Oseosarcoma

Introduction:Osteosarcoma is one of the common types of bone cancer. Though Osteosarcoma can develop in any part of the body, the most common sites are around the knee joint and close to the shoulder. As it develops from osteoblasts (the cells of developing bone), it commonly occurs in children. It is probably caused by genetic factors which changes immature bone cells into cancer cells.Clinical Presentation:1. pain and swelling in leg or arm2. limping gait3. fracture with trivial trauma4. backache5. loss of bladder/ bowel control ( pelvic osteosarcoma)Signs:1. swelling just above or below knee joint/ upper arm/ near shoulder2. painful & limited movements of joint3. limping gait in case of leg swelling4. signs of incontinence of bladder/ bowel in case of pelvic or spinal osteosarcoma5. chest signs in case of metastatic or advanced diseaseDiagnosis:1. X-ray of bone- Lytic lesion with indistinct margins or ossification in the soft tissue with sunburst pattern. Reactive new bone formation is seen as a periosteal elevation, a sign named as a ‘Codman’s angle’ or ‘Codman’s triangle’.2. MRI of involved bone3. CT chest4. Bone scan5. Tru-cut needle biopsy of tumorTypes1. Central OsteosarcomaConventionalTelangiectaticSmall cellLow grade2. Surface OsteosarcomaParaostealPeriostealHigh gradeTreatment:1. Surgical: Surgical treatments for osteosarcoma consist of either amputation or limb-salvage surgery. Nowadays Limb salvage surgery preferred over amputation. In case of metastatic disease in the lungs, surgery is done to do pulmonary metastatecomy.2. Chemotherapy: Chemotherapy is given before as well as after surgery. This is called Neoadjuvant chemotherapy and Adjuvant chemotherapy. It removes the microscopic disease in the body.3. Radiotherapy: The use of radiotherapy is limited in osteosarcoma as it is not very effective. It is used in osteosarcoma that can not be removed surgically.Prognosis:In localized disease 60 to 80% survival rate has been reported. Limb osteosarcoma has better prognosis than flat bone osteosarcoma.