Peds - Oncology - Osteosarcomas

Front 1

• What is the main characteristic of osteosarcomas (aka osteogenic sarcoma)?
  
• What are 5 types of osteosarcoma?
• What age range has peak incidence?
• What locations are most common for primary osteosarcoma?

Back 1

• Presence of osteoid (immature bone) produced by malignant cells within the bone
  
• Parosteal, periosteal, telangiectatic, small cell, intermedullary (most common)
  
• During pubescent growth spurts
• Distal femur, prox. tibia, prox. humerus, pelvis

Front 2

• How does osteosarcoma develop and progress?
  
• How does this relate to pathologic fx?

Back 2

• Of unknown origin, but osteoid is deposited within bone as thick masses that infiltrate normal compact bone, destroying it
• As the tumor develops, it breaks through the cortex, lifting the periosteum and forming a soft-tissue mass
• Destruction of the bone cortex predisposes pathological fx

Front 3

How does pain develop through tumor growth?

Back 3

• Tumor site pain is 2º growth into joint space and surrounding joint space tissue
  
• Pain begins minimal and intermittent
  
• As the tumor grows, it becomes consistent and intensifies. It does not resolve with rest
  

Front 4

How do joints change that are infiltrated by tumor?

Back 4

• Joints become effused
  
• ROM becomes limited after just a few weeks
  
• Skin over joints become warm
  

Front 5

How is dx of osteosarcoma made?

Back 5

• Typically it is delayed 2º delayed MD visit due to diffuse complaints
  
• Radiographs reflect tumor formation with "moth-eaten" appearance
  
• CT/MRI used to further evaluate the extent of injury
  
• Confirmed with biopsy and histologic exam
  

Front 6

• Stage I A
  
• Stage I B
  
• Stage II A
  
• Stage II B
  
• Stage III
  

Back 6

• Low grade, intracompartmental
• Low grade, extracompartmental
• High grade, intracompartmental
• High grade, extracompartmental
• Anything with mets

Front 7

How is osteosarcoma typically treated?

Back 7

• Surgery with both pre- and post-op chemo
  
• No radaition
  

Front 8

What are the goals of chemotherapy

Back 8

• Control growth/development or shrink the size of primary tumor (may ↑ feasibility of limb salvage or ↓ degree of amputation)
  
• Control micro-metastatic lesion
  

Front 9

• What are 5-year survival rates of osteosarcomas with surgery and adjunctive chemo?
  
• With lung mets?
• With mets to other body areas?

Back 9

• 70-80%
  
• 20-30%
• 10-15%

Front 10

• What are 3 types of sx for osteosarcomas?
  
• What are characteristics of each?

Back 10

• Limb salvage (80-90% of cases; removal of bone tumor and surrounding tissue with reconstruction)
• Amputation (~6 cm prox. to tumor to remove all tumor and some lesions, afford longest residuum possible)
• Rotationplasty (dist. femur or prox. tibia tumors, ankle becomes new knee)
  

Front 11

What are acute care (phase 1) PT considerations for pts s/p rotationplasty?

Back 11

• Immune system precautions
  
• Wound care
• Coordinate treatments with pain meds
• Lab values
• WB status
• Desensitization of residuums
• Early mobilization, strengthening, ROM

Front 12

What are rehab (phase 2) PT considerations for pts s/p rotationplasty?

Back 12

• Strengthening of all limbs and core
  
• ROM, balance training
  
• Endurance activity/NRG conservation
  
• Utilization of ADs
  
• Pre-prosthetic and prosethetic fitting/training
  
• Age-appropriate play/ADLs
  

Front 13

What are outpatient (phase 3) PT considerations for pts s/p rotationplasty?

Back 13

• Continued prosthetic adjustment
  
• Continued endurance/cardio training
  
• Increase diversity of environments
  
• Sports, age-appropriate play/activity