OSTEOSARCOMA

FUNCTIONS OF BONE

TISSUES

1. SUPPORT

2. PROTECTION

4. BONE HOMEOSTASIS

5. PRODUCTION OF BLOOD

CELLS

Osteogenic cells

Osteoblast cells

Osteocyte cells

Osteoclast cells

FOUR MAJOR TYPES OF CELL IN THE BONE

TISSUES

TYPES OF BONES

a. Long Boneb. Short Bonec. Irregular Boned. Flat Bone

CB AO NN CE E R

also known as “OSTEOGENIC SARCOMA”.

comes from a Greek work “osteon” which means

“bone” and “sarcoma” which is a type of cancer that develops from a certain “tissue”.

OSTEOSARCOMA

is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth. 

most common type of primary malignant bone tumor.

it is the 6th most common type of cancer in children.

OSTEOSARCOMA

begins in bones and sometimes

spread (or metastasize) usually to

the lungs or other bones.

Most common and fatal in children

and males between 10-25 years

old.

Common sites:

a. long bones,

o knee,

o upper leg,

o thigh bone,

o lower leg and

o upper arm.

OSTEOSARCOMA

Etiology

Unknown.

It is thought to be

related to rapid bone

growth, such as in

adolescents.

Pathophysiology

Risk Factors

Predisposing Factors

Age (10 to 30 years oldGender ( males )Genetics

Precipitating Factors

Exposure to radiation therapyPaget’s Disease Li Fraumeni Syndrome Rothmund-Thomson Syndrome

Changes in cell behavior

Damaged in the DNA

Error in the cellular growth

Failure of the DNA to repair itself

Genetic mutation occurs of NORMAL cell into

ABNORMAL cell (bone cells)

overactive bone cells

Produces immature bone cells

Develop into tumor cells instead of bone

Formation of new bone tissue

CODMAN’S TRIANGLE

TYPES of OSTEOSARCOMA

HIGH GRADE LOW GRADE

Most tumors arising from the central (or medullary) portion of the bone.

most tumors arising from the surface of the bone.

SUB – TYPES OF HIGH GRADE OSTEOSARCOMA

A. OSTEOBLASTIC OSTEOSARCOMA

the cancer cells look like bone forming cells

B. CHONDROBLASTIC OSTEOSARCOMA

If the cancer is trying to make cartilage as well as bone then the tumor

C. FIBROBLASTIC SARCOMA

Produces a small amount of bone

D. TELANGIECTATIC OSTEOSARCOMA

If there are lots of abnormal blood vessels in the tumor as well as bone forming cells then the tumor

D. SMALL CELL OSTEOSARCOMA

contain small round cells 

Stages of Osteosarcoma STAGE IA The cancer is found only in the bone, is smaller

than 8 cm, and is low grade 

STAGE IB The cancer is found only in the bone, is larger than 8 cm, and is low grade

STAGE IIA The cancer is found only in the bone, is smaller than 8 cm, and is high grade

STAGE IIB The cancer is found only in the bone, is larger than 8 cm, and is high grade

STAGE III The cancer is found only in the bone but has spread to other places on the bone

STAGE IVA The cancer has spread to the lung

STAGE IVB

The cancer has spread to lymph nodes and other parts of the body, or the cancer has spread to distant parts of the body other than the lung

Clinical

Bone Pain Swelling and

tenderness near the affected area

Limping (if the legs are the affected part)

broken bone (fracture)

manifestations

MOST COMMON

Chief Complaint

Dia

gn

osti

c

Tests

a. Chest X-ray

spread

(metastasized) to

the lung

b. Bone X-ray

Determine the

bone lesions that

could indicate

osteosarcoma.

c. CT ScanAllows a cross

sectional views that

will show

abnormalities and

TUMORS

Diagnostic Tests

d. Positron emission

tomography (PET) 

This test is useful to see if the cancer has spread.

e. Radionuclide bone scan 

to show how responsive the tumor was to the chemotherapy drugs

f. BIOPSY DEFINITIVE TESTS FOR BONE CANCER

Laboratory Tests

C-reactive Protein Lactic

Dehydrogenase (LDH)

Alkaline Phosphatase (ALP)

Therapeutic Management

Radiation therapy- uses high energy beams of radiation to shrink tumors and eliminate cancer cells.

Chemotherapy High-dose methotrexate with leucovorin citrovorum factor rescue Doxorubicin (Adriamycin)c Combinations of bleomycin, actinomycin,

cyclophosphamide(Cytoxan),ifosfamide(Ifex), and cisplatin are used

Carboplatin (Paraplatin

Surgical Management

Limp-sparing surgery- removes the cancerous tumor and bone, replacing it with either a graft or prosthesis to make the limb as functional as possible. Seventy percent to 90 percent of osteosarcomas in the limbs can be treated by this method

Surgical Management

Rotation-plasty is a limb-sparing technique. The doctor removes a portion of the leg, including the knee. The lower part of the leg is rotated and reattached so that the ankle becomes the new knee, and a prosthetic device is attached to replace the ankle and foot.

Amputation is the removal of the limb. In most cases, prosthesis can be used to replace the limb.

Assessment

Encourage patient to discuss problem and course of symptoms.

Note patient and family’s understanding of the disease, coping with the problem and management of pain.

Palpate mass gently on physical examination.

Assessment

Note size and associated soft-tissue swelling, pain and tenderness of the mass.

Assess neuromuscular status and range of motion extremity.

Evaluate motility and ability to perform activities of daily living.

Priority Nursing DiagnosisAcute 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

Priority Nursing Diagnosis

Impaired social interaction related to limited physical mobility

Ineffective role performance related to body image alteration; physical illness

Planning and ImplementationAssist patient in doing his ADLs.Administer analgesics as

prescribed.Encourage visitors to entertain

the patient.Use pain alleviating techniques

like relaxation, imaging, deep breathing exercises and the likes.

Oxygen therapy for DOB

Planning and Implementation

Encourage the patient to verbalize his feelings.

Provide wound care for post-operative patients.

Place the patient to high-fowler’s or semi-fowler’s position.

Assist patient in doing ROM exercises.

Keep side rails up all the time.

THANK YOU!!