Counsel an adolescent and family on a new diagnosis of osteosarcoma — OSCE

Candidate brief

You have eight minutes to counsel a fourteen-year-old boy and his parents following a new diagnosis of a high-grade osteosarcoma of the distal femur, confirmed by magnetic resonance imaging after three months of night pain and a palpable mass. Use a structured, honest, empathic approach that names the diagnosis, explains the biopsy and staging, addresses the online fears about amputation and infertility, and builds a shared plan. [1][2]

Key teaching and communication objectives

Acknowledge and validate the family's fear before delivering the information, and allow silence. Explain in plain language that osteosarcoma is the commonest bone cancer of adolescence, that it arose in the growing end of the thigh bone near the knee, and that the night pain and the firm swelling were the signs that led to the scan. Reassure them that the team now has a clear plan, and that the outlook for a localised tumour treated in a specialist centre is around seventy per cent survival at five years. [1]

Address the biopsy and the local-hospital question directly. Explain that the biopsy of a suspected bone tumour is performed at the specialist sarcoma centre, not at the local hospital, because the small cut the needle makes must lie within the line of the future operation so that it can be removed with the tumour. A biopsy done in the wrong place can spread the tumour cells into the healthy tissue and make it harder or impossible to save the leg, which is why the referral to the specialist centre happens before any tissue is taken. [2]

Address the amputation fear honestly without minimising it. Explain that the aim of the treatment is to save the leg wherever it is safe to do so, by giving chemotherapy first to shrink the tumour and then removing it with a clear margin and rebuilding the bone with a metal prosthesis. Amputation is reserved for the tumour that cannot be safely separated from the major blood vessels or nerves, and the team will know which path is right only after the scans and the biopsy. Acknowledge that this is a great deal to take in and that they will meet the surgeon and the oncologist together. [1]

Address the fertility and the chemotherapy fears directly. Explain that the chemotherapy uses strong medicines, including one that can affect the sperm and the future fertility, and that the team offers sperm banking before the treatment begins so that the option of having his own children in the future is protected. Name the common side effects honestly, the hair loss, the nausea, the infection risk and the tiredness, and explain that each is anticipated and managed. Close with a shared plan, a clear next appointment at the specialist centre, a named key worker, and a connection to a sarcoma support organisation. [1][2]