What is Osteogenic sarcoma?
Prevalence
According to Wikipedia.org, Osteogenic Sarcoma is the 6th leading cancer in children under age 15. Osteogenic Sarcoma affects 400 children under age 20 and 500 adults (most between the ages of 15-30) every year in the USA. Most often it affects the lower end of femur... it tends to affect the area around the knee in 60% of cases. Osteosarcoma is categorized as a rare cancer.
Symptoms
Many patients first complain of pain that may be worse at night, and may have been occurring for some time. If the tumor is large, it can appear as a swelling. The affected bone is not as strong as normal bones and may fracture with minor trauma (a pathological fracture). (Steve's pain fit this statistic perfectly.)
Diagnosis
Family physicians and orthopedists rarely see a malignant bone tumor (most bone tumors are benign). Thus, many patients are initially misdiagnosed with cysts or muscle problems, and some are sent straight to physical therapy without an x-ray.
The route to osteosarcoma diagnosis usually begins with an x-ray, continues with a combination of scans (CT scan, PET scan, bone scan, MRI) and ends with a surgical biopsy. Films are suggestive, but bone biopsy is the only definitive method to determine whether a tumor is malignant or benign.
The biopsy of suspected osteosarcoma should be performed by a qualified orthopedic oncologist. The American Cancer Society states: "Probably in no other cancer is it as important to perform this procedure properly. An improperly performed biopsy may make it difficult to save the affected limb from amputation."
Treatment
Patients with osteosarcoma are best managed by a medical oncologist when possible (or amputation in some cases) and an orthopedic oncologist experienced in managing sarcomas. Current standard treatment is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection. The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regime should be altered after surgery.
Standard therapy is a combination of limb-salvage orthopedic surgery when possible (or amputation in some cases) and a combination of high dose methotrexate with leucovorin rescue, intra-arterial cisplatin, adriamycin, ifosfamide with mesna, BCD, etoposide, muramyl tri-peptite (MTP). Rotationplasty is also another surgical technigue that may be used. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. (Steve received the metho/leucovorin, cisplatin and adrimyacin chemo protocol.
Despite the success of chemotherapy for osteosarcoma, it has one of the lowest survival rates for pediatric cancer. The best reported 10-year survival rate is 92%; the protocol used is an aggressive intra-arterial regimen that individualizes therapy based on ateriographic response.[1] Three-year event free survival ranges from 50% to 75%, and five-year survival ranges from 60% to 85+% in some studies. Overall, 60-65% of patients treated five years ago will be alive today. These survival rates are overall averages and vary greatly depending on the individual necrosis rate.
Fluids are given for hydration, while drugs like Kytril and Zofran help with nausea and vomiting. Neupogen, epogen, Neulasta help with white blood cell counts and neutrophil counts. Blood transfusion helps with anemia.
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