Osteosarcoma 🦴 : Orthopedic lectures

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Osteosarcoma 🦴 -
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Osteosarcoma is the most common primary malignant bone tumor, predominantly affecting adolescents and young adults. It arises from primitive bone-forming mesenchymal cells and typically occurs in the metaphysis of long bones, with the most common sites being the distal femur, proximal tibia, and proximal humerus 🦴.
Osteosarcoma is highly aggressive and characterized by the production of immature bone (osteoid) by the malignant cells.
The exact cause is unknown, but risk factors include genetic conditions like Li-Fraumeni syndrome, Retinoblastoma, and previous radiation exposure.
Clinical Manifestations include persistent bone pain, swelling, and sometimes a palpable mass. Pain may initially be mistaken for growing pains or sports injuries, which can delay diagnosis.
Pathologic fractures can occur due to weakened bone structure. Systemic symptoms like fever and weight loss are rare and usually indicate advanced disease.
Diagnosis begins with imaging studies such as X-rays 📊, which show a characteristic "sunburst" pattern or Codman’s triangle (periosteal reaction). MRI and CT scans are used for further evaluation and surgical planning, while a biopsy confirms the diagnosis.
Staging is crucial to assess the extent of local and distant spread, commonly to the lungs.
Treatment involves a combination of neoadjuvant chemotherapy (to shrink the tumor before surgery), surgical resection (limb-sparing surgery or amputation), and adjuvant chemotherapy (to eliminate residual disease). Chemotherapy agents commonly used include methotrexate, doxorubicin, and cisplatin.
Advances in chemotherapy and surgical techniques have significantly improved the prognosis, with a five-year survival rate of about 60-70% in localized cases. However, the prognosis is poor for patients with metastasis at diagnosis.
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