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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. Predisposing factors include, Age- (10-25), Gender-

(male),Family history, Teenage growth spurt, Tall for age, Previous treatment with

radiation, Benign &non-cancerous bone tumor, Lack of exercise, Smoking and

drinking ,DNA mutation, Familial susceptibility, Injury and Metabolic/hormonal

disturbance.
Once there is mutation of tha DNA,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 RBC leads to anemia while a

decrease in WBC 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 metastasizes spreading to other parts of the body especially the

lungs,kidneys, CNS, liver and the spleen.


PATHOPYSIOLOGY OF OSTEOSARCOMA

Predisposing factors Etiology


Unknown
 Age- (19)
 Gender-(male)
 Family history Osteoblast
 Teenage growth spurt
 Tall for age
 Previous treatment with radiation Mutations in DNA
 Benign &non-cancerous bone tumor
 Lack of exercise
 Smoking and drinking Activate Oncogene
 DNA mutation
 Familial susceptibility
 Injury
Deactivation of tumor
 Metabolic/hormonal disturbance
suppressor gene

Malignant osteoblast

Proliferation of abnormal osteoblast

Formation of osteiod tissue


Uncontrolled growth of tumor in
bone

Overcrowding of the bone

Increased pressure
inside bone

Decrease bone mass

Sudden injury, Pathologic fracture

Break in the continuity of the bone

Disruption of surrounding tissues, periosteum,


blood vessel and nerve supply
Damaged bone tissue Damaged muscle

Intense Spasm
inflammatory
response

Initial Limitation of ROM, immobility


vasoconstriction and reduction of ADLs

Bleeding occur from the damaged bone and


Bleeding neighboring tissue
vasodilation Vascular
permeability

hyperemia Hematoma forms at site


Filtration
pressure
Outpouring of plasma
Release of cytokines

Redness Heat (calor) Swelling

Fibroblast will proliferate

pressure/irritation
Pain
of nerve endings
angiogenesis

Administer
analgesics
CONCLUSION

In most cases, by the time osteosarcoma is discovered and diagnosed in a patient, it

has already metastasized and most commonly into the lungs. Patients are either

terminal or are waiting to be amputated. we should do our best As nursing students by

doing some of the following: provide quiet environment and calm activities to prevent or

lessen pain, Provide comfort measure such as back rub, change position and use of

heat or cold application, Encourage diversional activities, Administer analgesics as

indicated to maximal dose as needed, Encourage the patient to increase fluid intake,

Encourage rest periods to prevent fatigue, Provide accurate information about the

situation, medication and treatment, Assess muscle strength, gross and fine motor

coordination, Provide 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. Proper management and treatment and

specially ensuring that the patient is kept comfortable and that he receives support and

understanding.