Symptoms of osteosarcoma recurrence

Written by Li Jie
Orthopedics
Updated on October 26, 2024
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Osteosarcoma is a relatively common type of malignant bone tumor, ranking second in incidence among malignant bone tumors. Typically, upon the development of osteosarcoma, surgery is required to scrape out the tumor focus, followed by limb-sparing or amputation surgery. Additionally, adjuvant radiotherapy and chemotherapy are employed. Generally, the local area may be maintained for a period, but the disease is prone to recurrence. There may be local recurrence at the site of surgery or distant recurrence, meaning tumor cells might seed and lead to tumors in other locations. Symptoms of both local and distant recurrences are similar to those at the initial onset, generally including significant pain, night pain, and rest pain. There will also be distinct X-ray signs of osteosarcoma in the bone. Furthermore, osteosarcoma may metastasize to the lungs, potentially causing symptoms such as cough, bloody sputum, phlegm, and fever—typical signs of intrapulmonary tumors. These are some of the common symptoms associated with the recurrence of osteosarcoma.

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Written by Na Hong Wei
Orthopedics
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What is osteosarcoma?

Firstly, osteosarcoma is a common type of malignant tumor, characterized by a mechanism that produces bone-like tissue. It has multiple subtypes and can also develop into a secondary osteosarcoma. Secondly, it commonly occurs in adolescents. Thirdly, it typically affects the proximal femur, distal tibia, and proximal humerus. Fourthly, common osteosarcomas are generally spindle-shaped, often located near joints. The surface may have elevated skin temperature and sometimes superficial vein distension is apparent. It often involves the entire bone, including the periosteum, cortical bone, and bone cavity. Generally, the tumor appears as a very fine greyish-white or brownish-red fish-flesh-like change. Osteosarcoma is a malignant tumor and is particularly prone to lung metastasis. According to tumor staging, it is at least stage IIB, indicating that it should be detected, diagnosed, and treated early. The earlier the treatment, the better the outcome and the higher the five-year survival rate.

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Written by Na Hong Wei
Orthopedics
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Postoperative recurrence symptoms of osteosarcoma

Symptoms of recurrent osteosarcoma after surgery are generally consistent with the symptoms before the initial surgery. The main symptoms include: Firstly, localized pain, which is persistent, progressive, and does not alleviate, including pain that worsens at night. Secondly, localized swelling, which usually occurs around the surgical site if limb-sparing surgery was performed, or at the stump if amputation was done. Thirdly, the appearance of systemic cachexia and symptoms of metastasis. Systemic cachexia typically includes weight loss, anemia, fatigue, and loss of appetite. For osteosarcoma, metastasis primarily targets the lungs, where numerous cancerous shadows can be detected. Thus, the main recurrent symptoms of osteosarcoma after surgery include pain, swelling, and cachexia.

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Written by Guan Yu Hua
Orthopedic Surgery
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Osteosarcoma Causes

Osteosarcoma is the most common malignant tumor of the bone and typically presents without symptoms in its early stages. The cause of osteosarcoma is unknown, and it often goes undetected until it has reached a moderate or advanced stage. It commonly develops at the distal end of the femur near the knee joint, at the proximal end of the tibia, or at the proximal end of the humerus, primarily at the end of the growth plate. The pain associated with osteosarcoma is usually persistent, especially severe at night, and can lead to symptoms such as anemia or general wasting. The tumor's surface may be warm to the touch, with prominent veins visible, and radiographic imaging might show a Codman's triangle, indicative of sunlight-like radiation patterns, as well as bone destruction and clear periosteal reaction. Surgical treatment is typically pursued, with amputation being the most common procedure, though limb-sparing surgeries are possible if the tumor is detected early enough. Some cases metastasize, most commonly to the lungs, requiring continued high-dose chemotherapy post-surgery to prolong survival. Generally, the five-year survival rate for osteosarcoma can exceed 50% with early diagnosis and treatment. The chances of survival heavily depend on the individual’s constitution, the timing of tumor detection, and the surgical intervention. The exact causes of osteosarcoma are unclear, and the potential for metastasis complicates treatment. Therefore, early surgical intervention is crucial for improving survival rates and enabling patients to maintain a normal life and work activities.

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Written by Na Hong Wei
Orthopedics
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Is there a cure for osteosarcoma?

Osteosarcoma is treatable, but it requires proper medical treatment. Currently, adjuvant chemotherapy significantly improves the five-year survival rate for osteosarcoma. The main treatment approach is still surgery as part of a comprehensive therapy. Specifically, the first step involves adequate preoperative chemotherapy, generally no fewer than six sessions over about eight weeks, or approximately two months. After this, patients often experience reduced pain, weight gain, improved positioning of the tumor, and a decrease in tumor size. Depending on the specific situation, a decision is made on the type of surgery to be performed—whether to amputate, preserve the limb, install a prosthetic, or use artificial bone as a replacement. Postoperative chemotherapy is usually also required to help ensure that the tumor does not recur and to increase the five-year or ten-year survival rate. Therefore, the current five-year survival rate for osteosarcoma has increased from the previous 40%-50% to about 80%. So, as long as one chooses the right hospital and the right treatment plan, and maintains confidence, osteosarcoma is usually treatable.

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Written by Na Hong Wei
Orthopedics
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Is osteosarcoma a cancer?

If we are to speak strictly, osteosarcoma is not cancer. This is because cancer typically refers to malignant tumors of epithelial tissue, whereas osteosarcoma, like all sarcomas, is a malignant tumor that occurs in connective or muscle tissue. Therefore, their origins are different: osteosarcoma is not cancer; it is a malignant tumor that occurs in bone tissue, commonly found in the distal femur, proximal tibia, and proximal humerus. So, strictly speaking, osteosarcoma is a sarcoma, a malignant tumor that occurs in bone tissue. It is not what one would typically refer to as cancer, which usually pertains to epithelial tissues, such as in cases of skin cancer or breast cancer. Osteosarcoma is therefore classified as a sarcoma, not as cancer.