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

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

Risk factors • Race/ethnicity – Osteosarcoma is slightly more common in African Americans than in whites. . – Affected bones are heavy and thick but are weaker than normal bones and are more likely to break. • 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.

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

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

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.Incidence • Osteosarcoma is uncommon but an average of 8. .

*Multifocal 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.tumor appear in 2 or more bones.Types of Osteosarcoma • Localized Osteosarcoma . • Recurrent Osteosarcoma.osteosarcoma which recurs after osteosarcoma has been cured which usually develops in other parts of the body.

prognosis depends on the site of the tumor. tolerance to specific medications and new developments of treatment. degree of necrosis of the primary tumor and number of metastasis prognosis in this stage is 30% . presence or absence of metastases.With the presence of lung metastasis prognosis depends on the respectability of the primary tumor and lung. size of the tumor and degree of necrosis from neoadjuvant therapy. the size and location of the tumor.Prognosis: Depends on the extent of disease. It is divided into three groups: – Stage 1/Low grade.osteosarcoma is rare and includes periosteal sarcoma. tumor’s response to therapy. age and overall health. 40-50% has a good prognosis in these stage – Stage III/Metastatic tumors. Has excellent prognosis >90% with wide resection – Stage II/High grade localized tumors. If metastases is present the longer time to metastasis has better prognosis and even better if fewer metastases. localized tumors.

Pathophysiology .

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

• 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. Radionuclide bone scan are ordered to check the extent of metastasis. the doctor will order a CT scan particularly chest. . 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). • If a diagnosis of osteosarcoma is made. This is also used to determine the histologic features and cell type of the tumor.Management continuation… • Magnetic resonance imaging (MRI) scan on the affected area also ordered.

. 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.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. Preoperative chemotherapy induces tumor necrosis in the primary tumor and provides early treatment of micro metastatic disease.

Studies have shown that limb salvage surgery has no adverse effects on the long-term survival of persons with osteosarcoma. – In limb-salvage surgery. Limb salvage surgical procedures. 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.Treatment • Surgical management continuation… – In the past. . the bone and muscle affected by the osteosarcoma are removed. using a metal prosthesis or cadaver allograft. are becoming a standard alternative. treatment usually entailed amputation above the level of the tumor. 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. – Rotationplasty. – Prosthetic implant. rotation plasty or implanting artificial (prosthetic) joints. – Autograft (bone graft from own tissue of the patient). . – Allograft (bone graft from donor tissue).

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

To reduce fatigue motion. 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 .Impaired physical mobility related when Diagnosis: To note incongruencies with to pain as evidenced by limited range of motion. foot supports.For position changes overhead trapeze and roller pads . and decrease reluctance to the day attempt movements. 3-4 days of rendering and reduce reluctance to attempt After intervention.To and function being and intake promote well of flexibility causing limitation of movement.Tomobility. move freely. to . move freely. the patient will be or shoes.Nursing Interventions Nursing Care Rationale Plan Observe movement Nursing client is . . parts especially was able to affectedof strengththe limbs it affects the joints Encourage adequate increasefluids . 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. the patient nursing perform mobility related task. Instruct patient in use of side rails.Inference: due to the presence of tumor on function.risk of pressure ulcers movements. unaware of observation reports of abilities slowed movements and reluctance to attempt Nursing withmovements.To promote optimal level of Provide patientEvaluation: After 4 days of rendering ample time appropriate Nursing intervention. decrease Nursing Goal: using pillows or rolls.maintain position of function range of body parts or joints .

manifested by of prevent fatigue that Encourage adequate rest absence To guarding behaviour. patient so that immediate and diversional activities as will be manifested by appropriate nursing interventions absence of guarding behaviour. thus relieving pain. grimacing and hours of focused breathing and imaging. scale of 8/10. absence of can be done grimacing face and a pain scale will or fear. quiet environment and techniques and diversional activities as will be to inflammatory process it releases pain chemicals calm activities. nurse’s relaxation. face by the patient. endings thus activating the nocireceptors and due presence. . able to demonstrate use of relaxation repositioning. 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.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. 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. Review procedure/expectation and To reduce level of anxietysubside to 5/10. prostaglandin and bradykinin thus pain. 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. tell patient when treatment may Nursing Care Plan cause pain. about the pain. thus relieving the pain felt using relaxation techniques such asas manifested by guarding behaviour.

anticipated conflicts Nursing Care Plan Rationale . 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. other people. by Discuss meaning of loss/change to patient. 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. knowledge. Encourage verbalization of and role play To enhance handling of potential situations. there will beparticularly at the femur Establish therapeutic nurse-patient To able to provide a more of knowledge. loss. Encourageamputated area and less stigma patient and the significant stigma. to able interventions. and was able to be prepared the long-term patient. preoccupation of the loss.. 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. 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. Listen to patient’s 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 individual’s 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. the patient part. missing loss maywill preoccupation the presence of A small body have a deep impact nursing interventions. the patient was able be have to patient.Nursing interventions Evaluate level of patient’s knowledge of To be able to anticipate the proper words to Nursing evaluation use for explanation BODY IMAGE the and anxiety related to situation. unable to socialize to other of loss and or prolonged depression able to be prepared in in the longmedications.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. Observe • Nursing Diagnosis DISTURBED and able to address emotional changes.

Thank you for listening  Demandante. Ibuos . Gonzales. Gaoiran.

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