Osteosarcoma


Introduction:
Osteosarcoma is one of the common types of bone cancer. Though Osteosarcoma can develop in any part of the body, the most common sites are around the knee joint and close to the shoulder. As it develops from osteoblasts (the cells of developing bone), it commonly occurs in children. It is probably caused by genetic factors which changes immature bone cells into cancer cells.

Clinical Presentation:
1. pain and swelling in leg or arm
2. limping gait
3. fracture with trivial trauma
4. backache
5. loss of bladder/ bowel control ( pelvic osteosarcoma)

Signs:
1. swelling just above or below knee joint/ upper arm/ near shoulder
2. painful & limited movements of joint
3. limping gait in case of leg swelling
4. signs of incontinence of bladder/ bowel in case of pelvic or spinal osteosarcoma
5. chest signs in case of metastatic or advanced disease

Diagnosis:
1. X-ray of bone- Lytic lesion with indistinct margins or ossification in the soft tissue with sunburst pattern. Reactive new bone formation is seen as a periosteal elevation, a sign named as a ‘Codman’s angle’ or ‘Codman’s triangle’.
2. MRI of involved bone
3. CT chest
4. Bone scan
5. Tru-cut needle biopsy of tumor

Types
1. Central Osteosarcoma
Conventional
Telangiectatic
Small cell
Low grade
2. Surface Osteosarcoma
Paraosteal
Periosteal
High grade

Treatment:
1. Surgical: Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery. Nowadays Limb salvage surgery preferred over amputation. In case of metastatic disease in the lungs, surgery is done to do pulmonary metastatecomy.
2. Chemotherapy: Chemotherapy is given before as well as after surgery. This is called Neoadjuvant chemotherapy and Adjuvant chemotherapy. It removes the microscopic disease in the body.
3. Radiotherapy: The use of radiotherapy is limited in osteosarcoma as it is not very effective. It is used in osteosarcoma that can not be removed surgically.

Prognosis:
In localized disease 60 to 80% survival rate has been reported. Limb osteosarcoma has better prognosis than flat bone osteosarcoma.

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Hainan said...

Does it need to be knee or shoulder, as I have a similar symptom in my left index finger top joint.

SK
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