Osteosarcoma

What is osteosarcoma?

Osteosarcoma Care Guide

 Osteosarcoma
 Osteosarcoma Aftercare Instructions
 Osteosarcoma Discharge Care
 Osteosarcoma Inpatient Care
 En Espanol

 Osteosarcoma is a kind of cancer. Cancer is a condition where cells grow and divide
without control or order, often making a tumor (lump). Osteosarcoma is a tumor made of
cells that produce bone. Osteosarcoma is commonly found inside the long bones of your
body, such as your arm and leg bones. It may also grow on the surface of your bones or in
your soft tissue, such as muscles. Osteosarcoma can occur in people of all ages. The cancer
more commonly occurs when a person's bones are still growing, such as with children and
young adults.

 Cancer cells may spread to other areas of your body. Once cancer cells spread, the
cancer becomes harder to treat. Having your osteosarcoma treated may help relieve your
symptoms, such as pain and swelling. Osteosarcomas that are found and treated early have
a higher chance of being cured.

What causes osteosarcoma?

The exact cause of osteosarcoma is unclear. Caregivers believe any of the following conditions
may increase your risk of having osteosarcoma:

 Bone diseases: Bone diseases, such as Paget's disease and fibrous dysplasia, may
increase your risk of having osteosarcoma. Ask your caregiver for more information about
these bone diseases.
 Chemicals: Being around certain chemicals, such as beryllium oxide, may increase
your chances of getting osteosarcoma. Ask your caregiver for more information about these
chemicals.

 Genetic diseases: Genes are little pieces of information that tell your body what to do
or make. You may be at an increased risk for osteosarcoma if you have damaged genes.

 Other cancers: Cancer in other areas of your body, such as a retinoblastoma, also

increases your risk for osteosarcoma. Retinoblastoma is a cancer of your retina. Your retina
is the part of your eye that captures light and sends information to your brain.

 Radiation: Past exposure to radiation may increase your risk for osteosarcoma. You
may have had radiation in the past to treat another cancer

What are the signs and symptoms of osteosarcoma?

At first, you may have no signs and symptoms of osteosarcoma. As your tumor grows, you may
have any of the following:

 Early stage:

o Pain with movement of the area where your tumor is growing.

o Fever (high body temperature).

o Feeling tired most of the time.

 Late stage:

o Pain with movement, and at rest in the area where your tumor is growing.
Your pain may worsen and begin to wake you from sleep.

o Trouble moving or using your arm or leg (limb) where your tumor is. Your
limb may lose strength and feel limp (floppy).
 o A lump in your involved limb that you can see or feel.

o Red and warm skin around the area of your tumor.

o Swelling of your involved limb or area of your tumor.

o Swollen blood vessels that may cause bulges under your skin.

o Weak or damaged bones. Your tumor may cause a fracture (break) in your
involved bone.

How is osteosarcoma diagnosed?

Your caregiver will do a complete physical exam. If your tumor forms a mass that can be seen,
your caregiver will measure its size. The location and shape of your tumor, and your skin
temperature will also be noted. Your caregiver may move your involved limb to see if your mass
changes with the movement. He may feel your tumor to check if it is hard or soft, and painful
when touched. He will check your muscles near your tumor to see if they have become smaller.
He will feel for any masses that may have spread to other areas. You may also need any of the
following tests:

 Biopsy: This procedure is needed to see if you actually have cancer. Your caregiver
will remove a part of your mass using a needle. He may also cut out a small piece of your
bone. The bone or tissue sample is then sent to a lab for tests. Your biopsy will be done
after the following imaging tests:

o Bone scan: This is a test to look at your bones. You are given a special dye
as a shot into your vein (blood vessel). Pictures are then taken of your bones.
Caregivers can look at the pictures to check for cancer in your bones and for any
broken bones. Your caregiver may also use these pictures to see if your cancer has
spread.

o Computerized tomography scan: This is also called a CT scan. A special

x-ray machine uses a computer to take pictures of your body. Your caregiver may
 take pictures of your involved bone to check for a tumor or other problem. This test
will also show your nerves and the blood flow around your tumor. Your caregiver
may also take pictures of your chest to see if cancer has spread to your lungs.

o Magnetic resonance imaging: This test is also called an MRI. During the

MRI, 3-D (three-dimensional) pictures are taken of your body. If you have a tumor,
your caregiver will use these pictures to check its size. The pictures will also show if
your tumor is affecting the blood vessels, nerves, and tissues around it. Your
caregiver may also be able to see if your tumor has spread to other bones and nearby
joints. MRI pictures may also help your caregiver plan your biopsy and treatment.

o X-ray: Your caregiver will take a picture of your involved bone. The picture
may show if your bone has a tumor, a fracture (break), or other problem. X-rays may
also show if there are changes in your bone where your tumor is growing. The X-ray
may also be used to take a picture of your lungs to see if your cancer has spread.

How is osteosarcoma treated?

The goal of treatment is to remove the cancer from your body. You may need one or more of the
following:

 Chemotherapy: This medicine, often called chemo, works by killing cancer cells. It is

normally given through a vein (blood vessel). Your caregiver may use this medicine to
make your tumor smaller before surgery. Chemo may also be needed after your surgery.
Chemo after your surgery may help to kill any cancer cells that have spread to other areas.

 Surgery: Surgery may be needed to remove your tumor. The bones and tissues around
your tumor may also need to be removed. A bone graft may be used to replace any bone
that was removed. A bone graft is a piece of bone that may be taken from another area of
your body. The bone graft may also come from a donor (another person). A prosthesis
(man-made part) may also be used to replace the bone that was removed. In some cases,
your caregiver may have to amputate (remove) your limb to remove your cancer.
 Radiation therapy: Radiation is a treatment using x-rays or gamma rays to treat your
cancer. Radiation works to kill cancer cells and prevent it from spreading. You may need
this treatment if your tumor cannot be removed through surgery. You may also need
radiation along with chemo or surgery to treat your cancer.

Where can I find support and more information?

Osteosarcoma is a life-changing condition for you and your family. Accepting that you have
cancer is hard. You and those close to you may feel scared, sad, or angry. These feelings are
normal. Talk to your caregivers, family, or friends about your feelings. Learning about your
cancer may help you and your family cope with your condition. You may also want to join a
support group for people who have osteosarcoma. Contact the following for more information:

 American Cancer Society

250 Williams Street
Atlanta , GA 30303
Phone: 1- 800 - 227-2345
Web Address: http://www.cancer.org

 Cancer Information Service

Cancer Information Service
Phone: 1- 800 - 422-6237
Web Address: http://www.nci.nih.gov

When should I call my caregiver?

Call your caregiver if:

 Your pain and swelling worsen.

 You see or feel new lumps under your skin.

 You have a lump that is getting bigger.

 You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

 You have no feeling in or near the area where your osteosarcoma is.

 You are unable to move your limb where your tumor is.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your
health condition and how it may be treated. You can then discuss treatment options with your
caregivers. Work with them to decide what care may be used to treat you. You always have the
right to refuse treatment.

Treatment options:

The main goal of treatment is to remove the cancer from your body. You may have any of the
following treatments alone or together:

 Chemotherapy: This medicine, often called chemo, works by killing cancer cells. It is

normally given through an IV into your vein. Your caregiver may use this medicine to
make your tumor smaller before surgery. Chemo may also be needed after your surgery.
Many different chemo medicines are used to treat cancer. Chemo can also have many side
effects. Caregivers will watch you closely and work with you to decrease any side effects.

o Folinic acid: Your caregiver may give you folinic acid with your chemo.
Chemo may kill your normal cells along with your cancer cells. Folinic acid may
protect the cells in your bone marrow and stomach lining from the effects of
chemotherapy. Do not confuse this medicine with the vitamin folic acid.
 Radiation therapy: Radiation is a treatment using x-rays or gamma rays to treat
cancer. Radiation kills cancer and works to keep your cancer from spreading. You may also
need radiation along with chemo or surgery to treat your cancer.

 Surgery:

o Surgery may be needed to remove your osteosarcoma. The bones and tissues
around your tumor may also need to be removed. A bone graft may be used to replace
any bone that was removed. A bone graft is a piece of bone that may be taken from
another area of your body. The bone graft may also come from a donor (another
person). A prosthesis (man-made part) may also be used to replace the bone that was
removed. In some cases, your caregiver may have to amputate (remove) your limb to
remove your cancer.

o If cancer cells have spread to other areas of your body, you may need
another surgery to remove them. Ask your caregiver for more information about
additional surgeries.

Treating Osteosarcoma
Treatment of osteosarcoma in children includes chemotherapy(the use of medical drugs to kill
cancer cells and shrink the cancer) followed by surgery (to remove cancerous cells or tumors)
and then more chemotherapy (to kill any remaining cancer cells and minimize chances of the
cancer coming back). Surgery often can effectively remove bone cancer, while chemotherapy
can help eliminate remaining cancer cells in the body.

Surgical Treatment

Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery.

Currently, most teens with osteosarcomas involving an arm or leg can be treated with limb-
salvage surgery rather than amputation. In limb-salvage surgery, the bone and muscle affected by
the osteosarcoma are removed, leaving a gap in the bone that is filled by either
a bone graft (usually from the bone bank) or more often a special metal prosthesis. These can be
appropriately matched to the size of the bone defect. The risk of infection and fracture is higher
with bank bone replacement and therefore metal prostheses are more commonly used for
reconstruction of the bone after removal of the tumor.

If the cancer has spread to the nerves and blood vessels surrounding the original tumor on the
bone, amputation (removing part of a limb along with the osteosarcoma) is often the only choice.

When osteosarcoma has spread to the lungs or elsewhere, surgery may also be performed to
remove tumors in these distant locations.

Chemotherapy

Chemotherapy is usually given both before and after surgery. It eliminates small pockets of
cancer cells in the body, even those too small to appear on medical scans. A child or teen with
osteosarcoma is given the chemotherapy drugs intravenously (through a vein) or orally (by
mouth). The drugs enter the bloodstream and work to kill cancer in parts of the body where the
disease has spread, such as the lungs or other organs.

Short-Term and Long-Term Side Effects

Amputation carries its own short-term and long-term side effects. It usually takes at least 3 to 6
months until a young person learns to use a prosthetic (artificial) leg or arm, and this is just the
beginning of long-term psychological and social rehabilitation.

With a limb salvage surgery, one usually starts bending the knee or the affected body part almost
immediately. A continuous passive motion (CPM) machine, that continuously bends and
straightens the knee may be used to improve motion for tumors around the knee. Physical
therapy and rehabilitation for 6 to 12 months following surgery usually enables the child to walk
initially with a walker or crutches and then without any assistive devices. Early complications
after surgery include infection and slow healing of the surgical wound, and the metal prosthetic
device or the bank bone may need to be replaced in the long term. Other late problems might
include fracture of the bank bone or failure of the bank bone to heal to the child's bone, which
might require more surgery.
Many of the medications used in chemotherapy also carry the risk of both short-term and long-
term problems. Short-term effects include anemia, abnormal bleeding, and increased risk of
infection due to destruction of the bone marrow, as well as kidney damage and menstrual
irregularities. Some drugs carry a risk of bladder inflammation and bleeding into the urine,
hearing loss, and liver damage. Others may cause heart and skin problems. Years after
chemotherapy for osteosarcoma, patients have an increased risk of developing other cancers.

Chances for a Cure

Recent studies have reported that survival rates of 60% to 80% are possible for osteosarcoma
that hasn't spread beyond the tumor, depending on the success of chemotherapy.

Osteosarcoma that has spread cannot always be treated as successfully. Also, a child whose
osteosarcoma is located in an arm or leg generally has a better prognosis than one whose disease
involves the ribs, shoulder blades, spine, or pelvic bones.

New Treatments

Treatments are being developed and researched with new chemotherapy drugs. Other research is
focused on the role certain growth factors might play in the development of osteosarcoma. This
research may be used to develop new medications to slow these growth factors as a way to treat
the cancer.

For osteosarcomas that cannot be removed surgically, studies are now underway to test
treatments that use new combinations of chemotherapy and localized, high-dose radiation.

What is standard therapy for osteosarcoma?

The standard therapy for osteosarcoma is surgery with chemotherapy given before and after

surgery. The chemotherapy is used to reduce tumor size or prevent any recurrence of cancer

cells.

The percentage of destroyed tumor cells found in the tumor after surgery will indicate the type
of chemotherapy treatment that should be used after the surgery.

Before major surgery to remove the tumor, chemotherapy is usually given. This can
shrink the tumopr and it makes surgery easier. It also may kill any cancer cells that have
spread to other parts of the body.

Common chemotherapy medicines include:

 Cisplatin
 Carboplatin (Paraplatin)
 Cyclophosphamide (Cytoxan)
 Doxorubicin (Adriamycin)
 High-dose methotrexate with leucovorin
 Ifosfamide (Ifex)

Surgery is used after chemotherapy to remove any remaining tumor. In most cases,
surgery can remove the tumor while saving the affected limb (this is called limb-salvage
surgery). Rarely, more radical surgery (such as amputation) may be necessary.

Nursing Responsibilities:
•
Assist child and family to cope with the problem
•
Provide time for child and family to accept the diagnosis
•
Encourage family and client to verbalize
•
Post-operatively, child is fitted with a prosthesis
•
Provide nursing care of post-op amputation
•
Provide with normal growth and development activities