WHAT IS OSTEOSARCOMA?

A.K.A: Osteogenic Sarcoma

Osteosarcoma is a type of cancer that produces immature bone. It is the most common
type of cancer that arises in bones, and it is usually found at the end of long bones, often around
the knee. Most people diagnosed with osteosarcoma are under the age of 25, and it is thought to
occur more often in males than females.
Osteosarcomas range from low grade tumors that only require surgery to high grade tumors that
require an aggressive treatment regimen. Patients with osteosarcoma are best treated at a cancer
center where an expert sarcoma team and resources are available to provide specialized and
responsive care.
Stages of osteosarcoma

Once osteosarcoma has been found, more tests may be done to find out if cancer cells
have spread to other parts of the body. This is called staging.

At present, there is no staging system for osteosarcoma.

Instead, most patients are grouped depending on whether cancer is found in only one part
of the body (localized disease) or whether the cancer has spread from one part of the
body to another (metastatic disease).

The following groups are used for osteosarcoma:

1. Localized osteosarcoma
The cancer cells have not spread beyond the bone or nearby tissue in
which the cancer began.
2. Metastatic osteosarcoma
The cancer cells have spread from the bone in which the cancer began to
other parts of the body. The cancer most often spreads to the lungs. It may
also spread to other bones.
In multifocal osteosarcoma, tumors appear in 2 or more bones, but have
not spread to the lungs.
3. Recurrent

 Recurrent disease means that the cancer has come back (recurred) after it
has been treated. It may come back in the tissues where it first started or it
may come back in another part of the body. Osteosarcoma most often
recurs in the lung. When osteosarcoma recurs, it is usually within 2 to 3
years after treatment is completed. Later recurrence is possible, but rare.

Different types of osteosarcoma

There are many different types of osteosarcoma that are quite different in natural
history and their potential for lethal growth. The grade is a term used to indicate
the level of aggressive growth and potential for metastasis, usually based upon the
appearance of the tumor under microscopic analysis.

1. Classical or conventional high grade central type

which accounts for 90% of all osteosarcomas.
By far the most common osteosarcoma.
Several other unusual high grade types:
2. Telangiectatic
3. Small cell
4. Secondary (associated with another pre-existing disease such as
Pagets disease or prior radiation exposure) type.
There are low grade types of osteosarcoma too.
5. Surface or juxtacortical low grade osteosarcoma
also known by the names parosteal or periosteal osteosarcoma
6. Low grade central osteosarcoma.

WHAT CAUSES OSTEOSARCOMA?

Scientists have not discovered the cause of most cases of osteosarcoma. Osteosarcoma
can develop as a result of radiation to an area of the body. It can also be associated with specific
genetic changes and diseases.
RISK FACTORS ASSOCIATED WITH OSTEOSARCOMA
Age, height and gender are all risk factors for osteosarcoma.
General risk factors

Age: Osteosarcoma is more common in people between 10 and 24 years old.

Duringadolescence, bones grow very quickly. It is thought that this rapid bone growth
may be part of the reason why young people develop osteosarcoma more often
duringadolescence than younger children or older adults.
Height: Research has shown that patients who develop osteosarcoma are more likely to
be taller than people of average height.
Osteosarcoma is also common in the long bones of tall dogs, such as Great Danes and
Irish Wolfhounds. This may be further evidence of a link between rapid bone growth and
osteosarcoma.
Gender: Males have a slightly higher risk compared to females. This could be simply
because boys tend to be taller than girls.

SYMPTOMS OF OSTEOSARCOMA
Symptoms of osteosarcoma vary depending on the location of the tumor. Common signs of this
type of cancer include:

bone pain on motion, at rest, or when lifting objects

bone fractures
swelling
redness
limping
limitation of motion of joints

How bone pain is experienced may vary. Your child may feel a dull ache or have pain that keeps
him or her awake at night. If your child has bone painor if you notice any of the above
symptomsexamine his or her muscles. In the case of osteosarcoma, the muscles in the
cancerous leg or arm will appear smaller than those in the opposite limb.
Symptoms of osteosarcoma can mimic growing painspain in the legs caused by normal bone
growth. However, growing pains typically stop during the early teenage years. Contact a doctor
if your child has any chronic bone pain or swelling past his or her initial growth spurts, or if the
pain is causing your child serious issues.

HOW IS OSTEOSARCOMA DIAGNOSED?

An x-ray is often the first diagnostic test that osteosarcoma patients receive, and an experienced
radiologist may recognize immediately that bone cancer is the likely diagnosis. There are several
additional tests that are a critical part of osteosarcoma diagnosis and staging:

An MRI of the entire bone where the primary tumor is located. This test can rule out
"skip metastases" (spread of the tumor to other areas of the bone).
A chest x-ray and CT scan of the chest to detect lung metastases
A bone scan of the body to rule out distant spread of the disease
A biopsy of the tumor, which provides a definite diagnosis based on the characteristics of
tumor tissue seen under a microscope. The biopsy will also show whether the tumor is
high grade (highly malignant, which is the case for most osteosarcomas) or low grade.
Blood tests are not needed to diagnose osteosarcoma, but they may be helpful once a
diagnosis is made. For example, high levels of chemicals in the blood such as alkaline
phosphatase and lactate dehydrogenase (LDH) can suggest that the osteosarcoma may be
more advanced than it appears.

TREATMENT
The types of treatment used for osteosarcomas include:

Surgery
Chemotherapy
Radiation therapy (in certain cases)

Most often, both chemotherapy and surgery are needed.

Osteosarcoma is often treated with a combination of therapies that can include surgery,
chemotherapy and radiation therapy. Most patients with high grade tumors receive about three
months of chemotherapy, known as neo-adjuvant therapy, before surgery. A surgeon will then
remove the tumor, along with a wide margin of healthy tissue around the tumor, with the goal of
leaving the area free of all disease.
Most tumors at the bones and joints can be removed safely while sparing the involved limb. A
surgeon might use a metal implant, an allograft (bone taken from a cadaver), a combination of an
implant and allograft, or a bone taken from the patient in order to replace tissues that are
removed during surgery. Occasionally, because of a tumors size or location, an amputation or
rotationplasty is the best way to completely remove the cancer and restore the patient to a
functional life.

NURSING DIAGNOSIS:
Acute pain related to physical injuring agents
Ineffective breathing pattern related to musculoskeletal impairment as evidenced by
usage of accessory muscles in breathing
Activity intolerance related to pain
Impaired social interaction related to limited physical mobility
Ineffective role performance related to body image alteration; physical illness

NURSING RESPONSIBILITIES:

Assist child and family to cope with the problem

Provide time for child and family to accept the diagnosis
Encourage family and client to verbalize
Post-operatively, child is fitted with a prosthesis
Provide nursing care of post-op amputation
Provide with normal growth and development activities