Anatomy of the Bone What is bone? Bone is living tissue that makes up the body's skeleton.

There are three types of bone tissue, including the following:
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compact tissue-the harder, outer tissue of bones. cancellous tissue-the sponge-like tissue inside bones. subchondral tissue-the smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and the tissue from which most bones develop in children.

Click Image to Enlarge Together, compact and cancellous tissues are called the periosteum. Beneath the hard outer shell of the periosteum there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone. Muscles, ligaments, and tendons may attach to the periosteum. Bones are classified by their shape - as long, short, flat, and irregular. Primarily, they are referred to as long or short. There are 206 bones in the human skeleton, not including teeth and sesamoid bones (small bones found within cartilage):
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80 axial bones which include the head, facial, hyoid, auditory, trunk, ribs, and sternum. 126 appendicular bones which include arms, shoulders, wrists, hands, legs, hips, ankles, and feet

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Click Image to Enlarge What are the functions of bone?

Bone provides shape and support for the body, as well as protection for some organs. Bone also serves as a storage site for minerals and provides the medium - marrow - for the development and storage of blood cells. What are the different types of bone cells? The different types of bone cells include the following:
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osteoblast-found within the bone, its function is to form the tissue and minerals that give bone its strength. osteoclast-a very large cell formed in bone marrow, its function is to absorb and remove unwanted tissue. osteocyte-found within the bone, its function is to help maintain bone as living tissue.

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Fat cells and hematopoietic cells are found within the bone marrow. Hematopoietic cells are those that produce blood cells. Because of the complexities of a bone's function, from providing strength and support for the body, to serving as a site for development and storage of blood cells, there are many disorders and diseases that can affect bone Osteosarcoma What is osteosarcoma? Osteosarcoma is a type of bone cancer that develops in the osteoblast cells that form the outer covering of bone. It occurs most often in children, adolescents, and young adults. Approximately 900 new cases of osteosarcoma are reported each year in the US. It occurs slightly more often in males than in females, and represents more than one-third of all bone tumors. Osteosarcoma most commonly occurs in the long bones around the knee. Other sites for osteosarcoma include the upper leg, or thighbone, the lower leg, upper arm bone, or any bone in the body, including those in the pelvis, shoulder, and skull. Osteosarcoma may metastasize, or spread, into nearby tissues of the foot, or into tendons or muscles. It may also metastasize through the bloodstream to other organs or bones in the body. What causes osteosarcoma? The exact cause of osteosarcoma is not known, but it is believed to be due to DNA mutations - either inherited or acquired after birth. Other theories and associations have been suggested as risk factors. What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors. Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop the disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease. What are the risk factors for osteosarcoma? Suggested risk factors for osteosarcoma include the following:
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teenage growth spurts being tall for a specific age previous treatment with radiation for another cancer, especially at a young age or with high doses of radiation presence of certain benign (non-cancerous) bone diseases presence of certain rare, inherited cancers, such as the following:
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Li-Fraumeni syndrome - a rare family predisposition to multiple types of cancers (such as soft tissue sarcomas, breast cancer, brain tumors, osteosarcoma, leukemia, melanoma, cancer of the adrenal cortex, and others) caused by a mutation in a gene - the p53 tumor-suppressor gene - that normally curbs cancer. retinoblastoma - a malignant tumor of the retina that usually occurs in children younger than 4 years old.

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What are the symptoms of osteosarcoma? The following are the most common symptoms for osteosarcoma. However, each individual may experience symptoms differently. Symptoms may include:
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pain in the affected bone swelling around the affected site increased pain with activity or lifting limping decreased movement of the affected limb

The symptoms of osteosarcoma may resemble other medical conditions problems, such as Ewing sarcoma, or medical conditions. Always consult your physician for a diagnosis. How is osteosarcoma diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for osteosarcoma may include the following:
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multiple imaging studies of the tumor and sites of possible metastasis, such as:
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x-ray-a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. radionuclide bone scans-a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures. magnetic resonance imaging (MRI)-a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to look for any nearby spread of tumors. computed tomography scan (Also called a CT or CAT scan.)-a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce crosssectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. positron emission tomography (PET) scan-radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.

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complete blood count (CBC)-a measurement of size, number, and maturity of different blood cells in a specific volume of blood. blood tests(including blood chemistries) biopsy of the tumor-a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present; to remove tissue from the affected bone.

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Treatment for osteosarcoma: Specific treatment for osteosarcoma will be determined by your physician based on:

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your age, overall health, and medical history extent of the disease your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference

Treatment may include:
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surgery (i.e., biopsy, resections, bone/skin grafts, limb salvage procedures, reconstructions) amputation chemotherapy radiation therapy resections of metastases (spreading of the tumor to other locations) rehabilitation including physical and occupational therapy, and psychosocial adapting prosthesis fitting and training supportive care (for the side effects of treatment) antibiotics (to prevent and treat infections) continued follow-up care (to determine response to treatment, detect recurrent disease, and manage the side effects of treatment)

Long-term outlook for an individual with osteosarcoma: Prognosis for osteosarcoma greatly depends on:
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the extent of the disease. the size and location of the tumor. presence or absence of metastasis. thetumor's response to therapy. your age and overall health. your tolerance of specific medications, procedures, or therapies. new developments in treatment.

A person who was treated for bone cancer as a child or adolescent may develop effects months or years after treatment ends. These effects are called late effects. The kind of late effects one develops depends on the location of the tumor and the way it was treated. Some types of treatment may later affect fertility. If this side effect is permanent, it will cause infertility, or the inability to have children. Both men and women can be affected. As with any cancer, prognosis and long-term survival can vary greatly from person to person. Every individual is unique and treatment and prognosis is structured around your needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a person diagnosed with osteogenic sarcoma. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of osteogenic sarcoma. New methods are continually being discovered to improve treatment and to decrease side effects. Diagnostic Procedures for Bone Disorders How are bone disorders diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for bone disorders may include the following:
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laboratory tests for blood, urine, and other body fluids x-ray-a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. computed tomography scan (Also called a CT or CAT scan.)-a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. A CT scan provides information about bone, muscle, and fat. It is also used to assist the physician in locating the exact area for a biopsy. magnetic resonance imaging (MRI)-a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI scans provide detailed information about soft tissue, the bone marrow cavity, and bone tumors. bone densitometry-a noninvasive, evaluation procedure that uses x-rays to measure bone mass, or the weight of the skeleton. The amount of bone in the skeleton determines how strong it is. Bone densitometry is often used to measure bone mass in the spine, hips, and arms, as these are the areas most likely to fracture when bone mass is low. Bone densitometry is not used to provide a diagnosis, but is used in combination with other procedures, along with personal and family medical history, to provide information toward or to support a diagnosis.

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radionuclide bone scan-Technetium-99, a radioactive material, is used in a radionuclide bone scan. The tumor absorbs the material and a special camera is used to produce an image using a computer. The bone scan is used to pinpoint the location of the bone tumor, as well as to detect the spread into other organs. biopsy-a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present. There are two types of biopsy, including the following:
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needle biopsy-a small needle is inserted into the abnormal area in almost any part of the body, guided by imaging techniques, to obtain a tissue biopsy. This type of biopsy can provide a diagnosis without surgical intervention. open biopsy-a surgical procedure in which an incision is made through the skin to expose the tumor and allow a sample of tissue to be cut or scraped away.

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