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Osteosarcoma
How should osteosarcoma be treated?
Osteosarcoma is a malignant tumor that devours bone, commonly occurring in adolescents and young adults, typically at the proximal end of the tibia or the distal end of the femur, and at the proximal end of the humerus in the upper limbs, which is the metaphysis. The main clinical symptoms are pain, which becomes more pronounced at night, and there is generally a mass at the site, with limited movement. The local skin temperature may increase, and some may exhibit distended veins. Patients with malignant tumors generally gradually lose weight, eventually developing cachexia and even pathological fractures. Osteosarcoma is asymptomatic in its early stages, and once detected, it is usually in the middle to late stages. Radiographic examinations are necessary for diagnosis, typically showing specific changes such as Codman’s triangle or a sunburst pattern, which are characteristic of osteosarcoma. Surgery is necessary at times, to remove and examine the pathology. Common surgical approaches include resection with inactivation and reimplantation, or the insertion of a prosthesis for limb-sparing procedures, while another option is amputation, followed by extensive chemotherapy. With the rapid advancements in chemotherapy in recent years, the survival rate for osteosarcoma has generally increased significantly, typically about 50% over five years. However, early-stage pulmonary metastasis occurs very frequently with osteosarcoma, necessitating early diagnosis and treatment. The primary treatment is surgical, complemented by postoperative chemotherapy.
Is there a cure for bone metastasis of osteosarcoma?
Is there any hope for osteosarcoma bone metastasis? If osteosarcoma develops bone metastasis, there is still hope for treatment. However, once metastasis occurs, the treatment costs, difficulty, and prognosis tend to be relatively unfavorable. Additionally, osteosarcoma itself invades and damages the bone. As the disease progresses, it stimulates osteogenesis which eventually leads to both bone formation and damage. Generally, the appearance of osteogenic changes often indicates a shift towards a better prognosis for the bone. Therefore, if osteosarcoma has metastasized, while treating the primary lesion of the tumor, it is also crucial to actively treat the metastatic sites. Thus, the difficulty of the treatment and the prognosis might not be very optimistic, but it certainly hasn't reached a point where the disease is untreatable. Therefore, once osteosarcoma metastasizes, it is recommended to visit the oncology department of a reputable hospital for systematic treatment by a doctor.
Can osteosarcoma be seen on an X-ray?
Osteosarcoma can be detected through characteristic changes in X-ray imaging, such as the Codman's triangle, which usually occurs around the joints at the metaphyseal ends of the long tubular bones in the limbs. This leads to the destruction of the trabeculae and increased density of the tumor tissue, which can break through the cortical bone. The tumor can lift the periosteum to form the characteristic Codman's triangle. Therefore, orthopedic doctors can preliminarily diagnose it as a bone tumor or osteosarcoma based on the appearance in this X-ray. Additionally, diagnosis should be correlated with clinical symptoms such as the presence of a noticeable mass, pain, tenderness in the localized area, and general symptoms of cachexia, such as weight loss, anemia, fever, and malaise.
What are the symptoms of osteosarcoma recurrence?
The symptoms of recurrent osteosarcoma include the following points: Firstly, if osteosarcoma recurs, it can cause sudden severe pain in the affected limb. This pain tends to intensify as the disease progresses and may shift from intermittent pain to continuous pain. Secondly, there might be metastasis to the lungs or other parts of the body. In such cases, if lung metastasis occurs, the patient will experience significant chest tightness and breathing difficulties. Thirdly, recurrent osteosarcoma can also lead to weight loss, decreased appetite, and the occurrence of low-grade fever. Fourthly, if the tumor recurs, the patient’s joints and the affected limb's mobility will be significantly hindered, and this can also cause numbness in the affected limb.
Is a fracture in osteosarcoma very dangerous?
Osteosarcoma is a malignant tumor of the bone, commonly found in adolescents and young adults, primarily occurring near the proximal tibia, distal femur, and proximal humerus, mostly at the metaphyseal ends. The tumor itself can lead to bone destruction and periosteal reactions. Pathological fractures may occur, which are frequently observed clinically. If a fracture occurs, radiographic examination can generally detect it, often showing a Codman's triangle or sunburst pattern. Early detection and treatment are crucial. Once a pathological fracture is observed, it typically indicates a middle to late stage of the disease, with a particularly high likelihood of lung metastasis. The situation with just a pathological fracture is quite severe, and unlike other fractures that might be managed with steel plates or intramedullary pins, treatment here is conservative, possibly requiring amputation, though limb-sparing approaches may also be necessary. Detecting the condition early, before distant metastasis, and combining treatment with radiotherapy or chemotherapy, can result in a five-year survival rate above 50%. The threat posed by pathological fractures alone is significant, and amputation may be necessary, with chemotherapy likely required post-surgery.
How is osteosarcoma formed?
The causes of osteosarcoma are not yet definitively determined, but it is generally believed to be closely related to trauma, genetics, and living environment. Osteosarcoma typically occurs in adolescents and is a highly malignant disease. If not treated promptly, it can lead to death within three to six months. After the diagnosis of osteosarcoma, amputation through surgery is the only effective treatment method. Amputation may extend the patient's survival period, but there is a high risk of recurrence, which can lead to death.
What is the metastatic pathway of osteosarcoma?
Osteosarcoma commonly spreads in three ways. The first is through hematogenous dissemination, meaning that tumor cells spread throughout the body via the bloodstream, a process known as hematogenous spread. The second method is called implantation metastasis, where tumor cells directly implant in the common sites of osteosarcoma, leading to localized disease. The third type is lymphatic spread, where tumor cells spread to multiple parts of the body through the lymphatic system, causing new tumor growth. These three pathways are the most common routes of metastasis seen clinically in osteosarcoma, with hematogenous spread being the most frequent.
During the treatment of osteosarcoma
Osteosarcoma is a highly malignant tumor of the bone, primarily presenting with pain, elevated skin ridges, and bulging veins. Radiological examination often reveals bone abnormalities, such as Codman's triangle and periosteal reactions due to sun exposure. If there is no metastasis in the early stages, limb amputation surgery can be performed, as well as limb-sparing surgeries involving devitalization and reimplantation or prosthetic implantation. Post-operative treatment involves high-dose chemotherapy, which can inhibit the growth of the bone tumor and extend the patient's survival time. There is a high probability of lung metastasis occurring in the early stages of the disease. If metastasis occurs, the survival time may be significantly reduced. Early diagnosis of this disease is crucial, and it must be treated with chemotherapy as early as possible. With the rapid development of chemotherapy, the five-year survival rate for osteosarcoma can increase to over 50%. Thus, early detection, early treatment, early surgery, followed by chemotherapy and radiotherapy are essential to prolong the patient's survival time.
The cause of osteosarcoma
At present, the causes of osteosarcoma are not yet clear, but it may be related to genetics, exposure to radioactive substances, and viral infections. It can also be secondary to other deformative osteitis and fibrous dysplasia of bone. Furthermore, some cases can also develop from other benign tumors, gradually degenerating into malignant tumors. Osteosarcoma commonly affects the long bones, mostly located at the metaphyseal ends, with fewer cases in the middle of the diaphysis. The tumor develops very rapidly, generally spreading gradually towards the ends of the bone, destroying the bone tissue, causing the tumor mass to quickly reach under the periosteum, and invading the neighboring muscle tissue outwardly.
Osteosarcoma common onset age
Osteosarcoma most commonly occurs in adolescents under the age of 20, or in children, and is a type of malignant tumor. It is the most common malignant bone tumor in children, accounting for about 5% of all malignant tumors in children, making this age group highly susceptible to osteosarcoma. The formation of osteosarcoma is mainly due to external factors such as viral infections and genetic mutations that lead to cell mutations. Osteosarcoma is a typical malignant tumor that destroys bone and surrounding soft tissue, leading to pathological fractures. It can also form distant metastases, thus posing a significant threat.