OSTEOSARCOMA

By Rochelle Joy T. Ramos

DEFINITION
-bone cancer which mainly affects osteoblasts or bone-building cells.
-a malignant neoplasm arising from bone cells which are undifferentiated and capable of forming bone cartilage, and
collagenous tissue. It is commonly occurring primary tumor of the bone.
-highly aggressive disease that metastasizes or spread to distant sites.
-occurs mostly in teenagers (75%), ages 5-30 yrs. old (10-20 most common)
-common sites are the metaphyses of long bones

CAUSES/ETIOLOGY
The exact causes are unknown, but it is believed to be due to the DNA mutations.

CLASSIFICATIONS/TYPES
A. Classic Osteosarcoma
B. Hemorrhagic or Telangiectatic Osteosarcoma
C. Parosteal Osteosarcoma
D. Periosteal Osteosarcoma
E. Secondary Osteosarcoma
F. Low-Grade Intramedullary Osteosarcoma
G. Irradiation-Induced Osteosarcoma
H. Multicentric Osteosarcoma
I. Soft-Tissue Osteosarcoma

Stages
The higher the stage number, the more serious (advanced) the cancer is.
A. Stage IA - The cancer is found only in the bone, is smaller than 8 cm, and is low grade (T1, N0, M0, G1-G2).
B. Stage IB - The cancer is found only in the bone, is larger than 8 cm, and is low grade (T2, N0, M0, G1-G2).
C. Stage IIA - The cancer is found only in the bone, is smaller than 8 cm, and is high grade (T1, N0, M0, G3-G4).
D. Stage IIB - The cancer is found only in the bone, is larger than 8 cm, and is high grade (T2, N0, M0, G3-G4).
E. Stage III - The cancer is found only in the bone but has spread to other places on the bone (T3, N0, M0, any G).
F. Stage IVA - The cancer has spread to the lung (any T, N0, M1a, any G).
G. Stage IVB - The cancer has spread to lymph nodes and other parts of the body, or the cancer has spread to distant
parts of the body other than the lung (Any T, N1, any M; or any T, any N, M1b, any G).
H. Recurrent - The cancer has come back (recurred) in the original bone or another part of the body after it has been
treated.

CLINICAL MANIFESTATIONS RISK FACTORS

Localized Pain A. Age and Height
Swelling or stiffness B. Radiation therapy
Debilitated and feverish C. Presence of a benign bone disease
Decreased range of motion D. Presence of inherited cancers
Lump E. Lifestyle factors
Fracture

PATHOPHYSIOLOGY
Osteosarcoma is a malignant tumor of mesenchymal cells, characterized by direct formation of osteoid or immature bone by
malignant osteoblasts. These cells synthesize thin, wispy, and purposeless fragments of bones. Osteosarcomas grow rapidly,
it moves from metaphysic of the bone out to the periosteum, and later spread to nearby soft tissues.
The primary clinical feature is localized pain and swelling in the affected bone and usually of sudden onset. The skin
overlying the tumor may be warm, shiny, stretched, and with prominent superficial veins. Osteosarcoma usually begins as a
firm white or reddish mass and later becomes softer with a viscous interior. The tumor commonly metastasizes to the lungs
because most often, the tumor cells exit the primary tumor through the venous end of the capillary.
The prognosis of this disease depends on the aggressiveness of the disease, size of the tumor, fast growth of tumor,
radiologic features, presence of pathologic fracture, and sex of the person.
COMPLICATIONS
A. Lung metastases
B. Pathological Fracture
C. Side Effects from chemotherapy
D. Side Effects from radiation therapy
E. Amputation

DIAGNOSTIC TESTS
Medical history and physical examination

Laboratory results:
Alkaline phosphatase
Erythrocyte sedimentation rate
Lactate dehydrogenase (LDH)

Imaging Procedures:
Bone x-ray
Chest x-ray
CT scan
MRI
PET
Radionuclide bone scan
Needle biopsy
Open Biopsy

NURSING MANAGEMENT
#1 Acute Pain related to pathologic process and surgery
Goal: After nursing intervention, the patient will report pain is controlled or relieved, and demonstrate use of relaxation and
diversional activities to provide relief.
Nursing Interventions:
1. Encourage verbalization of feelings about the pain. (to assess level of pain)
2. Provide comfort measures such as touch, repositioning, nurse’s presence, quiet environment and calm activities (to
promote nonpharmacologic pain management)
3. Instruct and assist in use of relaxation techniques such as focused breathing and imaging. (to distract attention and
reduce tension)
4. Encourage diversional activities such as TV/radio, reading, or talking to the client. (to distract attention and reduce
tension)

5. Review procedure/expectation and tell client when treatment may cause pain. (to reduce level of anxiety or fear)
6. Suggest family support system during procedures. (to comfort client)
7. Encourage adequate rest. (to prevent fatigue)

#2 Risk for Injury: pathologic fracture related to tumor

Goal: After nursing intervention, the client will be free from injury
Nursing Interventions:
1. Perform thorough assessment regarding safety issues when planning for client care. (Failure to accurately assess
and intervene or refer these issues can place the client at needless risk and creates negligence issues for HP)
2. Assess client’s muscle strength, gross and fine motor coordination. (to identify risk for falls)
3. Maintain bed/chair in lowest position with wheels lock. (to promote individual safety)
4. Place assistive device such as walker, cane, hearing aid pr materials within reach. (to promote safe physical
environment)
5. Instruct client to request assistance as needed. (to promote safety)
6. Ensure that pathway to bathroom is unobstructed and properly lighted. (to promote safe physical environment)

#3 Deficient Knowledge: Bone Tumor related to the disease process and therapeutic regimen
Goal: After nursing intervention, the client will verbalize understanding of condition/disease process and treatment.
Nursing Interventions:
 1. Determine client’s ability/readiness and barriers to learning. (individual may not be physically, emotionally, or
mentally capable at this time. To assess readiness to learn and individual learning needs)
2. Provide an environment that is conducive to learning. (to facilitate learning)
3. Begin with information the client already knows and move to what the client does not know, progressing from
simple to complex. (to arouse interest/limit sense of being overwhelmed)
4. Use short and simple sentences. Repeat and summarize as needed. (to facilitate learning)
5. Discuss one topic at a time; avoid giving too much information in one session. (for better understanding)
6. Deal with the client’s anxiety/other strong emotions. Present information out of sequence, if necessary, dealing first
with material that is most anxiety-producing. (anxiety might interfere with the client’s ability to learn)
7. Provide written information/guidelines for client to refer as necessary. (reinforces learning process, allows client to
proceed at own pace)

#4 Ineffective coping related to fear of the unknown, perception of disease process, and inadequate support system
Goal: After nursing intervention, the client will verbalize effective patterns of coping
Nursing Interventions:
1. Determine sleeping and eating patterns. (these mechanism are often used when individual is not coping effectively
with stressors)
2. Determine previous methods of dealing with life problems. (to identify successful techniques that can be used in
current situation)
3. Explain disease process/procedures/events in a simple, concise manner. Devote time for listening. (May help client
to express emotions, grasp situation and feel more in control)
4. Provide for quiet environment. (anxiety is increased by noisy surroundings)
5. Schedule activities so period of rest alternate with nursing care. Increase activity slowly. (for easy adaptation)
6. Encourage verbalizations of fears and anxieties, and expressions of feelings of denial, depression and anger. Let the
client know that these are normal reactions. (enhances therapeutic relationship)
7. Give updated/additional information needed about events, cause and potential course of illness as soon as possible.
(Knowledge helps reduce anxiety/fear, allows client to deal with reality)

#5 Fatigue related to altered body chemistry

Goal: After nursing intervention, the client will perform ADLs and participate in desired activities at level of ability.
Nursing Interventions:
1. Assess vital signs every four hours. (to evaluate fluid status and cardiopulomonary response to activity)
2. Determine degree of sleep disturbances. (fatigue can be a consequence of, and/or exacerbated by sleep deprivation)
3. Plan interventions to allow individually adequate rest periods. Schedule activities for periods when client has the
most energy. (to maximize participation)
4. Instruct in methods to conserve energy: sit instead of stand during daily care; combine and simplify activities; take
frequent short breaks during activities, delegate tasks; plan steps of activity before beginning so that all needed
materials are at hand. (to maximize participation and decrease use of energy)
5. Provide diversional activities. Avoid overstimulation/understimulation. (participating in pleasurable activities can
refocus energy and diminish feelings of unhappiness, sluggishness, and worthlessness that can accompany fatigue)
6. Encourage nutritionally dense, easy to prepare/consume foods and to avoid caffeine and high sugar foods/drinks.
(to promote energy)

MEDICAL MANAGEMENT
Drugs: high dose methotrexate, doxorubicin, cisplatin, etoposide and ifosphamide.

SURGICAL MANAGEMENT
Chemotherapy
Radiation therapy
Limb salvage surgery
Reconstructive surgery:
Autogenous bone grafts
Structural bone allografts
Metallic endoprosthetics
Lung Metastases Removal
Amputation