillan Cancer Support; 2013: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Ewingssarcoma.aspx.
Macmillan Cancer Support. Osteosarcoma in Children. Macmillan Cancer Support; 2013: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Osteosarcoma.aspx.
Morgan, H and Conrad, E.U.III . Limb salvage and spinal surgery. Wallace, H. & Green, D. M. Late Effects of Childhood Cancer. London, UK: Arnold; 2004: 9c:pp.293-303.
Gorlick R, Janeway K, Marina N. Osteosarcoma. Pizzo PA, Poplack DG, eds.. Principles and Practice of Pediatric Oncology . 7th ed. Philadelphia, PA: Wolters Kluwer; 2016: 34:877–899.
Hawkins DS, Brennan BMD, Bolling T, Davidson DJ, Dirksen U, DuBois SG, Hogendoorn PCS, Lessnick SL. Ewing sarcoma. Pizzo PA, Poplack DG, eds.. Principles and Practice of Pediatric Oncology . 7th ed. Philadelphia, PA: Wolters Kluwer; 2016: 33:855–876.