OSTEOSARCOMA

Definition
Osteosarcoma is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth that occurs in adolescence, as a teenager matures into an adult.

Causes
The exact cause is unknown

Risk factors
Age The risk of osteosarcoma is highest during the teenage "growth spurt The risk goes down in young adults, but rises again in older adults (usually over the age of 60). Height Patients are usually tall for their age. This is another indication that osteosarcoma may be related to rapid bone growth. Gender More common in males than in females. Females tend to develop it at a slightly earlier age, possibly because they tend to have their growth spurts earlier.

Risk factors
Race/ethnicity Osteosarcoma is slightly more common in African Americans than in whites. Radiation to bones People who were treated with radiation therapy for another cancer may have a higher risk of later developing osteosarcoma Certain bone diseases Paget disease of the bone: This is a condition that causes abnormal bone tissue to form in one or more bones. Affected bones are heavy and thick but are weaker than normal bones and are more likely to break.

Risk factors
Certain bone diseases Multiple hereditary Osteochondromas. o These are benign bone tumors formed by bone and cartilage. o The more osteochondromas a person has, the greater the risk of developing osteosarcoma.

 Inherited cancer syndromes Retinoblastoma a rare eye cancer of children that can be hereditary. The inherited form of retinoblastoma is caused by a mutation (abnormal copy) of the RB1 gene. The Li-Fraumeni syndrome Makes people much more likely to develop several types of cancer, including breast cancer, brain cancer, osteosarcoma, and other types of sarcoma. Most of those cases are caused by a mutation of the TP53 tumor suppressor gene. Rothmund-Thompson syndrome. Children with this syndrome are short and tend to have skeletal problems and rashes. They also are more likely to develop osteosarcoma. This syndrome is caused by abnormal changes in the REQL4 gene.

Risk factors

Incidence
Osteosarcoma is uncommon but an average of 8,000 cases a year is diagnosed in the United States And in the Philippines it was found out that the incidence of osteosarcoma is second to India which has the highest incidence of osteosarcoma in Asia from the years 1983-1997 but after that there was no updates on the incidence of osteosarcoma in the Philippines after that year.

Types of Osteosarcoma
Localized Osteosarcoma - Cancer cells have not spread beyond the bone or nearby tissue in which cancer began Metastatic Osteosarcoma- Cancer cells have spread from the bone in which the cancer began to the other parts of the body. *Multifocal Osteosarcoma- tumor appear in 2 or more bones. Recurrent Osteosarcoma- osteosarcoma which recurs after osteosarcoma has been cured which usually develops in other parts of the body.

Prognosis:
Depends on the extent of disease, the size and location of the tumor, presence or absence of metastases, tumors response to therapy, age and overall health, tolerance to specific medications and new developments of treatment. It is divided into three groups: Stage 1/Low grade, localized tumors- osteosarcoma is rare and includes periosteal sarcoma. Has excellent prognosis >90% with wide resection Stage II/High grade localized tumors- prognosis depends on the site of the tumor, size of the tumor and degree of necrosis from neoadjuvant therapy.
If metastases is present the longer time to metastasis has better prognosis and even better if fewer metastases. 40-50% has a good prognosis in these stage

Stage III/Metastatic tumors- With the presence of lung metastasis prognosis depends on the respectability of the primary tumor and lung, degree of necrosis of the primary tumor and number of metastasis prognosis in this stage is 30%

Pathophysiology

Medical Management
DIAGNOSTIC PROCEDURES Physical Exam, Initially, the physician will have to take a complete medical history asking the patient about heredity, risk factors and other pressing issues that are related to the condition. The assessment includes physical examination to look for possible signs of Osteosarcoma and other health problems. Blood Test. Doctors usually order a series of blood tests that include a complete blood count, alkaline phosphates and lactate dehydrogenase. CBC is done to determine the blood counts of the patient.

Management

continuation

Magnetic resonance imaging (MRI) scan on the affected area also ordered, wherein they could obtain a specific or obtain the best spot to perform biopsy and to check whether the cancer had spread from the bone to near fats and tissues (metastasis has taken place). The most used procedure to confirm osteosarcoma is through a BIOPSY wherein they will aspirate a sample of the tumor in needle biopsy but commonly samples are obtained through an open biopsy where they take a part of the tumor or the tumor itself. This is also used to determine the histologic features and cell type of the tumor. If a diagnosis of osteosarcoma is made, the doctor will order a CT scan particularly chest, Radionuclide bone scan are ordered to check the extent of metastasis.

Treatment
The standard therapy for osteosarcoma is surgery with chemotherapy given before and after surgery.

MEDICAL MANAGEMENT Chemotherapy Chemotherapy is vital in the treatment of osteosarcoma. Advances in chemotherapy over the past 30 years have been responsible for improved limb salvage and higher survival rates. Standard regimens include preoperative (induction) and postoperative (adjuvant) chemotherapy. Preoperative chemotherapy induces tumor necrosis in the primary tumor and provides early treatment of micro metastatic disease.

Treatment
Surgical management

continuation

In the past, treatment usually entailed amputation above the level of the tumor. Limb salvage surgical procedures, using a metal prosthesis or cadaver allograft, are becoming a standard alternative. Studies have shown that limb salvage surgery has no adverse effects on the long-term survival of persons with osteosarcoma. In limb-salvage surgery, the bone and muscle affected by the osteosarcoma are removed, leaving a gap in the bone that is filled by either a bone graft (usually from the bone bank) or more often a special metal prosthesis. These can be appropriately matched to the size of the bone defect.

treatment

continuation

Limb-sparing techniques Limb-sparing (saving) tchniques available at Mayo Clinic may include bone grafts, rotation plasty or implanting artificial (prosthetic) joints.

Autograft (bone graft from own tissue of the patient). Allograft (bone graft from donor tissue). Rotationplasty. Prosthetic implant.

treatment

continuation

Amputation is another surgical procedure that involves either the removal of expendable bones such as the fibula, ribs, toes, ulna or the complete removal of the tumor and the affected limb.

Nursing Interventions Nursing Care Rationale

Plan

Observe movement Nursing client is - Impaired physical mobility related when Diagnosis: To note incongruencies with to pain as evidenced by limited range of motion, unaware of observation reports of abilities slowed movements and reluctance to attempt Nursing withmovements. to - To promote optimal level of Provide patientEvaluation: After 4 days of rendering ample time appropriate Nursing intervention, the patient nursing perform mobility related task.Inference: due to the presence of tumor on function. parts especially was able to affectedof strengththe limbs it affects the joints Encourage adequate increasefluids - To and function being and intake promote well of flexibility causing limitation of movement, also due to or nutritious foods pain felt upon manifested by hesitant to move maximize energy production affected body part as exertion the client is unlimited thus impairing physical and Support affectedmotion, move freely,maintain position of function range of body parts or joints - Tomobility. decrease Nursing Goal: using pillows or rolls, foot supports, 3-4 days of rendering and reduce reluctance to attempt After intervention,risk of pressure ulcers movements. the patient will be or shoes, air mattress appropriate nursing and water bed able to increase strength and function of affected Encourage to have enoughpart as will be manifested by unlimited range of body rest during - To reduce fatigue motion, move freely, and decrease reluctance to the day attempt movements. Instruct patient in use of side rails, - For position changes overhead trapeze and roller pads

Nursing Responsibilities Rationale Administer analgesics as prescribed To relieve pain Nursing Diagnosis: Chronic pain related to reduce Instruct and assist the patient in To distract attention and nerve compression tension, thus relieving the pain felt using relaxation techniques such asas manifested by guarding behaviour, grimacing and hours of focused breathing and imaging. face by the patient. scale of 8/10. Nursing Evaluation: After 3with a pain Nursing Inference: Due to the enlargement of the Provide rendering nursing intervention, the client was comfort measures such as This allows the promotion of affected part it causes compression of the nerve touch, able to demonstrate use of relaxation repositioning, nurses relaxation, thus relieving pain. endings thus activating the nocireceptors and due presence, quiet environment and techniques and diversional activities as will be to inflammatory process it releases pain chemicals calm activities. prostaglandin and bradykinin thus pain. manifested by of prevent fatigue that Encourage adequate rest absence To guarding behaviour, could Nursing Goal: After 2-3 a pain rendering nursing aggravate the pain felt by absence of grimacing face and hours of scale the patient intervention, the client will pain felt Encourage verbalization of feelings To assess the level of be ableby to the will subside demonstrate use of relaxation techniques and to 5/10. about the pain. patient so that immediate and diversional activities as will be manifested by appropriate nursing interventions absence of guarding behaviour, absence of can be done grimacing face and a pain scale will or fear. Review procedure/expectation and To reduce level of anxietysubside to 5/10. tell patient when treatment may

Nursing Care Plan

cause pain.

Nursing interventions

Evaluate level of patients knowledge of To be able to anticipate the proper words to Nursing evaluation use for explanation BODY IMAGE the and anxiety related to situation. Observe Nursing Diagnosis DISTURBED and able to address emotional changes. After 14 After lossrendering nursing related to 7-14 adays part as evidenced of body of rendering Nursing Goal days ofdifferent emotions of the patient. by Discuss meaning of loss/change to patient. missing loss maywill preoccupation the presence of A small body have a deep impact nursing interventions, the patient part, to able interventions, the patient was able be have to patient. loss, not looking with the changecourage to face at the togrieving/indicators of severe In order to evaluate need for the have knowledge and or face the losscounseling or and courage to Note signsknowledge loss body part, unable to socialize to other of loss and or prolonged depression able to be prepared in in the longmedications. and was able to be prepared the long-term patient. Listen to patients comments Nursing Inference: Disturbed are upsetting Different situations will be acceptance and responses situation as body image is of the the situation as term acceptance of depending to the individuals coping skills regards to the situation evidenced experienced acquisition of wider the by the by the patient because of evidenced by acquisition ofpreoccupation ofwhich and past wider loss of a limb less experiences. knowledge, there will beparticularly at the femur Establish therapeutic nurse-patient To able to provide a more of knowledge,commonly lookbepreoccupation open of there is less the amputatedgrowth affected by the area relationshipthe loss an attitude of caring conversation about the situation conveying and able to carcinogenic tumor. The thealoss of trustwas to other look theloss of the limb and sense and talk able to patients and others a able to and developing causes fear, preoccupation of the loss.. Encourageamputated area and less stigma patient and the significant stigma. To alleviate the feelings commonly stigma without fear in the others to communicate feelings to each of the client towards the SO and other experienced. other people. Encourage verbalization of and role play To enhance handling of potential situations. anticipated conflicts

Nursing Care Plan

Rationale

Thank you for listening

Demandante, Gaoiran, Gonzales, Ibuos