Osteosarcoma

Osteosarcoma

Osteosarcoma

  • Type of bone cancer that develops in the cells (forms the outer covering of the bone).
  • Most common and fatal in children and males between 10-25 years old.
  • 5% of all childhood cancers.
  • Common sites: long bones, knee, upper leg, thigh bone, lower leg and upper arm.

Etiology

Causes:

  • Unknown
  • DNA mutation – either inherited or acquired after birth.
  • Familial susceptibility
  • Injury
  • Infection
  • Metabolic or hormonal disturbance

Risk Factors:

Children

  • Teenage growth spurt
  • Tall for the age
  • Previous treatment with radiation
  • Benign and non-cancerous bone tumors
  • Retinoblastoma

Adult

  • High fat diet
  • Lack of exercise
  • Smoking
  • Drinking alcohol

Pathophysiology

  1. Osteoblast
  2. DNA mutation
  3. Malignant osteoblast (abnormal)
  4. Proliferation of abnormal osteoblast
  5. Formation of osteoid or immature bone
  6. Signs and symptoms are then observed such as pain, swelling, and tenderness.

Assessment

  1. Encourage patient to discuss problem and course of symptoms.
  2. Note patient and family’s understanding of the disease, coping with the problem and management of pain.
  3. Palpate mass gently on physical examination.
  4. Note size and associated soft-tissue swelling, pain and tenderness of the mass.
  5. Assess neuromascular status and range of motion extremity.
  6. Evaluate motility and ability to perform activities of daily living.

Diagnostic Procedures

  • X-ray
  • MRI
  • CT scan
  • Biopsy
  • CBC
  • Blood chemistry
  • Urine analysis
  • Sternal marrow puncture

Nursing Diagnosis

  • Acute or chronic pain
  • Risk for injury: pathologic fracture related to tumor
  • Ineffective coping
  • Activity intolerance

Nursing Intervention

  1. Provide quiet environment and calm activities to prevent or lessen pain.
  2. Provide comfort measure such as back rub, change position and use of heat or cold application.
  3. Encourage diversional activities
  4. Administer analgesics as indicated to maximal dose as needed.
  5. Encourage the patient to increase fluid intake.
  6. Encourage rest periods to prevent fatigue.
  7. Provide accurate information about the situation, medication and treatment.
  8. Assess muscle strength, gross and fine motor coordination.
  9. Provide pillows for cushion and support.
  10. Keep side rails up all the time.

Complications

  • Alopecia
  • Reduction in number of leucocytes and platelets
  • Septicemia
  • Bleeding
  • Anemia
  • Kidney damage
  • Hearing loss
image from www.nlm.nih.gov

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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