OSTEOSARCOMA

P E M B I M B I N G : D R A S W E D I P U T R A S P. O T

NAMA : RICKY DWI SAPUTRA

R I Z K A D W I L E S TA R I
 DEFINITION

Synonyms : Osteogenic sarcoma

Osteo = bone/ osteoid tissue
Sarcoma = malignant tumor of connective tissue
Osteosarcoma is a primary malignant tumour of the skeleton characterised by the direct
formation of immature bone or osteoid tissue by the tumour cells. More rarely osteosarcoma
may arise in the soft tissue.
INCIDIENCE
• More prevalent in male than female
• Involves any age but highest occurrence in adolescence 12-25 years
SKELETAL DISTRIBUTION
• Distal femur
• Proximal tibia
• Proximal humerus
• (site of rapid bone growth)
• Other

Metaphyseal (89%)> diaphyseal(10%) > epiphyseal (1%)

ETILOGY
• Rapid bone growth – adolescence growth spurt in the metaphyseal area near
the growth plate
• Radiation exposure – mostly causes secondary forms.
• Genetic predisposition :
- hereditary form of retinoblastoma
- Li-Fraumeni syndrom (p53 gene mutation)
-Rothmund – Thomson syndrome (autosomal recessive)
- Paget disease of bone – mostly secondary forms
CLASSIFICATION
Primary and Secondary
• Primary Osteosarcomas ( 15 – 25 years)
- conventional / classic osteosarcoma ( high grade, intra medullar )
- low-grade intramedullary osteosarcoma
- paraosteal osteosarcoma
- periosteal osteosarcoma
- high- grade surface osteosarcoma
- telangiectatic osteosarcoma
- small cel osteosarcoma
• Secodary osteosarcoma
Osteosarcoma occuring at the site of another disease process. More
common in > 50 years of age
Most commonly premalignant condition like
- Paget disease
- Previous radiation treatment
- Endochondromatosis
- Fibrous dysplasia
- Osteochondromas
- Osteogenesis imperfecta
PATOFISIOLOGY
SYMPTOMS
Symptoms of osteosarcoma vary depending on the location of the tumor. Common
signs of this type of cancer include:

• bone pain (in motion, at rest, or when lifting objects)

• bone fractures
• Swelling
• Redness
• Limping
• limitation of motion of joints
INVESTIGATIONS
• Radiology examination
- plain X-rays
- MRI
- CT Scan
- Bone scan
• Laboratory studies – serum alkaline phosphatase
• Biopsy – core biopsy, FNAC
• Angiogram
ENNEKING STAGING SYSTEM
The staging system is typically depicated as follows
Stage I : Low grade tumors
I-A intra compartmental
I-B extra compartmental
Stage II : High grade tumors
II-A intra compartmental
II-B extra compartmental
Stage III : Any tumors with evidence of metastasis
TREATMENT
Radiological staging

Biopsy to comfirms diagnosis

Preoperative cheotherapy

Repeat radiological staging ( access chemo response, fibalize surgical treatment plan)

Surgical resection with wide margin

Recontruction using one of many techniques

Post op chemo based on preop response

• Chemotherapy
Chemotherapy given preoperatively – Neodjuvant
Given post operatively – Adjuvant
• Surgery
The main goal of surgery is to safely and completely remove the tumor
• Rotationplasty
• Radiotherapy
• Immunotherapy
FOLLOW UP AND PROGNOSIS
• Sign of recurrence, metastasis and treatment related complications
• Physical examination, radiographs of the primary site, serial chest imaging,
bone scans and laboratory examinations
• 50% cases with high grade osteo sarcoma have some type of relapse in 5 months
• If recurrence is detected, additional surgery (radical amputation) and
chemotherapy may be warranted.
• 5 years survival rate is 5% - 23%
THANKYOU