Knee pain in teens may signal cancer, experts warn

Persistent knee pain in teenagers, frequently attributed to sports injuries or the common aches of growth, may signal a more serious underlying condition: cancer. Osteosarcoma, an aggressive form of bone cancer, predominantly affects children and adolescents, with a significant majority of cases occurring before the age of 25. This cancer frequently manifests around the knee, making its early symptoms easily mistaken for typical athletic injuries.

Dr. Tie Teck Liang, an Orthopedic Surgical Oncologist at Sunway Medical Centre, emphasizes that parents should observe the pattern of pain, not just its intensity. While injury-related pain typically subsides with rest or painkillers, pain that endures for over two weeks warrants a doctor's examination. Additional warning signs include swelling, limping, or the appearance of a lump, especially if the pain wakes the child at night or is not alleviated by medication.

Recognizing osteosarcoma can be challenging due to the high activity levels of children and teenagers. Their frequent running, jumping, and occasional falls can mask the symptoms. Unlike common injuries, osteosarcoma is characterized by continuous growth, with tumors potentially enlarging rapidly. Early and accurate diagnosis is therefore critical.

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Parents also need to pay attention if the pain causes the child to wake up at night or is not relieved even after taking medication. Other signs to watch out for include swollen legs, the appearance of a lump, limping, or pain without a clear cause.

Diagnostic imaging plays a vital role. An initial X-ray is standard for persistent bone pain. If suspicious findings emerge, an MRI can provide detailed information about the tumor's size and its proximity to nerves and blood vessels. A biopsy is necessary to confirm the diagnosis, but this procedure should be carefully planned and ideally performed by the surgeon who will undertake the tumor removal to ensure the biopsy tract is excised during the subsequent surgery.

Treatment for osteosarcoma has advanced significantly. While amputation was once a common approach, limb-salvage surgery is now feasible in many cases. This involves removing the tumor with a margin of healthy tissue, followed by reconstruction using implants or biological methods. Cryotherapy, using liquid nitrogen at -196 degrees Celsius to destroy cancer cells in the affected bone before reimplantation, is one such technique used in select cases. Rehabilitation, including physiotherapy, is a crucial part of the recovery process, which can span about a year and often includes chemotherapy.

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Osteosarcoma is difficult to identify because children and teenagers are very active. They often run, jump, or fall. Therefore, knee pain is easily associated with sports activities. However, unlike ordinary injuries, osteosarcoma continues to grow and the tumor can enlarge rapidly.