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Transcript of Osteosarcoma
The only environmental agent known to cause osteosarcoma in human is ionising radiation.
Several families have been described with multiple members who developed osteosarcoma, suggesting genetic predisposition to this tumour. EPIDEMIOLOGY Classic osteosarcoma represents approximately 15% of all biopsy-analysed primary bone tumours. Among primary malignant bone tumours, it ranks second in frequency after multiple myelomas. The incidence of classic osteosarcoma is 3 cases/million population/year. It represents 0.2% of all malignant tumours . In about 75% of cases, patients with osteosarcoma are between 15–25 years of age. Male are more frequently affected than female (ration 1.5:1). Osteosarcoma rarely occurs in patients younger than 6 years or older than 60 years. Tumours observed in older age usually develop secondary to Paget's disease, radiation or dedifferentiated chondrosarcomas. PATHOPHYSIOLOGY Predisposing factors
Age and Height
Radiation to bones
Radiation to bones
Genetic Risk Factors:
- Age and Height
- Paget disease
- Multiple hereditary osteochondromas
- Li-Fraumeni syndrome
- Rothmund-Thompson syndrome
- Retinoblastoma Mesenchymal origin Exhibit osteoblastic differentiation Formation
osteoid Bone pain
Pain that may be worse at night, and may have been occurring for some time.
If the tumor is large, it can appear as a swelling.
The affected bone is not as strong as normal bones and may fracture with minor trauma (a pathological fracture).
MANIFESTATIONS: LABORATORY/DIAGNOSTICS TEST: Complete medical history
Complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.
Blood tests (including blood chemistries)
Biopsy of the tumor Multiple imaging studies of the tumor and sites of possible metastasis, such as:
X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Computed tomography scan (CT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. Positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. (Image of Osteosarcoma in PET scan) Maximum intensity projections of truncus and extremities of patient with primary high-grade mixed pattern osteosarcoma of left humerus. Intense tracer accumulation of 18F-FDG is evident at primary tumor site with second focus of less uptake (arrow) above, suggesting a skip metastasis. LAO = left anterior oblique; RAO = right anterior oblique.
Clinical appearance of a teenager who presented with osteosarcoma of the proximal humerus. Note the impressive swelling throughout the deltoid region, as well as the disuse atrophy of the pectoral musculature. NURSING DIAGNOSES Acute or chronic pain
Risk for injury: pathologic fracture related to tumor
Activity intolerance PLANNING/IMPLEMENTATION EVALUATION/OUTCOMES: Describe disease process and treatment regimen
Describes pathologic condition
States goal o the therapeutic regimen
Seeks clarification of information
Achieves control of pain
Uses multiple pain control techniques, including prescribed medications
Experiences no pain or decreased pain at rest, during ADLs, or at surgical sites Demonstrates effective coping patterns
Identifies strengths and abilities
Requests assistance as needed
Demonstrates positive self-concept
Identifies home and family responsibilities that can be accomplished
Exhibits confidence in own abilities
Demonstrates acceptance of altered body image
Demonstrates independence in ADLs Exhibits absence of complications
Demonstrates wound healing
Experiences no skin breakdown
Maintains or increases body weight
Experiences no infection
Does no experience hypercalcemia
Manages side effects of therapies
Reports symptoms of medication toxicity or complications
Experiences no pathologic fracture
Avoid stress to weakened bones
Uses assistive devices safely and appropriately
Strengthens uninvolved extremities with exercise Formation of demineralisated bone / immature bone Formation of Destruction of the trabeculae Metastasize through Invade the bone Bone overgrowth Blastic lesion Reaches the Pain and muscle atrophy The muscles are compressed
Tumor grows outward forming a ball like mass
Bone structure becomes weak Lytic lesion Localized bone destruction In Asia, the Philippines (Manila) has the highest rate of males while Thailand (Khon Kaen) has the highest frequency in females. It is interesting that Singapore Indians have the lowest male/female ratio of bone cancer in the world (0.5), while Israeli on-Jews show the second highest worldwide male/female ratio (4.0).
Hi! Risk for
Pathologic Fracture The treatment goal for the client with a primary tumor: •to eradicate the tumor completely
•to promote long-term survival
For the client with metastatic disease: • Palliation
• Extension of life
SURGICAL Treatments! Chemotherapy
A person with osteosarcoma typically receives a combination of cancer-fighting drugs (chemotherapy), followed by surgery to remove the tumor.After surgery, additional chemotherapy may improve the chances of killing any cancer cells that remain but are not detected by imaging tests. Surgery
Surgical treatment options for osteosarcoma include techniques such as tumor removal, rebuilding bone tissue, sparing or amputation of an arm or leg, leg rotation and implant placement.
Limb-sparing techniques Autograft (bone graft from your own tissue). In this procedure, a surgeon implants your own bone tissue at the site where cancerous tissue is removed.
Allograft (bone graft from donor tissue). Surgeons use bone, tendons and ligaments from a tissue bank to rebuild areas at the site of a tumor. Amputation
Large tumors or those located in complex regions may require surgery to remove all or part of the arm or leg (amputation).
• Prosthetic implant. Surgeons replace sections of bone with artificial expandable and solid implants if, based on your age, you are not expected to have more bone growth in that region. Prosthetic implant. Surgeons replace sections of bone with artificial expandable and solid implants if, based on your age, you are not expected to have more bone growth in that region. Rotationplasty. The surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle becomes the knee. You are then fitted with a prosthetic ankle and foot, allowing you to run or walk with near-normal function. Radiation therapy may be used:
• to decrease tumor size
• improve bone strength
• help in pain management
Drugs and Medications
1.Provide quiet environment and calm activities to prevent or lessen pain.
2.Provide comfort measure such as back rub, change position and use of heat or cold application.
3.Encourage diversional activities
4.Administer analgesics as indicated to maximal dose as needed.
5.Encourage the patient to increase fluid intake.
6.Encourage rest periods to prevent fatigue.
7.Provide accurate information about the situation, medication and treatment.
8.Assess muscle strength, gross and fine motor coordination.
9.Provide pillows for cushion and support.
10.Keep side rails up all the time.
Nursing Interventions Hypercalcemia Uncontrolled Osteoclastic activity Swelling Lung Cancer Reaches the Spinal compression Paralysis Pain and weakness Doxurubicin