Unit 6- Osteosarcoma

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Osteosarcoma:

Osteosarcoma Lauren Blankenship, Ashlee Blount & Gabrielle Crippen 10/13/2013

Description of the Disease5, 6:

Description of the Disease 5, 6 Rapidly growing, malignant bone tumor that begins in the metaphyseal region of long bones Most commonly affects the younger population Cause is unknown Genetics and radiation thought to play a role

Signs & Symptoms5:

Signs & Symptoms 5 The most common symptom is pain Mild & intermittent pain progresses to severe & constant Palpable warmth & tenderness over tumor mass Impaired joint function due to proximity to joint Sunburst appearance on radiograph

Incidence6,8,9:

Incidence 6,8,9 Each year, approximately 400 children under age 20 are diagnosed with osteosarcoma Peak incidence is in the second decade of life, during the adolescent growth spurt Rare under age of 5 Males > Females Black > White The National Cancer I nstitute’s S urveillance , Epidemiology and End R esults (SEER) program reports 3,482 cases between 1973 and 2004.

Diagnosis4:

Diagnosis 4 Most cases of osteosarcoma are diagnosed before it spreads to another part of the body Imaging can be used to detect spread to other areas of the body, as well as tumor growth A biopsy is required for diagnosis Differentiates osteosarcoma from other types of cancer

Prognosis5:

Prognosis 5 Poor prognosis until a few decades ago Quick spread to lungs via blood 90% of individuals died within 3 years of dx Recently, prognosis has improved According to Salter, “the 5-year disease-free survival increased to more than 70%” This improvement in prognosis is thought to be due to chemotherapy & more effective surgeries

Functional Impact7 :

Functional Impact 7 Patients usually present with pain, swelling, and decreased joint motion Can affect activities of daily living Patient can develop body image disorders, since age of diagnosis is in often during teenage/young adult years Greatest during 1st year of diagnosis/treatment Both physical and psychological effects can hinder school, work, social, and other daily aspects of life

Imaging used for Dx & Management4:

Imaging used for Dx & Management 4 X-Rays can show location of osteosarcoma MRI scans show if the cancer has moved to a nearby area CT scans show if the cancer has moved to nearby tissues, such as muscle or fat Bone scans show if the cancer has spread to other bones Chest x-rays can show if the cancer has spread to the lungs

MRI for Osteosarcoma2:

MRI for Osteosarcoma 2 Detects an Osteosarcoma secondary to the contrast between soft tissue and bone marrow Staging of the tumor occurs via MRI Determines the extent of bone and soft tissue involvement Note: T2 MRI shows Osteosarcoma at distal femur Byrne A. Osteosarcoma - distal femur. Radiopaedia. January 13, 2010. Available at: http://radiopaedia.org/images/175168. Accessed: October 13, 2013.

Osteosarcoma Radiograph:

Osteosarcoma Radiograph Alignment : Overall the bones, femur, tibia, and fibula appear to be in normal gross alignment, with slight decrease in medial joint space. The cortices of the femur and tibia are in good symmetry, whereas the fibular head lacks this quality. A obvious bone deformity of the fibula is present. The contour and shape of the bone is appropriate and there does not appear to be any form of subluxation, dislocation or exostoses. Bone Density : The femur and tibia seem to have good bone density, with the exception of the fibula. Local changes in bone density can be indicative of tumors, and the fibula in this image does show some general loss of density, with a decrease in contrast. Kiani EM. Osteosarcoma Knee. Radiopaedia . January 2, 2009. Available at: http://radiopaedia.org/images/19479. Accessed: October 10, 2013.

Osteosarcoma Radiograph (cont.):

Osteosarcoma Radiograph (cont.) Cartilage Space : The joint space appears to be of normal width, indicating the cartilage has not degenerated. There is no evidence of meniscal calcification at the tibiofemoral joint. The space between the two joint surfaces is radiolucent, instead of radiodense as would be present with meniscal calcifications. The fact that there are no erosions or sclerotic changes visible in the subchondral bone suggests osteoarthritis may not be a factor with this subject. Soft Tissue : There appears to be minimal to no joint edema or effusion; therefore the joint capsule is not visible in this radiograph. However, some swelling is noted just distal to the knee, lateral greater than medial. There appears to be a sunburst present at the fibular head, which is commonly associated with osteosarcomas. Kiani EM. Osteosarcoma Knee. Radiopaedia . January 2, 2009. Available at: http://radiopaedia.org/images/19479. Accessed: October 10, 2013.

Questions for Students:

Questions for Students 1. Why would a patient diagnosed with osteosarcoma present to physical therapy with a fracture? 2. What two bones does osteosarcoma most commonly affect?

References:

References Byrne A. Osteosarcoma - distal femur. Radiopaedia. January 13, 2010. Available at: http://radiopaedia.org/images/175168. Accessed: October 13, 2013. Hide G. Imaging in classic osteosarcoma. Medscape. July 11, 2013. Available at: http://emedicine.medscape.com/article/393927-overview#a01. Accessed: October 13, 2013. Kiani EM. Osteosarcoma Knee. Radiopaedia . January 2, 2009. Available at: http://radiopaedia.org/images/19479. Accessed: October 10, 2013. Osteosarcoma Overview. American Cancer Society. 24 January 2013. Available at: http://www.cancer.org/cancer/osteosarcoma/overviewguide/osteosarcoma-overview-diagnosed. Accessed: October 11, 2013. Salter R. Textbook of disorders and injuries of the musculoskeletal system. 3rd Ed. Baltimore, MD:Lippincott Williams & Wilkins; 199 9. St. Jude’s Childrens Research Hospital. Solid tumor: osteosarcoma. St.Jude’s Childrens Research Hospital. http://www.stjude.org/stjude/v/index.jsp?vgnextoid=e6ab061585f70110VgnVCM1000001e0215acRCRD. Accessed October 13, 2103. American Cancer Society. Social, emotional, and other issues in people with osteosarcoma. American Cancer Society . http://www.cancer.org/cancer/osteosarcoma/detailedguide/osteosarcoma-after-social-emotional-issues Accessed: October 13, 2013. Savage S, Troisi R, Mirabello L. International osteosarcoma incidence patterns in children and adolescents, middle ages and elderly persons. Int J Cancer. 2009;125(1):229-234. Savage S, Troisi R, Mirabello L. Osteosarcoma incidence and survival rates from 1973-2004: Data from the surveillance, epidemiology and end results program. Int J Cancer. 2009;115(7):1531-1543.

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