A.

INTRODUCTION
OSTEOSARCOMA
Osteosarcoma (also called osteogenic sarcoma) is the most common type of
cancer that starts in the bones. The cancer cells in these tumours resemble early kinds
of bone cells that ordinarily aid in the formation of new bone tissue. It is a malignancy
that causes the formation of immature bone and is the most prevalent type of bone
cancer, and it commonly develops near the ends of long bones. The majority of
osteosarcomas affect adolescents, teenagers, and young adults and males are thought
to be more likely than females to develop the disease. Osteosarcomas range in severity
from low-grade tumours requiring simply surgery to high-grade tumours requiring
rigorous treatment. Scientists have not discovered the cause of most cases of
osteosarcoma. Radiation to a specific part of the body can cause osteosarcoma. It's also
linked to some genetic mutations and disorders.
Osteosarcomas can be classified as high grade, intermediate grade, or low
grade. High-grade osteosarcomas are the fastest growing types of osteosarcomas.
There are many types of high-grade osteosarcomas; Osteoblastic, Chondroblastic,
Fibroblastic, Small cell, Telangiectatic, High-grade surface (juxtacortical high grade).
Other high-grade osteosarcomas include; Pagetoid, Extraskeletal, Post-radiation.
Intermediate-grade osteosarcomas, these uncommon tumors fall between high-grade
and low-grade osteosarcomas; Periosteal (juxtacortical intermediate grade). Low-grade
osteosarcomas are the slowest growing osteosarcomas; Parosteal (juxtacortical low
grade), Intramedullary or intraosseous well differentiated (low-grade central).
The incidence rates and 95% confidence intervals of osteosarcoma for all races
and both sexes are 4.0 (3.5-4.6) for the range 0-14 years and 5.0 (4.6-5.6) for the
range 0-19 years per year per million persons. The age distribution of osteosarcoma is
bimodal, with the first peak occurring during adolescence and the second peak
occurring in later adulthood. The first peak occurs between the ages of 10 and 14,
coinciding with the pubertal growth surge. This shows that the adolescent growth spurt
and osteosarcoma are linked. The second peak of osteosarcoma occurs in persons over
65 years old, and it is more likely to be a secondary cancer, often linked to Paget's
disease. The incidence of osteosarcoma has always been considered to be higher in
males than in females, occurring at a rate of 5.4 per million persons per year in males
vs. 4.0 per million in females, with a higher incidence in blacks (6.8 per million persons
per year) and Hispanics (6.5 per million), than in whites (4.6 per million). Death rates
for osteosarcoma have been declining by about 1.3% per year. The overall 5-year
survival rate for osteosarcoma is 68%, without significant gender difference.
B. Diagnostic Examination/ Laboratory Examination

How is osteosarcoma diagnosed?

An x-ray is often the first diagnostic test that osteosarcoma patients receive, and an
experienced radiologist may recognize immediately that bone cancer is the likely
diagnosis. There are several additional tests that are a critical part of osteosarcoma
diagnosis and staging:

 A medical history and physical exam. Your doctor will ask about your personal
and family health histories. They’ll check for unusual lumps around your bones.
 Imaging tests.

 X-rays and CT scans- X-ray chest can detect metastasis in form of

cannon ball appearance or nodules in the lungs but it is less sensitive
than computerized tomography (CT) scan of the thorax for early detection
of small sub-centimal nodules.

(a)X-ray chest of a patient of osteosarcoma showing multiple metastatic

lung nodules
(b) CT scan (axial section ) demonstrating multiple metastases in both
lungs.

A.)X-ray anteroposterior and lateral views of proximal tibia and knee joint
showing diaphyseal osteosarcoma of tibia with sclerosis ( arrow ), cortical
 destruction on posteromedial side ( arrow heads ) and new bone
formation in the soft tissue.
B.) X-ray showing sclerosis/ radi-opacity in sclerosing osteosarcoma.

 MRIs- is the most accurate tool for determining the limits of tumor within
and outside the bone. MRI should include the whole of the involved bone
with one joint above and below so that skip lesions are not missed in the
same bone and across the joint. MRI accurately and precisely delineates
(1) extent of the tumor into the soft tissues and the medullary canal, (2)
involvement of joint, (3) crossing of the lesion through and/or around the
growth plate, (4) any skip lesion in the same bone and across the joint in
other bone, (5) proximity and/or encasement of the neurovascular bundle
by the tumor

Osteosarcoma in the distal end of femur:

(a) X-ray thigh with knee anteroposterior view showing big soft tissue
component on the medial side
(b) MRI-coronal section showing the medullary extent (arrow)
(c) MRI-axial section showing the proximity of the popliteal vessels.

 Bone scans and PET scans can show unusual changes in bones that may
be signs of osteosarcoma. They can also show areas where a tumor may
have spread.

 Biopsy. Your doctor will take a small sample of bone or tissue from a painful or
swollen area. They may use a needle or make a cut in your skin, called a surgical
or open biopsy. A specialist looks at the sample under a microscope. This test
may show cancer cells in your bone or cancer cells that have spread to muscles
or other areas.

A biopsy of the tumor, which

provides a definite diagnosis
based on the characteristics
of tumor tissue seen under a
microscope. The biopsy will
also show whether the tumor
 is high grade (highly malignant, which is the case for most osteosarcomas) or
low grade.

C. CLINICAL MANIFESTATION

Physical examination findings are usually limited to the site of the primary tumor, as
follows:

 Mass - A palpable mass may or may not be present; the mass may be tender
and warm, though these signs are indistinguishable from osteomyelitis; increased
skin vascularity over the mass may be discernible; pulsations or a bruit may be
detectable
 Decreased range of motion - Involvement of a joint should be obvious on
physical examination
 Lymphadenopathy - Involvement of local or regional lymph nodes is unusual
 Respiratory findings - Auscultation is usually uninformative unless the disease is
extensive


Signs and symptoms of osteosarcoma may include, among others:

• Swelling near a bone

• Bone or joint pain

• Bone injury or bone break for no clear reason

DEF
G. NURSING DIAGNOSIS
1. Chronic pain r/t tumor infiltration as evidenced by local swelling

2. Impaired physical mobility r/t alteration in bone structure integrity secondary to postural instability

3. Risk for infection r/t suppressed inflammatory response secondary to chemical processes of
chemotherapy

4. Disturbed body image r/t alteration in body function secondary to osteosarcoma

H. DRUG STUDY
 DRUG MECHANISM OF ACTION
May cross-link strands of cellular
DNA an interfere with RNA
transcription, causing an
imbalance of growth that leads to
cell death, not specific to cell cycle
Therapeutic Class:
Antineoplastics
Pharmacological Class:
Platinum-containing compounds
May interfere with DNA-
dependent RNA synthesis by
intercalation
NURSING RESPONSBILITIES
BEFORE:
1. Hydrate patient with NSS for 8-12hours before giving drug.
2. Maintain urine output at least 100ml/ hour for 4 consecutive hours
before therapy
3. Lab test should be done before initiating every course of therapy and
repeated each week. (serum uric acid, serum creatinine, BUN, CBC and
platelet counts)
4. Audimetric testing should be performed before the 1st dose
DURING:
1. Check BP, mental status, pupils and fundi every hour during therapy.
Hydration and mannitol may increase the danger of elevated ICP
2. Institute infection precautions promptly if a temprature increase of 0.6
farenheight over the previos reading is noted.
3. Administered only under supervision of a qualified physician experienced
in the use of antineoplastics.
AFTER:
1. Instruct the patient to continue maintenance of adequate hydration of at
least 3000ml/24hours oral fluid and report promptly for reduced urinary
output, fluid retention and weight gain.
2. Advice the patient to report for any hearing impairment, unexplained
bleeding and easy bruising
3. Document the procedure
BEFORE:
1. Perform cardiac function studies including ECG and LVEF, before
treatment and then periodically throughout the therapy
2. Take preventive measures, including adequate hydration of the patient
before starting the treatment.
3. Wear gloves and use caution when preparing drug solution
4. Dilute the powder with NS to yield a final concentration of 2 mg/mL.
Bacteriostatic diluents are not recommended
DURING:
1. Explain the procedure to the patient including the indication and side
effects of the drug.
2. Administer slowly into y-site of freely running IV infusion of NS or D5W.