Osteosarcoma
Osteosarcoma is a malignant tumor of the bone that arises from osteoblasts, the cells that form
new bone. It causes the production of immature bone or osteoid tissue. It most commonly affects
the long bones, particularly around the knee, and is most frequent in children, adolescents, and
young adults
Osteogenic Sarcoma
-This is an older or alternative term for osteosarcoma, emphasizing its origin in bone-forming
cells (osteogenic).
PATHOPHYSIOLOGY
A. Risk Factors:
1. Age and Growth
-Adolescence and young adulthood, periods of rapid bone growth, and being taller than average.
2. Genetic Predisposition
-Inherited syndromes like Li-Fraumeni syndrome, retinoblastoma, and others affecting bone
development.
3. Pre-existing Bone Conditions
-Paget's disease of bone, hereditary multiple osteochondromas, and fibrous dysplasia.
4. Radiation Exposure
-Prior exposure to high doses of ionizing radiation.
5. Sex
-Males have a slightly higher risk than females.
6. Race/Ethnicity
-Some populations show slightly higher incidence, reasons not fully understood.
B. Disease Process
Osteosarcoma, a primary malignant bone tumor, develops from primitive mesenchymal cells that
produce bone. The exact cause remains unclear, but the disease process involves several key
steps.
1.Genetic Abnormalities
-The disease begins with genetic changes within bone-forming cells (osteoblasts). These
mutations, often involving tumor suppressor genes (like RB and p53) and oncogenes, disrupt
normal cell growth and regulation. This leads to uncontrolled cell proliferation.
2. Malignant Osteoid Production
-The abnormal cells produce malignant osteoid, an immature, disorganized bone-like substance.
This contributes to the characteristic radiographic appearance of osteosarcoma on X-rays.
3. Tumor Growth and Invasion
- The tumor grows progressively, often expanding into the surrounding bone marrow and soft
tissues. The tumor can weaken the bone, leading to pathologic fractures.
4. Metastasis
-A significant aspect of the disease process is the potential for metastasis, primarily to the lungs.
Cancer cells can break away from the primary tumor and travel through the bloodstream to
establish secondary tumors in other parts of the body. This significantly impacts prognosis.
The interplay between genetic alterations, abnormal osteoid production, local invasion, and
distant metastasis defines the complex disease process of osteosarcoma. Research continues to
uncover the intricate molecular mechanisms driving these processes to improve treatment
strategies.
C. Signs and Symptoms:
1. Bone pain
-Often localized, worsening with activity, and improving with rest. May initially be mild and
intermittent.
2. Swelling
-A palpable mass or lump around the affected bone or joint.
3. Limited range of motion
-Difficulty moving the affected joint.
4. Pathologic fracture
- a bone break caused by the weakened bone due to the tumor.
5. Limping
- If the leg is affected.
6. Unexplained fever
-A less common symptom.
7. Skin discoloration
-Around the tumor site.
LABORATORY AND DIAGNOSTIC FINDINGS
1.X-rays are often the first step, showing bone abnormalities suggestive of a tumor.
2.MRI provides detailed images of both bone and soft tissue, crucial for assessing tumor size and
spread.
3.CT scans offer cross-sectional views, helpful for surgical planning and detecting lung
metastases.
4.PET scans identify areas of high metabolic activity, indicating cancerous cells.
5.Blood Tests A complete blood count (CBC) checks overall blood health.
6.Alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels may be elevated,
suggesting bone damage.
Confirmatory test
Biopsy- A tissue sample from the tumor is microscopically examined to confirm the diagnosis
and determine the cancer type. This is the definitive test
MEDICAL AND SURGICAL MANAGEMENT
Surgical Management:
1. Limb-sparing surgery:
This is the preferred approach when possible, aiming to remove the tumor while preserving the
limb.
2. Rotationplasty:
A surgical procedure where the lower leg is rotated and reattached, used in cases of osteosarcoma
around the knee.
3. Limb amputation:
In some cases, if the tumor is large or in an inaccessible location, amputation may be necessary
to remove all of the cancer.
4. Surgical biopsy:
This can be done to remove all or part of the tumor for diagnosis and staging.
5. Bone repair:
After surgery, the bone may be repaired using a bone graft, metal implant, or plastic material.
Medical Management:
1. Chemotherapy:
A combination of chemotherapy drugs is used to kill cancer cells, often administered before and
after surgery.
2. Radiation therapy:
May be used to shrink tumors, kill remaining cancer cells after surgery, or treat areas where
surgery is not feasible.
3. Rehabilitation:
Physical and occupational therapy are important for regaining function and strength after surgery
and chemotherapy.
4. Supportive care:
Supportive care addresses the side effects of treatment, including pain management and
psychosocial support.
NURSING MANAGEMENT
Independent Nursing Interventions
1. Assess and manage pain
U-se pain scales, apply cold packs, relaxation techniques.
2. Educate patient and family
-Teach about osteosarcoma, treatment, and home care.
3. Encourage safe movement
-Help with walking aids, prevent falls, reposition regularly
Dependent Nursing Interventions
1. Give medications
-Administer pain meds, chemo, antiemetics, antibiotics.
2. Post-op care
-Change dressings, check surgical site, monitor drains.
3. Monitor labs and vitals
Check WBC count, kidney function, report abnormal results
Collaborative Nursing Interventions
1. Refer to physical therapy
- Support rehab after surgery or amputation.
2. Coordinate with dietitian
-Ensure proper nutrition during chemo.
3. Provide emotional support with counselor
-Help with fear, depression, or body image issues.
