Orthopedic Center with Orthopedist and Arthroplasty Services

Osteosarcoma: Bone Cancer | Bone Tumor

Bone Cancer Early Symptoms

We often get patients who suspect they have bone cancer, but in most cases, they’re just suffering from inflammation in the area.

However, we should always carry out comprehensive medical examinations because a few of them will have bone diseases caused by a tumor.

We’ll be discussing osteosarcoma in detail, which is a type of bone tumor.

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What is Osteosarcoma?

Osteosarcoma is the most common primary bone tumor in adults and children. Before the 1960s, there wasn’t an effective treatment for osteosarcoma.

The introduction of chemotherapy has made osteosarcoma a lot more manageable. The once-upon-a-time lethal disease can now potentially be cured in those with localized conditions.

A prognosis refers to the average time that most patients live after being diagnosed with a serious condition.

Osteosarcoma occurs in the 20s, and then in an individual’s later years when they’re over 70 years old.

Bone-Bonding Process

The delay in the bone-bonding process refers to delay in the consolidation or non-union of bone fragments after a fracture. In such cases, the person has difficulty flexing and feeling pain in the fracture region, weakness, and edema.

Although there is confusion about whether it should be called pseudoarthrosis or delayed consolidation, the difference is that in one, there is a complete absence of bonding, and in the other, there is just a delay.

Types of bones that are affected

Several studies indicate that osteosarcoma affects adolescents during the growth spurt phase. It’s commonly found in the femur bone (proximal femur) and the tibia bone (proximal tibia); together, they account for more than half of the cases. Another common region is in the humerus bone (proximal region of the humerus).

How does this bone cancer develop?

Osteosarcoma is subdivided into intramedullary and surface. Conventional osteosarcoma is a high-grade primary intramedullary tumor in which osteoid production occurs.

Conventional osteosarcoma is classically subdivided into osteoblast, chondroblasts, and fibroblast. It also has subdivisions called telangiectatic, osteoblastoma like small cells, and rich in giant cells.

Bone Cancer Early Symptoms

Severe pain is the primary symptom of bone cancer; it can get progressively worse and lead to a restriction in movement.

Depending on the severity, the skin may become hot and change color. The pain of bone tumors reportedly worsens at night. The intensity of the pain depends on the diagnosis of the lesions (benign, malignant, and its various types).

Teleangiectasic Osteosarcoma

This equates to only 4% of all osteosarcomas (bone cancer). On a radiographer, it looks like an aneurysmatic bone cyst with a radioluscence (bone destruction) filled with blood.

Anatomopathologically, we differentiate these cases based on the presence of nuclear pleomorphism and spindle cells producing bone matrix.

Small Cell Osteosacoma

This accounts for 1.5% of cases of osteosarcoma (bone cancer). It has small blue cells that produce bone matrix; the presence of these cells distinguishes it from Ewing’s Sarcoma. It has low survival-rates.

Low-grade central osteosarcoma

It is composed of a hypocellular fibroblastic stroma with a variation in the amount of osteoid that is produced.

This type of cancer appears in the tibia because we know that its histology mimics fibrous dysplasia; therefore, the clinical history and image tests are critical for diagnosis.

Surface Osteosarcoma

This can be divided into two categories, parosteal and periosteal. They are low-grade bone tumors that grow from the surface of the bone.

The parosteal type primarily affects femur bone, more precisely the posterior distal region (tumor in the knee). The spindle cells show a minimum amount of atypias.

About 91% of patients are free of disease in the first 5 years of treatment. There is also de-differentiated surface osteosarcoma that has a high-grade component that surrounds the low-grade area.

Bone cancer of the periosteal type manifests as a brain tumor of the intermediate chondroblastic grade; it can present varying degrees of atypia. The high-grade surface has similar characteristics to the conventional one.

Secondary Osteosarcoma

This etiology of bone cancer is caused by the presence of pre-existing pathology in the bone, such as Paget’s disease, bone infarction, chronic osteomyelitis, fibrous dysplasia, and those irradiated bones.

Genetic Syndromes

Some genetic syndromes are associated with the development of osteosarcoma, such as Li-Fraumeni syndrome, Rothmund-Thompson syndrome, Werner syndrome, and Bloom syndrome. There is also a sufficient number of patients with hereditary retinoblastoma who develop bone cancer.

Clinical Features of Osteosarcoma

Osteosarcoma can occur in any type of bone, but it’s most commonly found in femur bone (distal), tibia bone (proximal) (cancer of the knee), and the humerus bone (proximal).

This bone cancer affects mainly the appendicular skeleton and sometimes the axial one. Patients complain about pain and edema (swelling). The average time between the onset of symptoms and diagnosis is 4 months.

This type of tumor spreads through the blood, which is why the lungs are most prone to metastasis; other vulnerable points include bones and soft tissues.

Around 70% of patients with localized bone cancer without metastasis can become cancer-free with treatment. The recovery rate for metastatic patients drops to 20%.

 

Required Examinations

Medical experts have to use radiographs, whole bone resonance, computed tomography, and bone scintigraphy as initial exams.

Radiographs usually reveal poorly defined radiodense; the presence of the Codman triangle and the image of sun rays are also common.

MRIs can detect tumor plans and the presence of metastatic portions. Tomography informs us about the presence of lung metastasis.

Treatment of Osteosarcoma

The osteosarcoma treatment protocol is based on neoadjuvant chemotherapy (i.e., before the surgical procedure), followed by surgery and after that, adjuvant chemotherapy (after surgery).

Complete surgery with en bloc resection of the lesion is the standard for local control. There is still no consensus on how large the margin should be, but we know that the tumor-free margin is fundamental.

Amputation surgery is carried out when the medical team confirms that the patient can no longer have a functional limb after wide resection (disease-free limb). It is essential to take an updated image of the case for the correct planning of the resection.

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