Osteosarcoma

I. Definition/ other names

Another term that can be used as a substitute for osteosarcoma is

osteogenic sarcoma and it is the most common type of cancer that develops in
the bone. It is a type of cancer that produces immature bone. The term sarcoma
was introduced by the English surgeon Jhon Abernethy in 1804 and was derived
from Greek roots meaning fleshy excrescence. In 1905, the French surgeon
Alexis Boyer first used the term osteosarcoma. Its gross appearance was
described 1846 by Baron Guillaume Dupuytren as a whitish or reddish mass,
lardaceous and firm at an early stage of a disease; but presenting at a later
period, points of softening, cerebriform matter, extravasation of blood and white
or straw colored fluid of a viscid consistence in its interior. Like the osteoblast in a
normal bone, the cells that form this cancer make bone matrix but this bone
matrix is not as strong as that of a normal bone.

Osteosarcoma is deadly form of musculoskeletal cancer that most

commonly causes patients to die from pulmonary metastasis disease and which
has 5 year survival rate of 15-20%. Most osteosarcoma occurs in children and
young adults (<25 years old); thought to occur more often in males than in female
and in areas where the bone grows quickly such as the near ends of the long
bones. Most common sites are: bones around the knee, either in the distal femur
or the proximal tibia and also the proximal humerus. However, osteosarcoma can
also develop in any bone, including the bones of the pelvis, shoulder and jaw.

There are several subtypes of osteosarcoma, and these can be identified

by how they look on x-rays and under the microscope. Based on how they look
under the microscope, this type of cancer can be classified as high grade,
intermediate grade, or low grade. The grade of the tumor tells doctors how likely
it is that the cancer will grow and spread to the other parts of the body.

A. High grade osteosarcomas:

>fastest growing type of osteosarcoma
> they do not look like normal bone and have many cells in the process of
dividing into new cells
B. Intermediate grade osteosarcomas:
>These uncommon tumors fall in between high grade and low grade
osteosarcomas
C. Low grade osteosarcomas:
> These are the lowest slow growing osteosarcomas. The tumors look
more like normal bone and have few dividing cells which seen under the
microscope
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 founding 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 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, tumor appears in 2 or more
bones, but has not spread to the lungs.
3. Recurrent osteosarcoma: Recurrent diseases mean that the
cancer has come back after it has been treated. It may come back in
tissues where it first started or it may come back in another part of
the body. When osteosarcoma recurs, it is usually within 2 to 3
years after treatment is completed. Later recurrence is possible, but
rare.

II. Causes/ Etiology

Some sources indicated that the cause of osteosarcoma is unknown,

however recent studies shows that scientists have learned how certain changes
in our DNA can cause cells to become cancerous. DNA, which is the chemical in
each of our cells that make up our gene, does not only affects how we look but
also it is associated with our risk of developing certain diseases, including some
kinds of cancer. Cancers can be caused by DNA changes that turn on
oncogenes or turn off tumor suppressor genes. Some people inherit DNA
mutations or genes from a parent that increases their risk of cancer. However,
cancer-causing changes are acquired during life rather than inherited before
birth. In that case, the change occurs only in the cells that will develop the
cancer. These are called somatic or acquired gene changes.

Some DNA mutations cause syndromes that are linked with an increased risk of
osteosarcoma:

a. The Li-Frauman syndrome it turns off the TP53 tumor suppresor gene.
These mutations give a person a very high risk of developing one or more
types of cancer, including breast cancer, brain tumors, osteosarcoma,
and other cancers.
b. Inherited changes in Retinoblastoma (RB1) tumor suppressor gene-
increases risk of developing retinoblastoma, and also osteosarcoma.
 However, most osteosarcomas are not caused by inherited DNA mutations.
They result from gene changes acquired during the persons lifetime. These
changes are present only in the cancer cells and not on to children.

For example: Although radiation therapy is very useful in treating some forms
of cancer, it can also cause cancer by damaging DNA. This is why people who
get radiation therapy to treat another cancer are more likely to later develop
osteosarcoma in the treated site.

Other DNA changes have no clear cause. Other than radiation, there are no
known lifestyle-related or environmental causes of osteosarcoma. Researchers
now understand some of the gene changes that occur in osteosarcomas, but its
not always clear what causes these changes

III. Signs and Symptoms

Symptoms of osteosarcoma vary depending on the location of the tumor. The

common signs includes:
a. Bone pain (in motion, at rest, when lifting objects)
b. Painless swelling
c. A noticeable mass or lump in an arm, leg, or pelvis
d. Bone fractures
e. Swelling
f. Redness
g. Limping
h. Limitation of motion of joints

Patients who have osteosarcoma may have a history of pain in the affected
area and may have developed a limp (depending on which bone affected). Often
the pain is thought to be related to muscle soreness or growing pains, but it
does not go away with rest.
Some patients may also experience a dull ache or have pain that keeps them
awake at night. In some cases of osteosarcoma, it is also advisable to examine
or assess the muscles in the cancerous leg or arm because it may appear
smaller than those of the opposite limb.

IV . Common Laboratory and Diagnostic Findings

X-ray

Often the first diagnostic test to be done, and an experience radiologist may
recognize immediately that bone cancer is the likely diagnosis.

Additional tests:
MRI MRI of the entire bone where the primary tumor is located. The test can
rule out skip metastases or the spread of the tumor to other areas of the bone.
Chest X ray and CT Scan it is done to detect lung metastases
Bone Scan to rule out distant spread of the disease
Biopsy provides a definite diagnosis based on the characteristics of tumor
tissue seen under a microscope. This will also show the grade level of the tumor.
a. Needle aspiration
b. Surgical biopsy

V. Medical and surgical management

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.
 VI . Pathophysiology

OSTEOSARCOMA

Predisposing Factors Predisposing Factors

Children: Adult:
a. Genetics a. High fat diet
b. Teenage growth spurt b. Lack of exercise
c. Benign tumors c. Smoking
d. Injury/Trauma d. Alcoholism
e. Metabolic and hormonal e. Injury/Trauma
imbalance f. Metabolic and
hormonal imbalance

OSTEOBLAST

DNA MUTATION

MALIGNANT
OSTEOBLAST

PROLIFERATION
OF ABNORMAL
OSTEOBLAST

FORMATION OF OSTEOID
OR IMMATURE BONE

PAIN SWELLING TENDERNESS

 VII. Prognosis

Prognosis statistics are based on the study of groups of osteosarcoma

patients. These statistics cannot predict the future of an individual patient, but
they can be useful in considering the most appropriate treatment and follow-up
for a patient.

When treated appropriately, patients with high grade osteosarcoma in one

location have a survival rate of about 70%. The survival rate is higher for patients
with low grade tumors, and it is lower for those whose disease has spread
throughout the body and for those whose tumors have a poor response to
chemotherapy.

VIII. References:

https://www.cancer.org/cancer/osteosarcoma.html
http://sarcomahelp.org/osteosarcoma.html
https://www.cancer.org/cancer/osteosarcoma/causes-risks-prevention/what-
causes.html
http://sarcomahelp.org/osteosarcoma.html
http://www.cancer.net/cancer-types/osteosarcoma-childhood/symptoms-and-
signs
https://www.scribd.com/doc/17647444/OSTEOSARCOMA
http://careplannursing.blogspot.com/2015/01/nursing-care-plan-for-
osteosarcoma.html
http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-
nursing/osteosarcoma/
https://www.slideshare.net/abbirr/case-presentationosteosarcomab