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a brief lecture about osteosarcoma and its nursing management
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OSTEOSARCOMA
FUNCTIONS OF BONE
TISSUES
1. SUPPORT
2. PROTECTION
4. BONE HOMEOSTASIS
5. PRODUCTION OF BLOOD
CELLS
Osteogenic cells
Osteoblast cells
Osteocyte cells
Osteoclast cells
FOUR MAJOR TYPES OF CELL IN THE BONE
TISSUES
TYPES OF BONES
a. Long Boneb. Short Bonec. Irregular Boned. Flat Bone
CB AO NN CE E R
also known as “OSTEOGENIC SARCOMA”.
comes from a Greek work “osteon” which means
“bone” and “sarcoma” which is a type of cancer that develops from a certain “tissue”.
OSTEOSARCOMA
is a cancerous (malignant) bone tumor that usually develops during the period of rapid growth.
most common type of primary malignant bone tumor.
it is the 6th most common type of cancer in children.
OSTEOSARCOMA
begins in bones and sometimes
spread (or metastasize) usually to
the lungs or other bones.
Most common and fatal in children
and males between 10-25 years
old.
Common sites:
a. long bones,
o knee,
o upper leg,
o thigh bone,
o lower leg and
o upper arm.
OSTEOSARCOMA
Etiology
Unknown.
It is thought to be
related to rapid bone
growth, such as in
adolescents.
Pathophysiology
Risk Factors
Predisposing Factors
Age (10 to 30 years oldGender ( males )Genetics
Precipitating Factors
Exposure to radiation therapyPaget’s Disease Li Fraumeni Syndrome Rothmund-Thomson Syndrome
Changes in cell behavior
Damaged in the DNA
Error in the cellular growth
Failure of the DNA to repair itself
Genetic mutation occurs of NORMAL cell into
ABNORMAL cell (bone cells)
overactive bone cells
Produces immature bone cells
Develop into tumor cells instead of bone
Formation of new bone tissue
CODMAN’S TRIANGLE
TYPES of OSTEOSARCOMA
HIGH GRADE LOW GRADE
Most tumors arising from the central (or medullary) portion of the bone.
most tumors arising from the surface of the bone.
SUB – TYPES OF HIGH GRADE OSTEOSARCOMA
A. OSTEOBLASTIC OSTEOSARCOMA
the cancer cells look like bone forming cells
B. CHONDROBLASTIC OSTEOSARCOMA
If the cancer is trying to make cartilage as well as bone then the tumor
C. FIBROBLASTIC SARCOMA
Produces a small amount of bone
D. TELANGIECTATIC OSTEOSARCOMA
If there are lots of abnormal blood vessels in the tumor as well as bone forming cells then the tumor
D. SMALL CELL OSTEOSARCOMA
contain small round cells
Stages of Osteosarcoma STAGE IA The cancer is found only in the bone, is smaller
than 8 cm, and is low grade
STAGE IB The cancer is found only in the bone, is larger than 8 cm, and is low grade
STAGE IIA The cancer is found only in the bone, is smaller than 8 cm, and is high grade
STAGE IIB The cancer is found only in the bone, is larger than 8 cm, and is high grade
STAGE III The cancer is found only in the bone but has spread to other places on the bone
STAGE IVA The cancer has spread to the lung
STAGE IVB
The cancer has spread to lymph nodes and other parts of the body, or the cancer has spread to distant parts of the body other than the lung
Clinical
Bone Pain Swelling and
tenderness near the affected area
Limping (if the legs are the affected part)
broken bone (fracture)
manifestations
MOST COMMON
Chief Complaint
Dia
gn
osti
c
Tests
a. Chest X-ray
spread
(metastasized) to
the lung
b. Bone X-ray
Determine the
bone lesions that
could indicate
osteosarcoma.
c. CT ScanAllows a cross
sectional views that
will show
abnormalities and
TUMORS
Diagnostic Tests
d. Positron emission
tomography (PET)
This test is useful to see if the cancer has spread.
e. Radionuclide bone scan
to show how responsive the tumor was to the chemotherapy drugs
f. BIOPSY DEFINITIVE TESTS FOR BONE CANCER
Laboratory Tests
C-reactive Protein Lactic
Dehydrogenase (LDH)
Alkaline Phosphatase (ALP)
Therapeutic Management
Radiation therapy- uses high energy beams of radiation to shrink tumors and eliminate cancer cells.
Chemotherapy High-dose methotrexate with leucovorin citrovorum factor rescue Doxorubicin (Adriamycin)c Combinations of bleomycin, actinomycin,
cyclophosphamide(Cytoxan),ifosfamide(Ifex), and cisplatin are used
Carboplatin (Paraplatin
Surgical Management
Limp-sparing surgery- removes the cancerous tumor and bone, replacing it with either a graft or prosthesis to make the limb as functional as possible. Seventy percent to 90 percent of osteosarcomas in the limbs can be treated by this method
Surgical Management
Rotation-plasty is a limb-sparing technique. The doctor removes a portion of the leg, including the knee. The lower part of the leg is rotated and reattached so that the ankle becomes the new knee, and a prosthetic device is attached to replace the ankle and foot.
Amputation is the removal of the limb. In most cases, prosthesis can be used to replace the limb.
Assessment
Encourage patient to discuss problem and course of symptoms.
Note patient and family’s understanding of the disease, coping with the problem and management of pain.
Palpate mass gently on physical examination.
Assessment
Note size and associated soft-tissue swelling, pain and tenderness of the mass.
Assess neuromuscular status and range of motion extremity.
Evaluate motility and ability to perform activities of daily living.
Priority Nursing DiagnosisAcute pain related to physical injuring agents
Ineffective breathing pattern related to musculoskeletal impairment as evidenced by usage of accessory muscles in breathing
Activity intolerance related to pain
Priority Nursing Diagnosis
Impaired social interaction related to limited physical mobility
Ineffective role performance related to body image alteration; physical illness
Planning and ImplementationAssist patient in doing his ADLs.Administer analgesics as
prescribed.Encourage visitors to entertain
the patient.Use pain alleviating techniques
like relaxation, imaging, deep breathing exercises and the likes.
Oxygen therapy for DOB
Planning and Implementation
Encourage the patient to verbalize his feelings.
Provide wound care for post-operative patients.
Place the patient to high-fowler’s or semi-fowler’s position.
Assist patient in doing ROM exercises.
Keep side rails up all the time.
THANK YOU!!