Osteosarcoma

1 What is Osteosarcoma?

Osteosarcoma is a malignant bone tumor that arises from primitive transformed cells. The disease is the most common form of primary bone cancer and mostly affects children and young adults. 

It is most common in teenagers, but can occur at any age. 

In children and young adolescents, the tumor usually grows in rapidly-growing bones like near the ends of the long bones, for instance. 

Most of the time, osteosarcoma grows in the bones around the knee. The next most common site is the proximal humerus or the upper arm bone near the shoulder. 

Nonetheless, tumors can develop in any bone, including the shoulders, hips, and even the jaw, especially in older adults.

2 Symptoms

The first major symptoms of osteosarcoma most patients experience is pain. The pain may be intermittent and varies in intensity, but is mostly worse at night. 

Sports-active teens often complain of pain on the area below the knee. Localized swelling may also be present, particularly with large tumors. 

Since the affected bone is not as strong and healthy as the normal ones, sudden fractures even with only minor trauma are possible.

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3 Causes

Several researches are still studying the direct cause of osteosarcoma, but the following may play a big role in having the disease:

  • Genetic or familial cases
  • Having Bone dysplasias
  • Having Li-Fraumeni syndrome
  • Having Rothmund-Thomson syndrome

4 Making a Diagnosis

Osteosarcoma diagnosis typically starts with a physical exam followed with X-rays and scans, such as a combination of CT scan, bone scan, PET scan, and MRI

A typical tell-tale sign in X-rays is the Codman’s triangle, or a subperiosteal lesion that is formed upon raising of the periosteum due to tumor. 

To determine if the tumor is malignant or benign, bone biopsy is required. A qualified orthopedic oncologist should perform the biopsy.

5 Treatment

Treatment for osteosarcoma usually involves surgery and medication. About 90% of osteosarcoma patients can undergo limb-salvage surgery, but in some cases, infections and other complications may result in a more damaging surgery or amputation. 

After tumor-removal surgery, chemotherapy may be required to kill cancer cells and reduce the chance of recurrence.

Standard therapy procedure involves a combination of limb-salvage surgery (or in some cases,  amputation) and high doses of several medications, such as: 

  • methotrexate with leucovorinrescue
  • adriamycin
  • intra-arterial cisplatin,
  • ifosfamide with mesna,
  • etoposide
  • BCD (bleomycin, cyclophosphamide, dactinomycin),and muramyl tripeptide.

6 Risks and Complications

The risk factors for osteosarcoma include:

  • Age. Those who are aged 10 to 30 have a higher risk of having osteosarcoma. While the risk drops in middle age, adults aged 60 and up also have a greater risk. 
  • Height. Children who are diagnosed with osteosarcoma are usually taller than usual. This suggests that the cancer may be related to rapid growth of the bones. 
  • Gender. Although osteosarcoma occurs in both genders, it is more common in males. 
  • Ethnicity. African Americans are more prone to osteosarcoma than white people.
  • Radiation exposure to bones. People who have received radiation treatment have a higher possibility of having osteosarcoma compared to those who did not. 
  • Certain bone disease. People with noncancerous bone diseases, such as Paget disease of bone have a higher risk of developing osteosarcoma. 
  • Inherited cancer syndromes. People who have inherited cancers have a higher risk for osteosarcoma.
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