OSTEOSARCOMA

DR SHADRICK G. LUNGU
OSTEOSARCOMA

• DEFINITION INVESTIGATIONS
• EPIDEMIOLOGY TREATMENT
• AETIOLOGY PROGNOSIS
• RISK FACTORS END
• SYMPTOMS, SIGNS & DIAGNOSIS
• DIFFERENTIAL DIAGNOSIS
OSTEOSARCOMA

• OSTEOSARCOMA

• OSTEOGENIC SARCOMA
• BONE CANCER
• OSTEOBLAST
• BONE
OSTEOSARCOMA

• MOST OFTEN IN CHILDREN,

• ADOLESCENTS, AND
• YOUNG ADULTS
• MALES > FEMALES
• 8TH COMMON CHILDHOOD TUMOUR
• 20% OF ALL 1O BONE TUMOURS
OSTEOSARCOMA

• SITE
• LONG BONES OF THE LEGS
• KNEES
• DISTAL FEMUR (42%)
• PROXIMAL TIBIA (19%)
• PROXIMAL HUMERUS (10%)
• DISTAL RADIUS
• PELVIS
• SKULL
OSTEOSARCOMA

• MAY GROW INTO TISSUES,

• SUCH AS TENDONS OR
• MUSCLES
• SPREAD THROUGH BLOOD
• OTHER BONE
• ORGANS (LUNG)
OSTEOSARCOMA

• CAUSE

• NOT KNOWN
• HOWEVER – DNA MUTATION OF THE OSTEOBLASTS
• INHERITED
• ACQUIRED
OSTEOSARCOMA

• RISK FACTORS

• TEENAGE GROWTH SPURTS

• BEING TALL FOR A SPECIFIC AGE
• PREVIOUS TREATMENT WITH RADIATION FOR ANOTHER CANCER,
ESPECIALLY AT A YOUNG AGE OR WITH HIGH DOSES OF RADIATION
• PRESENCE OF CERTAIN BENIGN (NONCANCEROUS) BONE DISEASES
OSTEOSARCOMA

• RISK FACTORS (CONT’D)

• PRESENCE OF CERTAIN RARE, INHERITED DISORDERS E.G.

• LI-FRAUMENI SYNDROME (AUTOSOMAL DOMINANT HEREDITARY DISORDER)
• ROTHMUND-THOMPSON SYNDROME (AUTOSOMAL RECESSIVE SKIN
CONDITION)
• HEREDITARY RETINOBLASTOMA (AUTOSOMAL DORMINANT PATTERN)
OSTEOSARCOMA

• SYMPTOMS (VARY)

• PAIN IN THE AFFECTED BONE

• SWELLING AROUND THE AFFECTED SITE
• INCREASED PAIN WITH ACTIVITY OR LIFTING
• LIMPING
• DECREASED MOVEMENT OF THE AFFECTED LIMB (ESPECIALLY THE
IMMEDIATE JOINT)
OSTEOSARCOMA

• DIAGNOSIS

• HX
• PHYSICAL EXAMINATION
• X-RAY
OSTEOSARCOMA
• DIFFERENTIAL DIAGNOSIS (CHILDREN)

• OSTEOMYELITIS

• EWING’S SARCOMA

• RHABDOMYOSARCOMA

• CHONDROSARCOMA

• METASTASES FROM OTHER MALIGNANCIES

OSTEOSARCOMA

• INVESTIGATIONS

• PLAIN RADIOGRAPHS OF THE AFFECTED AND CHEST X-RAY

• BONE SCAN
• MRI (INVESTIGATION OF CHOICE)
• CT SCAN
• POSITRON EMISSION TOMOGRAPHY (PET) – INJECT GLUCOSE AND SEE THE
UPTAKE BY TUMOR
OSTEOSARCOMA

• INVESTIGATIONS CONT’D

• FBC/ESR

• BIOCHEMISTRY (LFT, RFT)

• BIOPSY (NEEDLE OR EXCISION BX)

COMMON SITE
SUNBURST & CODMAN TRIANGLE
CODMAN TRIANGLE
OSTEOSARCOMA

• TREATMENT

• SURGERY

• CHEMOTHERAPY

• RADIATION
OSTEOSARCOMA
• TREATMENT DEPENDENT ON

• SITE OF TUMOUR

• SIZE OF TUMOUR

• TYPE & GRADE SARCOMA

• SPREAD
OSTEOSARCOMA

• TREATMENT (DEPENDS ON)

• 1. AGE
• 2. TYPE & STAGE (EXTENT) + LOCATION OF OSTEOSARCOMA
• 3. TOLERANCE TO VARIOUS TREATMENT MODALITIES
• 4. EXPECTATION FOR THE COURSE OF THE DISEASE
• 5. YOUR (DR’S OPINION OR PREFERENCE)
OSTEOSARCOMA

• TREATMENT MAY INCLUDE

• 1. SURGERY (FOR EXAMPLE, BIOPSY, RESECTIONS, BONE/SKIN GRAFTS, LIMB

SALVAGE PROCEDURES, RECONSTRUCTIONS, OR AMPUTATION)
• 2. CHEMOTHERAPY
• 3. RADIATION THERAPY
• 4. REHABILITATION, INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY,
AND PSYCHOSOCIAL ADAPTING
OSTEOSARCOMA
• TREATMENT MAY INCLUDE

• 6. PROSTHESIS FITTING AND TRAINING

• 7. SUPPORTIVE CARE FOR THE SIDE EFFECTS OF TREATMENT

• 8. ANTIBIOTICS TO PREVENT AND TREAT INFECTIONS

• 9. CONTINUED FOLLOW-UP CARE TO DETERMINE RESPONSE TO TREATMENT,

FIND RECURRENT DISEASE, AND MANAGE THE SIDE EFFECTS OF TREATMENT
OSTEOSARCOMA

• TREATMENT CONT’D

• COMBINATION THERAPY – HIGHER GRADE TUMOURS

OSTEOSARCOMA

• A COMBINATION OF

• HIGH-DOSE METHOTREXATE WITH

• LEUCOVORIN RESCUE,
• INTRA-ARTERIAL CISPLATIN,
• ADRIAMYCIN,
• IFOSFAMIDE WITH MESNA, BCD (BLEOMYCIN, CYCLOPHOSPHAMIDE,
DACTINOMYCIN), ETOPOSIDE, AND MURAMYL TRIPEPTIDE
OSTEOSARCOMA

• PROGNOSIS DEPENDS ON

• 1. THE EXTENT OF THE DISEASE

• 2. THE SIZE AND LOCATION OF THE TUMOR
• 3. THE PATHOLOGIC GRADE OF THE CANCER
• 4. THE TUMOR'S RESPONSE TO THERAPY
• 5. AGE AND OVERALL HEALTH
• 6. TOLERANCE OF SPECIFIC MEDICINES, PROCEDURES, OR THERAPIES
• 7. NEW DEVELOPMENTS IN TREATMENT
OSTEOSARCOMA

• PROGNOSIS

• THESE EFFECTS ARE CALLED LATE EFFECTS

• SOME TYPES OF TREATMENT MAY LATER AFFECT FERTILITY

• PROGNOSIS AND LONG-TERM SURVIVAL CAN VARY GREATLY FROM PERSON

TO PERSON
OSTEOSARCOMA

• PROGNOSIS

• PROMPT MEDICAL ATTENTION AND AGGRESSIVE THERAPY ARE IMPORTANT

FOR THE BEST PROGNOSIS

• CONTINUOUS FOLLOW-UP CARE IS ESSENTIAL

• SIDE EFFECTS OF RADIATION AND CHEMOTHERAPY, INCLUDING SECOND

CANCERS, CAN HAPPEN IN SURVIVORS
END