Osteosarcoma

Definition
Osteosarcoma, also known as osteogenic sarcoma, is the most common primary
malignancy oI the bone. It is a highly malignant tumor and is Irequently Iatal. Osteosarcoma is
the most common type oI bone cancer, and the sixth most common type oI cancer in children.
Although other types oI cancer can eventually spread to parts oI the skeleton, osteosarcoma is
one oI the Iew that actually begin in bones and sometimes spread (or metastasize) elsewhere,
usually to the lungs or other bones.
Osteosarcoma usually starts in osteoblasts, which are a type oI bone cell that grows into
new bone tissue. Osteosarcoma is most common in teenagers and young adults. It commonly
Iorms in the ends oI the long bones oI the body, which include bones oI the arms and legs. In
children and teenagers, it oIten develops around the knee. Rarely, osteosarcoma may be Iound in
soIt tissue or organs in the chest or abdomen.
Predisposing/ Risk/ Precipitating Factors
O eing a teen or young adult. Osteosarcoma and MFH oIten Iorm during a growth spurt.
O eing male.
O !ast treatment with radiation therapy.
O !ast treatment with anticancer drugs called alkylating agents.
O Having a certain change in the retinoblastoma gene.
O Having certain conditions such as
4 Hereditary retinoblastoma.
4 !aget disease.
4 iamond-lackIan anemia.
4 i-Fraumeni syndrome.
4 Rothmund-Thomson syndrome.
4 loom syndrome.
4 erner syndrome.
O hen osteosarcoma is diagnosed in adults, it seems to be related to liIestyle Iactors such
as high-Iat diets, lack oI exercise, smoking and drinking alcohol.
$tages
II a patient is diagnosed with osteosarcoma, the doctor will do more tests to Iind out iI cancer
cells have spread to other parts oI the body. This process is called staging and is used to help the
doctor plan treatment.
At present, there is no staging system Ior osteosarcoma. Instead, most patients are grouped based
on whether cancer is Iound in only one part oI the body (localized disease) or has spread Irom
one part oI the body to another (metastatic disease).
The Iollowing groups are used Ior osteosarcoma:
O Locali:ed. The cancer cells have not spread beyond the bone or nearby tissue in which the
cancer began. In young patients most tumors occur around the knee.
O etastatic. The cancer cells have spread Irom the bone in which the cancer began to other
parts oI the body. The cancer most oIten spreads to the lungs. It may also spread to other
bones.
O #ecurrent. The cancer has come back (recurred) aIter it has been treated. It may come back
in the tissues where it Iirst started or it may come back in another part oI the body.

ncidence

Osteosarcoma ranks as the most common malinant tumor in children and adolescents: the distal
Iemur accounts Ior 30 oI cases. The cumulative incidence per million oI the population in
Nigeria, Uganda, Fiji, India, Hongkong, and Singapore ranges Irom 37 to 128. The incidence oI
osteosarcoma per million oI the population in the 0-14 age group is india 27, !hilippines 36,
Hongkong 30, Singapore chinese 48, and Singapore Malays 31.

In Asia, the !hilippines (Manila) has the highest rate oI males while Thailand (Khon
Kaen) has the highest Irequency in Iemales. It is interesting that Singapore Indians have the
lowest male/Iemale ratio oI bone cancer in the world (0.5), while Israeli on-Jews show the
second highest worldwide male/Iemale ratio (4.0).
Pathophysiology
A tumor in the bone causes the normal bone tissue to react by osteolytic response (bone
destruction) or osteoblastic response (bone Iormation). !rimary tumors cause bone destruction,
which weakens the bone, resulting in bone Iractures. Adjacent normal bone responds to the
tumor by altering its normal pattern oI remodeling. The bone`s surIace changes, and the contours
enlarge in the tumor area. Malignant bone tumors invade and destroy adjacent bone tissue.
enign bone tumors, in contrast, have a symmetric, controlled growth pattern and place pressure
on adjacent bone tissue. Malignant invading bone tumors weaken the structure oI the bone until
it can no longer withstand the stress oI ordinary use;
pathologic Iracture commonly results.


linical manifestations

O !ain, swelling, and, eventually, a loss oI Iunction, limited motion, and weight loss (which
is considered an ominous Iinding).
O The bony mass may be palpable, tender, and Iixed, with an increase in skin temperature
over the mass and venous distention.
O Sometimes the Iirst notable indication oI the tumor is a mild limp. The tumor is most
likely to develop in the metaphysis oI the long bones.
O The most common sites oI tumor growth are the proximal humerus, proximal tibia, and
distal Iemur. The pelvis is another potential site (Ruda, 2000b).


Laboratory Exam

The process used to Iind out iI cancer has spread to other parts oI the body is called
staging. For osteosarcoma and malignant Iibrous histiocytoma (MFH), most patients are grouped
according to whether cancer is Iound in only one part oI the body or has spread. The Iollowing
tests and procedures may be used:

O ray: An x-ray oI the organs and bones inside the body. An x-ray is a type oI energy
beam that can go through the body and onto Iilm, making a picture oI areas inside the
body. X-rays will be taken oI the chest and the area where the tumor Iormed.
O % scan (% scan): A procedure that makes a series oI detailed pictures oI areas inside
the body, taken Irom diIIerent angles. The pictures are made by a computer linked to an
x-ray machine. A dye may be injected into a vein or swallowed to help the organs or
tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography. !ictures will be taken oI
the chest and the area where the tumor Iormed.
O R (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and
a computer to make a series oI detailed pictures oI areas inside the body. This procedure
is also called nuclear magnetic resonance imaging (NMRI).
O one scan: A procedure to check iI there are rapidly dividing cells, such as cancer cells,
in the bone. A very small amount oI radioactive material is injected into a vein and
travels through the bloodstream. The radioactive material collects in the bones and is
detected by a scanner.
O PE% scan (positron emission tomography scan): A procedure to Iind malignant tumor
cells in the body. A small amount oI radioactive glucose (sugar) is injected into a vein.
The !T scanner rotates around the body and makes a picture oI where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture because they are
more active and take up more glucose than normal cells do.