Osteogenic Sarcoma (Osteosarcoma) -The most common and the most often fatal primary malignant bone tumor.

-Contain osteoid, produced by anaplastic stromal cells, which are atypical, abnormal cells not seen in normal developing bone. -It may also contain chondroid (cartilage) and fibrinoid tissue that may form bulk of the tumor.

The pink material in the center of the picture is non-mineralized bone that is being produced by the surrounding cancer cells. Incidence -Males 10-25years old -Older people with Pagets disease

-Primary lesion may involve any bone, but the common sites are: Proximal tibia

Proximal humerus

Distal femur

Classification according to Histologic Characteristics of Cells:

Osteoblastic- when majority of the cells produce osteoid. Chondroblastic- where production of chondroid matrix is predominant. Fibroblastic- when spindle cells are in the majority and little matrix is formed.

Types: CLASSIC -Malignant tumor of bone in which neoplastic osteoid is produced by a proliferating spindle cell stroma HEMORRHAGIC -Represents a high-grade variant that strikes in the second to third decade. This aggressive lesion has the same distribution as classic osteosarcoma, but advances rapidly and puts the patient at significant risk for pathologic fracture.

PAROSTEAL -Low-grade malignant bone tumor that usually occurs on the surface of the metaphysis of long bones

TELANGIECTATIC -Pathologic fractures very frequent

-May be more aggressive than conventional variety WELL-DIFFERENTIATED (Low-grade) INTRAMEDULLARY (Intraosseous) -Usually adult -Recurrences common -Metastases very rare unless tumor recurrence is conventional high-grade osteosarcoma (i.e. dedifferentiation)

OTHER VARIANTS -Defined on topographic, clinical, and/or radiographic features JUXTACORTICAL OSTEOSARCOMA -Infrequent -Slightly older age group than conventional variety -Grows very slowly: life history up to 15 years

OSTEOSARCOMA OF JAW -Distinctive -Usually slightly older (average age 34 years) OSTEOSARCOMA IN PAGETS DISEASE -Usually polyostotic Paget's disease STAGES

Localized - The cancer affects only the bone where it started and the tissues next to the bone, such as the muscle or tendon. Metastatic - The cancer has spread (metastasized) to other parts of the body, such as the lungs, or to other bones that are not connected to the bone where the tumor started.

Recurrent - The tumor has come back after it was treated. The most common places for recurrent osteosarcoma to appear are the lungs and bone. When osteosarcoma comes back (recurs), this is most likely to happen 2 or 3 years after treatment ended.

Risk factors -Injury -familial susceptibility -infection -exposure to sunlight and ultraviolet radiation -metabolic and hormonal disturbance -irradiation and assimilation of irritant substances (cigarette smoking, oil, tar, cobalt, chromium) Clinical Manifestation -Pain -swelling and local tenderness -limited joint movement -evidence of pressure on the neighboring structure -syndrome of cachesia: a. weight loss b. muscular weakness c. anorexia d. severe depression e. toxemia f. acidosis

Pathophysiology Predisposing Factor: -Age(5-12 y/o) and height -Gender (male/female 2:1) -Genetics (retinoblastoma gene (RB) and TP53 gene) -Hereditary -Certain bone disease (Paget Disease, Precipitating Factor: -High fat diet -Too much sedentary or strenuous activities -Trauma or injury -Cigarette smoking -Alcohol drinking

Etiology: Unknown

Balance of cell division and death is disturbed. Formation of tumor Osteoids infiltrate the normal compact bone

Tumor grows rapidly Metastasis to lymph nodes Tumor cells exits through venous end of capillary Metastasis

CT Scan, MRI, bone marrow aspiration

Osteolytic response (bone Weakens bones

Osteoblastic response (bone formation) Tumor will cause the bones surface to change Tumor will move out from the metaphysis It will go to the periosteal surface

Pathologic fracture Bone pain, decreased ROM, edema, loss of function, swelling, redness,

Lung

Kidne

Breas t, thyroi

Hypercalcemia

Subsequent spread to adjacent soft tissues Contours enlarge in tumor area

Chest x-ray, alkaline phosphatase

BUN Creatinin e

Muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmia, seizure

Swelling and local tenderness Diagnostic procedures -biopsy -x-ray revealing of local mass, secondary deposits in the lungs -CT scan -MRI

-biopsy -bone scan -myelography -arteriography -biochemical assays of blood and urine

Medical and Surgical Intervention

1.Physical therapy to improve muscle tone and range of motion 2.Hormonal and chemotherapy: a. steroid compound b. radio-active isotopes c. alkylating agents d. analgesic e. antibiotics f. vitamin preparation 3.Radiotherapy 4. Surgery -Surgical Excision -chemotherapy -limb-sparing procedure-used to remove the tumor and adjacent tissue

-amputation

-Dissitianlation

-Bone curettage and grafting -demispalyetory -Internal fixation in pathological fracture and dislocation -arthrodesis

-arthroplasty

Nursing Responsibility 1.Relieve pain 2.Encourage physical, intellectual and social 3.Promote adequate nutrition and hydration 4.Promote comfort of the patient 5.Assist in overcoming bladder and bowel disturbances 6.Recognize signs of toxicity from chemotherapy injury a.Sign of stomatities, nausea, vomiting, diarrhea, alopecia b.Check reduction in the number of leucocytes, and platelets c.Obsrve for evidence of infection and bleeding

Nursing Care Plan Assessm ent S: Ang sakit nitong kamay ko dahil sa bukol. Pain scale is 6/10 O: Facial grimace Swelling and local tendern ess Diagnosis Acute pain related to compressi on secondary to the presence of tumor manifeste d by reports of pain, grimacing face, and pain scale of 6/10. Rationa le Pain may be caused by direct pressur e of the mass on sensory nerves. Planning At the end of 8 hours nursing interventi on, the client will be able to reduce the pain from 6/10 to 4/10. Intervention --Perform a comprehens ive assessment of pain including location, characteristi cs, onset, duration, frequency, quality, intensity or severity and precipitating factors of pain. --Provide comfort measures like changing of position --Promote relaxation techniques like music therapy, bed rest, etc. Rationale --This is to have an effective manageme nt for pain Evaluation At the end of 8 hours nursing interventi on, the client has able to reduce the pain from 6/10 to 4/10.

--This will provide nonpharmacolo gical measures to relieve pain --To decrease pain perception and can help to the effectivene ss of pain manageme nt. --To decrease anxiety --To assist patient in exploring ways on how to alleviate

--Provide calm environmen t --Encourage verbalizatio n of feelings

the pain.

Assessme nt S: Hindi ko naman nararamd amang nagiging okay ang pakiramd am ko, kaya natatakot ako sa maaaring mangyari sakin dahil dito sa sakit kong to. Tapos kung kailan kailangan ko ng

Diagnosis Ineffectiv e coping related to fear of the unknown, and inadequat e support system as evidenced by inadequat e problem solving

Rationale

Planning At the end of 8 hours of nursing interventi on, the client will be able to: --Assess the current situation accuratel y. --Identify ineffectiv e coping behaviour s and

Interventi on --Provide verbalizati on of feelings of the client

Rationale --To assess and explore ideas on how to cope with the situation. --To promote independ ence in decision making and problem solving. --To be able to

Evaluation At the end of 8 hours of nursing interventi on, the client has able to: --Assess the current situation accurately . --Identify ineffective coping behaviour s and conseque nces

--Do not argue with the patient. Let the patient decide for his/her self. --Identify stressors

suporta galling sa pamilya ko, ngayon pa sila wala. Di din ako nakakaino m ng mga gamot ko dahil hindi nila ako binibilhan.

consequen ces -Verbalize awarenes so f o w n coping abilities.

identify some ways to avoid and prevent stressors.

-Verbalize awarenes sof own coping abilities.

References www.google.com Brunners Medical and Surgical Nursing Porths Pathophysiology: Concepts of Altered Health States