OSTEOSARCOM A

(OSTEOGENIC SARCOMA)

KAHLIA BIANCA A. NAZARETA 4 BSN 3 CAVITE STATE UNIVERSITY

NOVEMBER 2011

OSTEOSARCOMA
DEFINITION: a malignant primary neoplasm of bone composed of a malignant connective tissue stroma with evidence of malignant osteoid, bone or cartilage formation. 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. OTHER KNOWN NAME: Osteogenic Sarcoma INCIDENCE: Most common cancerous(malignant) bone tumor in youth. Average age diagnosis is 15, boys are commonly affected. 2500 US cases diagnosed per year. Most common childhood malignancy. Age affected: 15-30, most common: 10-20 y.o. In the Philippines: It is the 24th in overall, 18th in males and 21st in females. In 1998, an estimated 769 new cases will be seen, 479 cases among male and 290 among females. Incidence increase at age 60 (DOH). RISK FACTORS PREDISPOSING Hereditary or Family History Rapid bone growth Age and height Prescence of benign bone disease PRECIPITATING Previous treatment with radiation for another cancer, especially at young age or with high doses of radiation

STAGES /CLASSIFICATIONS /TYPES STAGES OF OSTEOSARCOMA: Stage I- low grade tumor tumor Stage IA- intracompartmental intracomparmental StageIB- extracompartmental extracompartmantal Stage II- high grade Stage IIAStage IIB-

Stage III- metastatic disease for either grade CLASSIFICATION 1. Localized osteosarcoma The cancer cells have not spread beyond the bone or nearby tissue in which the cancer began. 2. Metastatic osteosarcoma The cancer cells have spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs. It may also spread to other bones. In multifocal osteosarcoma, tumors appear in 2 or more bones, but have not spread to the lungs. 3. Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the tissues where it first started or it may come back in another part of the body. Osteosarcoma most often recurs in the lung. When osteosarcoma recurs, it is usually within 2 to 3 years after treatment is completed. Later recurrence is possible, but rare. TYPES OF OSTEOSARCOMA 1. Classical or conventional high grade central type which accounts for 90% of all osteosarcomas. By far the most common osteosarcoma.

Several other unusual high grade types: 2. Telangiectatic 3. Small cell 4. Secondary (associated with another pre-existing disease such as Pagets disease or prior radiation exposure) type. There are low grade types of osteosarcoma too. 5. Surface or juxtacortical low grade osteosarcoma also known by the names parosteal or periosteal osteosarcoma 6. Low grade central osteosarcoma.

CLINICAL MANIFESTATIONS: Localized pain at the site of the tumor Swelling, warmth, and redness caused by the vascularity of the tumor Cough Dyspnea limp or pathologic fracture Trauma Bone fracture Bone pain Limitation of motion Pain when lifting (if the tumor is in the arm) Muscle atrophy DIAGNOSTIC STUDIES Bone marrow aspiration Increased serum alkaline phosphate Blood tests Bone scan X-ray CT scan PET sacan Biopsy

PATHOPHYSIOLOGY: Predisposing Factors Hereditary/ Family History Rapid bone growth Age and height Presence of benign bone disease Precipitating Factor Exposure to radiation

Causes normal bone to react by osteolytic response Adjacent normal bone responds to tumor by altering its pattern or remodeling Bone surfaces changes, contour enlarges Bulky tumor forms and destroys the trabeculae of the affected area Tumor grows outward Muscle compressed Reaches lungs, bones, and visceral organs Pathologic fracture Metastasized through blood stream Bone structure becomes weak

Circulation impeded Pain, swelling, muscle atrophy

OSTEOSARCOMA

MANAGEMENT: MEDICAL:

Chemotherapy: -High-dose methotrexate with leucovorin citrovorum factor rescue -Doxorubicin (Adriamycin) -combinations of bleomycin, actinomycin, cyclophosphamide(Cytoxan), ifosfamide(Ifex), and cisplatin. -Carboplatin (Paraplatin) SURGICAL Amputation of affected extremity In most cases, surgery can remove the tumor while sparing the affected limb (this is called limb-salvage surgery). NURSING RESPONSIBILITIES: 1. Provide quiet environment/ calm activities to prevent or lessen pain 2. Provide comfort measures such as back rub, change position and use of hot and cold application. 3. Encourage diversional activities. 4. Administer analgesics as indicated. 5. Encourage to increase fluid intake. 6. Encourage rest periods to prevent fatigue. 7. Provide accurate information about the situation, medication, treatment,(health teachings). 8. Assess muscle strength, gross and fine motor coordination. 9. Provide pillow for cushion and support. 10. Keep side rails up to ensure safety. NURSING DIAGNOSIS: 1. Acute pain related to abnormal enlargement of bone as manifested by bone tumor. 2. Ineffective breathing pattern related to musculoskeletal impairment as evidenced by usage of accessory muscles in breathing 3. Activity intolerance related to pain 4. Impaired social interaction related to limited physical mobility 5. Ineffective role performance related to body image alteration and physical illness

Illustration:

This x-ray shows a malignant bone tumor (osteogenic sarcoma) of the knee. This type of tumor is usually seen in adolescents (around 15 years old). This tumor extends from the bone into the surrounding tissue.

An abnormal growth of cells within the bone that may be benign or malignant (cancerous).

REFERENCES: http://www.nlm.nih.gov/medlineplus/ http://www.fpnotebook.com/Hemeonc/Ortho/Ostsrcm.htm http://www.reininsarcoma.org/content/types-bone-sarcomas Huether, Sue. Understanding Pathophysiology 2nd ed. Black, Joyce, Medical-Surgical 7th ed.