The Five P’s of Osteosarcoma

Pathophysiology

Osteosarcoma is a cancer that affects the bones, caused by abnormal cells dividing and growing where they should not be. The cells grow out of control without dying off, creating a clump of cells that threaten the health of the functioning cells surrounding them. There is no definite cause for the cells multiplying in this way.

Presentation

Most cases present in the long bones of the body, with almost 75% of those cases being located in the leg bones, 11% in the upper long bones, and the remaining cases affecting any other bone in the body. In cases where the patient previously had a malignancy, the skull and pelvis are also at high risk for developing osteosarcoma, with a development rate of 24% (Mirabello, Troisi, & Savage, 2009, p. 4).

Like other cancers such as breast and prostate cancer, there is a possibility of a visible mass at the affected site, but there is no guarantee of this as an indicator; pain at the site is more common, especially since osteosarcoma usually affects a joint or growth plate, and thus mobility and function of the affected limb should be limited (Mehlman, 2012). Because it is not necessarily a visible disease, biopsy is the most reliable form of diagnosis, and must be performed by an orthopedic surgeon.

Population

75% of osteosarcoma patients are between the ages of 14-21 years of age, but patients 60-85 and over demonstrated a secondary peak in cases, indicating that the cancer is affected by the age of the patient (Mirabello et al., 2009, p. 3). Female patients are less common than male patients in every age bracket, while black patients are more common than any other race, including white, Asian, Hispanic, and American Indian (Mirabello et al., 2009, p. 2; p. 7). Patients with osteosarcoma also had a fairly high occurrence of Paget’s disease, suggesting at least a loose connection, especially in white patients 65 and older.

Patient Management

The best treatment for osteosarcoma is chemotherapy, which has been developed to a point where outpatient treatment is possible. With the updates in technology allowing for greater ease in tracking patient records (online records, phone contact with patients, etc.), attending nurses can spend more time tending to patients as individuals, all while keeping everything up to date during treatment and inpatient chemo administration. Amputation is also an option but runs a high risk of recurring if not treated with chemotherapy (Mehlman, 2012).

Thus, patients are often treated with chemotherapy to eliminate any cells that have metastasized elsewhere in the body, before undergoing surgery to remove the main tumor mass. In caring for the cancer patient this way, patients have a better prognosis than patients who undergo surgery alone (Mehlman, 2012). During this process, patients must go through the normal side effects of chemo and may depend on nurses to help improve their quality of life, both as in- and outpatients, to keep their stress down with friendly assessment and management of medication.

Prognosis

Female patients are more likely to have a survival rate in the 5-year remission stage, at 68.5% versus 58.4% in the 0-24 age bracket, 64% versus 54.6% in the 25-59 age bracket, and 27% versus 19.9% in the 60-85+ age bracket (Mirabello et. al, 2009, pp. 4-6). As expected, the survival rates for older patients are significantly lower. Patients who combine pre-surgery chemo with typical surgery to remove their remaining tumors have a higher rate of survival in the five-year period than patients who do not. The location of the tumor is an important factor also in survival rates.

References

Mehlman, C. T., & Cripe, T. P. (2012, April 24). Osteosarcoma. Medscape. Retrieved from emedicine.medscape.com/article/1256857-overview

Mirabello, L., Troisi, R. J., & Savage, S. A. (2009). Osteosarcoma incidence and survival rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program. Cancer, 115(7), 1531–1543.