2. Osteosarcoma
◦ Osteogenic sarcoma
Most common type of primary bone cancer.
Mostly children/pediatric patients suffer from
osteosarcoma
◦ Most male patients.
Osteosarcoma is classified as a form of bone cancer
that originates in the long bones of the body
◦ especially the femur, tibia and humerus.
Osteosarcoma forms in the metaphysis of the long
bones, near the epiphyseal plate.
This type of cancer begins as a tumor that grows to
be cancerous.
It is reassuring to know that osteosarcoma has a
high survival rate for patients who undergo
chemotherapy and surgery.
3. “The femur is involved in 40% of the cases,
the tibia 16%, and the humerus 15%. Seventy-
five percent of these tumors involve the
knee.” (Berg)
4. When the anatomy is not affected by
osteosarcoma the musculoskeletal system
◦ Provides structural support for the entire body
◦ Stores minerals and lipids
◦ Produces red blood cells
◦ Protects organs
◦ Provides leverage and moment.
5. Osteosarcoma, most commonly, affects the long
bones of the body.
◦ Clavicles, humeri, radii, ulnae, metacarpals, femurs, tibiae, fi
bulae, metatarsals, and phalanges.
“The long bones are composed of a hollow shaft, or
diaphysis; flared, cone-shaped metaphysis below the
growth plates; and rounded epiphyses above the
growth plates.
The diaphysis is composed primarily of dense cortical
bone, whereas the metaphysis and epiphysis are
composed of trabecular meshwork bone surrounded
by a relatively thin shell of dense cortical bone.
◦ Cortical bone is dense and solid and surrounds the marrow
space, whereas trabecular bone is composed of a
honeycomb-like network of trabecular plates and rods
interspersed in the bone marrow compartment.
Both cortical and trabecular bone are composed of osteons. ”
(Clarke)
6.
7. The cause of osteosarcoma is unknown
Scientists/researchers believe they have some
leads/ideas on the cause but they are not
100% positive
Possible causes: genetics, infected cells,
extreme amounts of radiation
They unsure of the cause, but they do know
that in older patients with osteosarcoma can
be developed if the patient has a bone
disorder such as Paget’s disease.
8. When a patient has osteosarcoma, the bone
that is affected is weakened by the pathology.
Specifically, the bone matrix in patients with
osteosarcoma is not as strong as the bone
matrix in a healthy patient, without
osteosarcoma.
9. “Each year in the United States, osteosarcoma is
diagnosed in approximately 400 children and
adolescents younger than 20 years.” (St. Jude
Research)
Osteosarcoma is a disease that is common to
children/adults between the ages of 10 years of
age and 25 years of age. “In about 75% of cases,
patients with osteosarcoma are between 15–25
years of age.” (Picci, 2007)
Along with only affecting people within a specific
age range, osteosarcoma, also, mostly affects
males. Females are less likely to be diagnosed
with osteosarcoma than males.
10. In many cancers, patients are in extreme pain, but it is
interesting to know that patients suffering from
osteosarcoma are not always in pain. If patients are
experiencing pain from osteosarcoma, it is tolerable
and not excruciating
The most common symptoms of osteosarcoma are:
◦ “Local swelling
◦ A fever
◦ Weight loss
◦ Secondary anemia.” (Eisenberg)
Other symptoms a patient with osteosarcoma could
be suffering from are:
◦ Limited movement in the nearest joint
◦ A fracture
This type of fracture would be called a pathological fracture
This is because it is due the weakness of the bone due to the
pathology.
11. If a patient is experiencing problems with a
joint, the physician will give them a physical
exam in the doctor office.
◦ While palpating the affected area, the physician is
most likely to feel an abnormal mass or tumor in or
around the joint or bone.
Even if the physician does not feel the tumor, the
swelling of the joint is enough for the physician to
order a radiograph.
12. In the diagnosis process, only a plain film
radiograph needs to be performed for an accurate
diagnosis.
“Typical appearances of conventional high grade
osteosarcoma include:
◦ Medullary and cortical bone destruction,
◦ Wide zone of transition,
◦ Permeative or moth-eaten appearance,
◦ Aggressive periosteal reaction
Sunburst type
Codman triangle
Lamellated (onionskin) reaction.
◦ soft-tissue mass and tumor matrix ossification /
calcification which can be visualized as ill-defined "fluffy" or
"cloud-like".” (Mudgal)
13.
14. “Osteosarcoma is often treated with a
combination of therapies that can include
surgery, chemotherapy and radiation therapy.”
(Ryan, 2012)
The patient will undergo many months of
chemotherapy before surgery is performed.
◦ The purpose of chemotherapy given to patient for
months before surgery is so the chemotherapy will
shrink the size of the tumor.
◦ Once the patient is finished chemotherapy treatment
then the surgeon will remove the tumor along with some
of the tissue around the site of the tumor.
15. The prognosis for a patient with osteosarcoma is
good with the advances in technology available to
patients today.
“With modern treatment, the 5-year survival rate for
patients with localized osteosarcoma is in the range
of 60% to 80%.” (American Cancer Society)
The disease is very responsive to the treatments
available today.
If a patient receives chemotherapy and then has the
tumor removed, the chance of the patient’s survival
increases up to 90%.
Most people who are diagnosed with osteosarcoma
survive the process of treatment and will be able to
live a normal life with few restrictions.
16. 33 years aged young gentle presented with
pain and swelling in the right side of the
shoulder for the last 1½ months.
Her history shows she had an M.R.I. of
shoulder done on 06.07.2005
◦ Her MRI showed a large expansile osteolytic mass
on the metaphysis and part of greater tuberosity of
right humerus.
There is extension to the paraosteal soft tissues.
17. A bone scan was the next procedure
performed on this woman.
◦ The bone scan showed the increase uptake at right
shoulder is compatible with increase osteogenic
activity in the region.
The rest of the skeletal tissue image morphology is
within normal limits
Next, C.T. guided F.N.A. of the lytic lesion in
the humerus performed
◦ The overall cytomorphological features are of
malignant tumor of messenchymal origin.
18. The patient is, next, treated with “our
medication” (medication not listed)
“Clinically patient feels much better and no
swelling and pain in right shoulder area after
8 – 9 months of our medication.”
19. During her treatment, an X-Ray of the right
shoulder done
◦ Much improvement is seen of the osteolytic lesion
in the upper part of the right humerus.
Another X-Ray of the right shoulder is
performed a year later
◦ Bone destruction at upper 3rd of right humerus
with soft tissue swelling. Patient feels much better
and continuing medicines for further improvement.
