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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.
Incidence:
• More common in male adolescents
• Common occurs between ages 10 and 25 years old
Manifestations:
• Localized pain at the site of the tumor
• Swelling, warmth, and redness caused by the vascularity of the
tumor
• Cough
• Dyspnea
• A child may limp or suffer a pathologic fracture
• Trauma may call attention to a pre-existing tumor
• Bone fracture (may occur after what seems like a routine
movement)
• Bone pain
• Limitation of motion
• Pain when lifting (if the tumor is in the arm)
• Muscle atrophy
Stages of osteosarcoma
• Once osteosarcoma has been found, more tests may be done to find out if
cancer cells have spread to other parts of the body. This is called staging.
• At present, there is no staging system for osteosarcoma.
• Instead, most patients are grouped depending on whether cancer is found
in only one part of the body (localized disease) or whether the cancer has
spread from one part of the body to another (metastatic disease).
• The following groups are used for osteosarcoma:
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.
Distal femur
Proximal tibia
Proximal humerus
Formation of osteoid
Management:
Medical:
• Chemotherapy
High-dose methotrexate with leucovorin
citrovorum factor rescue
Doxorubicin (Adriamycin)
combinations of bleomycin, actinomycin, cyclophosphamide(Cytoxan),
ifosfamide(Ifex), and cisplatin are used 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 Diagnosis:
Acute pain related to physical injuring agents
Ineffective breathing pattern related to musculoskeletal impairment as
evidenced by usage of accessory muscles in breathing
Activity intolerance related to pain
Impaired social interaction related to limited physical mobility
Ineffective role performance related to body image alteration; physical
illness
Nursing Responsibilities:
• Assist child and family to cope with the problem
• Provide time for child and family to accept the diagnosis
• Encourage family and client to verbalize
• Post-operatively, child is fitted with a prosthesis
• Provide nursing care of post-op amputation
• Provide with normal growth and development activities
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.