Osteosarcoma etiology

Written by Wang Cheng Lin
Orthopedics
Updated on February 15, 2025
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Currently, in clinical practice, the pathogenesis of osteosarcoma is not fully understood. However, it may be related to genetics, exposure to radioactive materials, and viral infections. It can also be secondary to other deformative osteitis, fibrous dysplasia, and some benign tumors transforming into malignant bone tumors. Osteosarcoma primarily occurs in the metaphysis of long bones. The tumor spreads along the marrow cavity, extending towards both the metaphysis of the long bones and the diaphysis of the bones. Once the tumor breaks through the bone shaft, it rapidly destroys the cortical bone, spreads under the periosteum, and invades the surrounding soft tissues outside the eardrum, damaging the surrounding muscles and soft tissues.

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Written by Wang Cheng Lin
Orthopedics
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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.

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Written by Wang Cheng Lin
Orthopedics
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Will osteosarcoma cause the skin to turn red?

Patients with osteosarcoma will not have red skin. The early symptoms of osteosarcoma are generally not obvious, primarily involving localized swelling, with pain around the joints leading to limited joint mobility. As the condition progresses, this pain may shift from intermittent to constant, and the severity of the pain will increase as the disease worsens. The second patient will exhibit a noticeable lump that can be felt; this lump is usually accompanied by significant tenderness. The third symptom is intermittent limping, caused by pain from the tumor during walking, which prevents the patient from bearing weight for extended periods. The fourth aspect involves systemic symptoms common to patients with tumors, such as anemia, mild fever, and even pathological fractures.

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Written by Fang Da Zheng
Orthopedics
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Are osteosarcomas sensitive to radiotherapy and chemotherapy?

Osteosarcoma is generally insensitive to radiotherapy, hence radiation therapy is not used for such diseases in clinical settings. Similarly, these diseases have a moderate sensitivity to chemotherapy, necessitating the use of relatively high doses of chemotherapy during treatment. The main mechanism of chemotherapy involves using a series of cytotoxic drugs to inhibit tumor growth. Although high-dose chemotherapy can effectively kill tumor cells, it can also damage some of the patient's normal cells, leading to severe reactions. If radical surgery is viable for these patients, then curative surgery is the preferred method of treatment.

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Written by Na Hong Wei
Orthopedics
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How is osteosarcoma diagnosed?

Currently, the diagnosis of osteosarcoma in clinical settings primarily relies on a combination of clinical symptoms, imaging studies, and pathological findings. Clinically, osteosarcomas commonly occur in the distal femur, proximal tibia, and lower end of the humerus, manifesting as localized persistent pain, nocturnal pain, and swelling, often accompanied by superficial venous engorgement and increased skin temperature. Systemic symptoms of cachexia may appear, and even pathological fractures. Imaging is indispensable, revealing osteoblastic, osteolytic, or mixed osteolytic lesions, usually with a pronounced periosteal reaction, Codman's triangle (a common sign of malignancy), or sunburst patterns. Magnetic resonance imaging (MRI) is very important for diagnosing bone tumors as it can indicate the tumor's boundaries and the extent of erosion. Additionally, PET-CT and radioactive isotope scanning are considered crucial for tumor diagnosis. Pathological examination is currently regarded as the gold standard for diagnosing osteosarcoma. This involves a biopsy, usually taking a small part of the tumor for examination from a molecular biology perspective. However, when performing a biopsy, it is important to note two things: first, it is preferable to take the biopsy intraoperatively; second, if there is no plan for systematic treatment of osteosarcoma, it is best not to proceed with a biopsy to avoid potentially accelerating the spread or even hastening metastasis. Therefore, the diagnosis of osteosarcoma must be approached with caution, requiring a combination of clinical symptoms, necessary auxiliary examinations, and pathological analysis.

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Written by Li Jie
Orthopedics
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Symptoms of osteosarcoma recurrence

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.