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OSTEOSARCOMA

Osteosarcoma is a type of rare sarcoma that start in the cells that form in the bones. one of the most common. It. It is most often found in the long bones like the legs  and arms but can start in any bone in the body. It happens more in teenagers and young adults, but can occur in younger children and older adults.

From a 10 year analysis in a research carried out on Osteosarcoma, the average age of the patient was 19.7 years. Over ten years, patients range from the age of nine years to seventy-five years. The majority of the cases were around the knee. Moreover, the male to female ratio was 2.7:1. The survival rate of osteosarcoma over five years was 7.5%. Only 25.8% of the patients survive for one year.  

Types of Osteosarcoma

Osteosarcoma can be classified into:

High grade osteosarcoma 

This type usually happens in teens and children  and is the fastest-growing type of osteosarcoma. Intramedullary osteosarcoma is the most common type of osteosarcoma. Almost 80% of patients suffer from this type of osteosarcoma. Subtypes of this include

  1. Osteoblastic 
  2. Chondroblastic 
  3. Fibroblastic 
Low-grade Osteosarcoma 

This type of cancer grows slowly and look quite similar to normal cells different subtypes are Parosteal or Intramedullary

 

Symptoms of Osteosarcoma

  • Pain in the bone the tumour is, especially at night
  • Swelling around the bone
  • Bones breaking at every slight injury
  • Patients mostly associate the pain with trauma or physical exercise.  
  • Limping

Causes of Osteosarcoma

The primary cause of osteosarcoma remains unclear. However, certain genetic abnormalities can be probable causes of primary osteosarcoma 

Age

Kids who are having a growth spurt are at risk of getting osteosarcoma.

Previous cancer treatment

Having previous chemotherapy or radiation treatments can slightly increase the risk of getting osteosarcoma in future.

Gender

Osteosarcoma tends to happen more in males than females.

Certain health conditions

Like Bloom syndrome, Paget’s disease, Werner syndrome, hereditary retinoblastoma, Li-Fraumeni syndrome, and Rothmund-Thomson syndrome can increase the risk of getting bone cancer.

Diagnosis

The complexity of bone malignancy can lead to difficulty in the diagnosis of the disease. It is always better to approach the diagnosis in a multidisciplinary manner.  

Physical Examination

The doctor may be able to detect or palpate a mass on physical examination. 

Imaging tests

This includes using x-ray, CT,MRI, PET and bone scans to check the location, if the cancer is still contained or if it has spread.

Biopsy

This can be done either as a needle biopsy ( a thin needle is inserted through the skin to remove small pieces of tissue from the tumour for testing) or surgical biopsy ( a portion or the entire tumour is removed).

Laboratory findings

Clinicians can also look for certain laboratory findings. These can be an indicator of osteosarcoma. Lactate dehydrogenase and alkaline phosphatase are the two most useful biomarkers. Alkaline phosphatase has a positive correlation with tumour volume. The same is the case with lactate dehydrogenase.  

Staging

According to the AJCC system, osteosarcoma is based on certain factors. It includes the size of the tumour spread to the lymph nodes, metastasis, and the grade.  

Stage 1

This is low-grade cancer. Stage 1 cancer has not spread outside of the bone. It has two subtypes. Stage 1a has not spread outside the bone. Stage 1b has somewhat spread to the bone wall.  

Stage 2

This type of osteosarcoma is a high grade. The cancer is still restricted to the bone that it started in (stage 2A). or it is high grade and grown outside of the bone wall.  

Stage 3

This can be either low-grade or high-grade but has  metastasized to other parts of the body. such as the lungs and liver.  

Treatment

The traditional treatment for the conventional type of osteosarcoma includes the use of chemotherapy and surgery. Surgeons can treat Low-grade osteosarcoma with simple excision of the tumour. However, before amputation, it is better to check for metastasis.  

Surgery

Surgery can be used to remove the cancer only and spare the limb. This will hugely depend on the extent of the cancer and how much muscle and tissue need to be removed. If a part of the bone is removed, the bone might need to be reconstructed.

Surgery can also be used to remove the affected limb ( amputation) if the cancer has spread or the lower portion of the leg (rotationplasty). The use  of prosthetic  joints or limbs will be used  to improve function of the limbs.

Chemotherapy

Chemotherapy uses cytotoxic drugs to kill the cancer cells. It is used pre-surgery to try shrink the cancer in order to avoid amputation if necessary. It can also be used after surgery to kill any remaining cancer cells or to slow the growth of the disease.

Radiation

This may be sued if surgery isn’t possible or the cancer cannot be removed during an operation.

REFERENCES 

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