OSTEOSARCOMA

General Objective:
The purpose of this study is to
analyze and improve understanding
of the disease, to develop necessary
nursing skills and to apply the
appropriate nursing care while
maintaining confidentiality of patient
having Osteosarcoma.

General Objective:
The purpose of this study is to analyze
and improve understanding of the
disease, to develop necessary nursing
skills and to apply the appropriate
nursing care while maintaining
confidentiality of patient having
Osteosarcoma.
Most osteosarcomas occur in children
and young adults. Teens are the most
commonly affected age group, but
osteosarcoma can occur at any age.

In children and young adults, osteosarcoma

usually develops in areas where the bone is
growing quickly, such as near the ends of the
long bones. Most tumors develop in the bones
around the knee, either in the distal femur (the
lower part of the thigh bone) or the proximal
tibia (the upper part of the shinbone). The
proximal humerus (the part of the upper arm
bone close to the shoulder) is the next most
common site. However, osteosarcoma can
develop in any bone, including the bones of the
pelvis (hips), shoulder, and jaw.

This is especially true in older adults,

The cancer starts
growing within a bone and forms an expanding, balllike mass. The tumor eventually breaks through the surface of
the bAone and begins to invade adjoining structures such as
muscles. If untreated, the disease usually appears elsewhere
in the same limb and metastasizes to distant parts of the
body, such as the
lungs.Itis the eighth most common form of childhood cancer,
comprising 2.4% of all malignancies in pediatric patients, and
approximately 20% of all bone cancers. Incidence rates for
osteosarcoma in U.S.

Patients under 20 years of age are estimated

at 5.0 per million per year in the
general population, with a
slight variation between individuals of black,
Hispanic, and white ethnicity. It is slightly
more common in males (5.4 per million per
year) than in females (4.0 per million per
year).

Subtypes of osteosarcoma
Several subtypes of osteosarcoma can be
identified by how they look on x-rays and
under the microscope. Some of these
subtypes have a better prognosis (outlook)
than others.
Based on how they look under the
microscope, osteosarcomas can be classified
as high grade, intermediate grade, or low
grade. The grade of the tumor tells doctors
how likely it is that the cancer will grow and
spread to other parts of the body.

High-grade osteosarcomas:
These are the fastest growing types of
osteosarcoma. When seen under a
microscope, they do not look like normal
bone and have many cells in the process of
dividing into new cells. Most
osteosarcomas that occur in children and
teens are high grade. There are many
types of high-grade osteosarcomas
(although the first 3 are the most
common).

Osteoblastic- a bone-forming cell

Chondroblastic- a subtype of central
medullary, whichcharacterised by
rapid growth.
Fibroblastic a cell from which connective
tissue develops
Extra-skeletal-a tumor that starts in a part
of the body other than a bone
Post-radiation: a tumor that starts in a
bone that had once received radiation
therapy

Intermediate-grade osteosarcomas: These

uncommon tumors fall in between highgrade and low-grade osteosarcomas. (They
are usually treated as if they are low-grade
osteosarcomas.)
Periosteal (juxtacortical intermediate grade)
Low-grade osteosarcomas: These are the
slowest growing osteosarcomas. The tumors
look more like normal bone and have few
dividing cells when seen under a microscope.

Parosteal (juxtacortical low grade)

Intramedullary or intraosseous well differentiated (low-grade central)
The grade of the tumor plays a role in determining its stage and the type of
treatment used.

Causes
-Unknown
-DNA mutation either inherited or acquired after birth
-familial susceptibility
-injury
-infection
-metabolic or hormonal disturbance
Risk Factors (Children)
-Genetics
-family history of certain types of cancer
-exposure to radiation

(Adults)
high fat diet
lack of exercise
smoking
drinking alcohol
Clinical Manifestation
-pain (sharp or dull) at the site of the tumor
- increased pain with activity or lifting
-limited motion/decreased movement of affected limb
-weight loss
-the bony mass may be palpable, tender and fixed with an
increased in skin -temperature over the mass and venous
distention.
-shiny and stretched skin with prominent superficial veins
-muscular weakness
-malaise, Anorexsia, fever

Rotation-plasty Surgery: In this technique, after the

removal of the portion of the limb, the limb is rotated and
reattached along with a prosthetic device. E.g. For tumors
involving the leg, the part of the leg below the knee is
removed and reattached so that the ankle becomes the
new knee. This is also a type of limb sparing surgery,
however, it is used less frequently.
Amputation Surgery: The limb is removed and supported
by a prosthetic limb. This procedure is used less frequently
andonly
in
extreme
cases
Occasionally,thepatientmayrequirepost
operative chemotherapyorradiation therapy when the
surgeon doubts the possibility of some cancerous cells
being left behind

Diagnostic Test
Multiple imaging studies of the tumor and sites of possible metastasis, such as:
X-rays
A diagnostic test that uses invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto film
Bone scans
A nuclear imaging method to evaluate any degenerative and/orarthritic 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)
Adiagnostic procedure that uses acombinatio
nof large magnets, radiofrequencies, and a computer to produce detailed images
of organs and structures within the body. This test is done to rule out any
associated abnormalities of the spinal cord and nerves.

 Computed Tomography scan (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
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.
Complete Blood Count (CBC)
A measurement of size, number, and maturity of different blood cells in a specific
volume of blood.
Treatment
Treatment usually starts after a biopsy of the tumor.
Before major surgery to remove the tumor, chemotherapy is usually given.
Chemotherapy is also used to kill or shrink any cancer cells that may have spread to
other parts of the body.

Management of Osteosarcoma:
Treatment of osteosarcoma begins after a biopsy of the tumor cells. Prior
to undertaking a major surgery, the patient is subjected to a series of
chemotherapy drugs, with the principle objective of reducing the size and
spread of the tumor cells.
The commonly used chemotherapy drugs include Cisplatin, Carboplatin,
Cyclophosphamide, Doxorubicin and Ifosfamide. The therapy is given
intravenously for about 6-10 weeks prior to the surgery.
Surgical intervention for the management of osteosarcoma includes the
following basic procedures,
Limb-sparing Surgery:
This surgery involves replacing the bone which is resected, by either an
endo-prosthesis (i.e. a metal rod is placed inside the body with muscle,
nerves and skin covering it) or a graft, to maintain as much functionality of
the limb as possible. 70% to 90% of ostesarcomas are treated using this
method. The use of this method however depends upon the size, location
and responsiveness of the tumor to chemotherapy.

Common chemotherapy medicines include:

Cisplatin
Carboplatin (Paraplatin)
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
High-dose methotrexate with leucovorin
Ifosfamide (Ifex)
Surgery is used after chemotherapy to remove any remaining tumor. In
most cases, surgery can remove the tumor while saving the affected limb
(this is called limb-salvage surgery). Rarely, more radical surgery (such as
amputation) may be necessary.
resections Partial excision of a bone or other structure
bone graft -A piece of bone taken from the patient that is used to take the
place of remove bone or a bony defect at another site
rehabilitation Including physical and occupational therapy and
psychosocial adapting

Nursing Responsibilities
Monitors vital signs
Provides comfort measure such as; back rub, change
position and use of heat or cold application and
emotional support.
Provides health teaching about proper nutrition
Encourages rest periods to prevent fatigue.
Provides accurate information about the situation,
medication and treatment.
Assesses muscle strength, gross and fine motor
coordination.
Provides pillows for cushion and support.
Keeps side rails up all the time
Collaboration with other health Care team regarding the
procedures to be done.
Administering medication as ordered by the Physician
Giving health teaching postoperatively.

An osteosarcoma arises from osteoblasts (bone-forming cells) and

osteoclasts (bone-digesting cells) in the interior of the bone; it
occurs most commonly in the femur but also in the tibia and
humerus. Evidence links the development of bone cancer with
exposure to therapeutic radiation. A higher incidence has not
occurred, however, in populations exposed to other radiation, such
as survivors of the atomic bomb. There have been reports of siblings
with bone cancer, suggesting genetic influences.
Osteogenic sarcoma is most common after puberty, which suggests
that hormonal fluctuations and spurts of growth may be
involved. The development of bone cancer has also been linked to
trauma and sites of old bone infarcts or fractures, multiple exostoses
(overgrowth of bone tissue), multiple osteochondromas
(benign bone tumor), and bone marrow transplantation.

Ac
Clinical photograph of a large mass of the distal femur

Radiographic Features (AP and Lateral X-Rays

of the mass)