Osteosarcoma is a malignant
Ewing's sarcoma it accounts for most primary bone malignancies.
There is a preference for the
region of tubular long
bones. 50% of cases occur around the
knee. It is a malignant
connective (soft) tissue tumor whose neoplastic cells present
differentiation and form tumoral bone.
It is the 6th leading cancer
in children under age 15. It affects 400 children under age 15 and 500 adults
between the ages of 15-30 every year. Approxiately 1/3 of the 900 will die each
year, or about 300 a year. A second peak in incidence occurs in the elderly,
usually associated with an underlying bone pathology such as
medullary infarct, or prior
Unfortunately although 90% or more of those with osteosarcoma will have a
limb-salvage surgery of their knee, because of infection, non-union, local
recurrence and other reasons some will lose a limb after limb-sparring surgery.
The tumor may be localized at the metaphyseal end of the long bones. Most
often it affects the upper end of
tibia or humerus, of
lower end of
femurus. The tumor is solid, hard, irregular ("fir-tree" or "sun-burst"
appearance on X-ray examination) due to the tumor spicules of calcified bone
radiating in right angles. Surrounding tissues are infiltrated.
Microscopically: Tumor cells are very
some are giant, numerous atypical
mitoses. These cells
with or without central calcification (hematoxylinophilic/blue,
granular) - tumor bone. Tumor cells are included in the
osteoid matrix. Cartilage may be present. Presence of immature blood vessels
(sarcomatous vessels lacking endothelial cells) favors the bloodstream
This type of bone tumor will first appears as a lump in long bones. Muscles
will start to become weaker as the affected bone part is not as strong as normal
bones. Since it is a bone tumor, the feel of it is bony but muscles are not
The causes of osteosarcoma are not known. Due to the rarity of osteosarcoma,
it appears that a
genetic predisposition exists which renders some individuals vulnerable to
developing the condition. Questions remain about whether
radium , or
fluoride, in drinking water can act as "environmental
triggers" for increasing the incidence of the disease.
Standard therapy is a combination of limb-salvage orthopaedic surgery and a
combination of high dose
cisplatin (with or without caffeine(Japan)),
ifosfamide with mesna,
muramyl tri-peptite (MTP).
Classic treatment is Intra-arterial cisplatin with Adriamycin. Ifosfamide can
be used as a adjuvant treatment if the
necrosis rate is low.
3-year event free survival ranges from 50% to 75%. and 5-year survival ranges
from 60% to 85+% in some studies. Overall, 60-65% treated 5-years ago(2000) will
be alive today. Osteosarcoma as one of the lowest survival rates for pediatric
cancer despite chemotherapy's success in osteosarcoma of 6 chemotherapies,
and being the prototype of solid tumors in cancer.
Treatment studies come from Children's hospital Boston, Memorial
Sloan-Kettering, Children's Oncology Group, Italian Oncology Group, Japan, and
MD Anderson in Texas.
Fluids are given for
Krytril and Zofran help
with nausea and
Neulasta help with
cell counts and
Blood helps with anemia.
Prognosis is separted into three groups.
- Stage I osteosarcoma has a good prognosis(>90%) and just requires
- Stage IIb prognosis depends on the site of the tumor(proximal
tibia, femur, pelvis, etc.) size of the tumor mass(in cm.), the degree of
necrosis from neoadjuvant chemotherapy(beforeoperation chemotherapy), and
pathological factors like the degree of p-glycoprotein, whether your tumor
CXCR4 positive, Her2 positive as these can lead to distant
metastases to the lung. Longer time to metastases, more than 12 months or 24
months and the number of metastases and resectability of them lead to the
best prognosis with metastatic osteosarcoma. It is better to have fewer
metastases than longer time to metastases. Those with a longer length of
time(>24months) and few nodules(2 or fewer) have the best prognosis with a
2-year survival after the metastases of 50% 5-year of 40% and 10 year 20%.
If metastases are both local and regional the prognosis is different
http://www.osteosarcomasupport.org/prognosis.htm) top two articles.
- Initial Presentation of stage III osteosarcoma with lung
metastates depends on the resectability of the primary tumor and lung
nodules, degree of necrosis of the primary tumor, and maybe the number of
metastases. Overall prognosis is 30% or greater depending.
Osteosarcoma is the most common bone tumor in dogs and typically afflicts
older large and giant breed dogs (for example,
German Shepherds, and
Great Danes). The
most commonly affected bones are the
the femur, and the
tibia. Other sites include
the ribs, the mandible,
the spine, and the pelvis.
tumors involving the limb bones is very common, usually to the lungs. The tumor
causes a great deal of pain, and can even lead to fracture of the affected bone.
Amputation of the leg is the initial treatment, although this alone will not
Chemotherapy combined with amputation improves the survival time, but most
dogs still die within a year. There are surgical techniques designed to save the
leg, but they do not improve the prognosis. One key difference between
osteosarcoma in dogs and humans is that the cancer is far more likely to spread
to the lungs in dogs.
Osteosarcoma is also the most common bone tumor in the cat and most commonly
affects the rear leg. The cancer is less aggressive in cats than in dogs, and
therefore amputation alone can lead to a significant survival time.
- Morrison, Wallace B. (1998). Cancer in Dogs and Cats (1st ed.).
Williams and Wilkins.
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