NARRATIVE PATHOPHYSIOLOGY Osteosarcoma occurs mainly in the metaphysic of the long bones.

Most tumors arise in bones involved with the knee joint at the distal end of the femur or proximal distal end of the tibia. As a tumor of the mesenchymal cells, osteosarcoma demonstrates production of osteiod tissue. The tumor borders are distinct and merge into adjacent normal bone. The etiology is unknown. redisposing factors include, Age! "#$!%&', (ender!"male',)amily history, Teenage growth spurt, Tall for age, revious treatment with radiation, *enign +non! cancerous bone tumor, ,ack of exercise, -moking and drinking ,./A mutation, )amilial susceptibility, 0njury and Metabolic1hormonal disturbance. Once there is mutation of tha ./A,it activates the oncogene which leads to a deactivation of the suppressor gene which causes a malignant osteoblast that leads to proliferation of abnormal osteoblasts. This causes formation of osteiod tissue. The osteiod tissue causes uncontrolled growth of the tumor in the bone and therefore overcrowding of the bone. There is then suppression of red bone marrow which leads to decreased production of blood cells. a decrease in 2*3 leads to anemia while a decrease in 4*3 leads to a lowered infection resistance. The overcrowding also causes pressure inside the bone which is a main cause of pain and fractures. The cancer then metastasi5es spreading to other parts of the body especially the lungs,kidneys, 3/-, liver and the spleen.

AT6O 7-0O,O(7 O) O-T8O-A23OMA Predisposing factors Age! "#$!%&' (ender!"male' )amily history Teenage growth spurt Tall for age revious treatment with radiation *enign +non!cancerous bone tumor ,ack of exercise -moking and drinking ./A mutation )amilial susceptibility 0njury Metabolic1hormonal disturbance Etiology Unknown Osteoblast

Mutations in DNA

Activate Oncogene

Deactivation of tumor suppressor gene

Malignant osteoblast

roliferation of abnormal osteoblast

)ormation of osteiod tissue

Uncontrolled growth of tumor in bone Overcrowding of the bone

%upression of red bone marrow

Cancer cells metastasize spread to other parts Organ infiltration

Increased pressure inside bone $ractures

#pain #swelling

Decreased production of blood

Decreased !C
Anemia

Decreases "!C

Decreased platelets

'owered infection resistance

#anero&ia #fatigue #%O! #diziness

kidne(s

CN%

'iver)spleen

lungs

Disturbances in renal filtration +idne( failure

'eucoc(te cells impair circulation of C%$ 'eukoc(te cells compress spinal)cranial nerves -rogress to coma

Invasion and overcrowding of the liver)spleen .epatomegal()spleenome gal( *&tra cells cause liver)spleen to rapture bleeding #d(sphagia

Overcrowding of cancer cells in lungs

!ronchial )tracheal obstruction

# 'ittle or no UO #Increased #$lank pain #edema

%evere h(po&ia

#"eakness #!lurred vision #!alance difficult( #,omiting #letharg(

.(povolemic shock #h(potension #tach(pnea #tach(cardia

#Cough #wheeze #%O! #chest pain # hoarseness #

CONCLUSION 0n most cases, by the time osteosarcoma is discovered and diagnosed in a patient, it has already metastasi5ed and most commonly into the lungs. atients are either terminal or are waiting to be amputated. we should do our best As nursing students by doing some of the following9 provide :uiet environment and calm activities to prevent or lessen pain, rovide comfort measure such as back rub, change position and use of heat or cold application, 8ncourage diversional activities, Administer analgesics as indicated to maximal dose as needed, 8ncourage the patient to increase fluid intake, 8ncourage rest periods to prevent fatigue, rovide accurate information about the situation, medication and treatment, Assess muscle strength, gross and fine motor coordination, rovide pillows for cushion and support. This study gives us information and knowledge about the Osteosarcoma and way on how to deal with these kinds of patients. roper management and treatment and specially ensuring that the patient is kept comfortable and that he receives support and understanding.