Osteosarcoma – the malignant tumor coming from a bone tissue. Is the most widespread malignant process in bones. In most cases has primary character though cases of developing of osteosarcoma because of chronic osteomyelitis are described. Differs in tendency to a rapid current and early metastasis. Usually affects long tubular bones and it is localized in the field of a metafiz. The onset of the illness is gradual. At initial stages osteosarcoma is shown by the local pain similar to pains at rheumatism. Further there is a swelling, restriction of movements in the joint located nearby. Pains become sharp, intolerable. There are metastasises. Treatment includes operation on removal of a tumor in combination with preoperative and postoperative chemotherapy.
Osteosarcoma (Latin osteon a bone, Greek sarkos meat, flesh + oma a tumor) – the malignant new growth arising from bone elements. Metastasis and a rapid current is characteristic of this tumor earlier. Earlier the forecast at this disease was very adverse. Five-year survival was observed less than in 10% of cases. Now, in connection with emergence of new methods of treatment, chances of patients significantly increased. Today 5 years after diagnosis endure more than 70% of patients with the localized osteosarcoma and 80-90% with a tumor, sensitive to chemotherapy.
Osteosarcoma is more often observed at young patients. More than two thirds of all cases are the share of age of 10-40 years. At the same time men suffer twice more often than women. The peak of incidence falls on the rapid growth period: 10-14 years at girls and 15-19 years at boys. After 50 years such tumor meets extremely seldom.
The reasons of development of a disease are not found out yet. However there is a number of circumstances under which the risk of its emergence increases. The radiation therapy and chemotherapy which is carried out earlier concerning other oncological disease belongs to their number. The trauma in itself (a bruise or a fracture) does not influence probability of developing of a tumor in any way. Nevertheless, in some cases exactly rather serious traumatic damage (a pathological change) or the unusual, remaining for a long time after a bruise pains to the struck area become the reason of the address to the traumatologist and the subsequent detection of osteosarcoma. In some cases osteosarcoma develops against the background of chronic osteomyelitis. The risk of formation of a tumor also increases at Pedzhet's disease (the deforming osteit).
Usually the disease affects long tubular bones. The share of short and flat bones makes no more than 20% of total number of all osteosarcomas. The lower extremities are surprised 5-6 times more often than top. At the same time about 80% of all quantity of osteogene sarcomas develop in areas of the disteel end of a femur. Further in decreasing order on frequency tibial, humeral, pelvic and low-tibial bones settle down. Then – bones of a humeral belt and an elbow bone. Bones of a skull suffer seldom, generally – at children or at elderly people.
Typical localization of osteosarcoma is the area of a metafiz (the part of a bone located between the articulate end and a diaphysis). Nevertheless, about 10% of total number of osteosarcomas of a hip are found in its diafizarny part, and at the same time remains metaphysical untouched. Besides osteosarcoma has "favourite" locations in each separate bone. So, at a hip the distalny end, at a tibial bone – an internal condyle, at humeral – area where the roughness of a deltoid muscle is located usually is surprised.
The disease begins gradually, gradually. In the beginning the patient is disturbed by the dull not clear aches arising near a joint. In character they can remind a pain syndrome at rheumatic mialgiya, artralgiya, miozita or periartrita. At the same time the exudate (liquid) in a joint is absent. The tumor gradually grows, nearby fabrics are involved in process, and pains amplify. The struck department of a bone increases in volume, soft fabrics over it become swelled up a little, on skin there are flebektaziya (network of small expanded veins). The contracture in a nearby joint is formed. At localization of osteosarcoma on bones of the lower extremity lameness develops. The palpation of the struck area is sharply painful.
After a while pains become intolerable, depriving of a dream. They appear both at loading, and at rest and do not act usual analgetics. Osteosarcoma continues to grow promptly, extending to the next fabrics, sprouting muscles and filling the marrowy channel. Cells of a tumor are carried with blood current, "settling" in various bodies and forming metastasises. At the same time the brain and lungs most often is surprised.
At diagnosis osteosarcoma is carried out a stadirovaniye – assessment of prevalence of process. Taking into account prevalence all osteosarcomas are divided into two big groups:
- The localized sarcomas. Cells of a tumor are only in the place of its initial localization or surrounding fabrics.
- Metastatic sarcomas. Metastatic defeat of other bodies comes to light.
It is supposed that 80% of patients have micrometastasises which are so small that are not found when carrying out additional researches. Besides, allocate multifocal sarcoma at which tumors at the same time arise in several (two or more) bones.
Osteosarcoma, as well as other malignant tumors, in some cases comes back after treatment. The new tumor can arise both in the place of localization previous, and in other part of a body (in the field of metastasises). Such state is called a recurrence. The recurrence at osteosarcoma most often develops in 2-3 years after treatment and it is found in lungs. Further a recurrence is possible too, but the probability of their development decreases.
The diagnosis is exposed on the basis of clinical yielded, results of tool and laboratory researches. The doctor asks the patient, paying attention to the gradual beginning and not clear pains near a joint, and also to strengthening of these pains eventually. The swelling in the field of defeat at initial stages is defined at only 25% of patients. Flebektaziya arise at late stages and also are observed not at all patients. Therefore lack of these symptoms cannot be a reason for an exception of a malignant new growth.
The final diagnosis is exposed on the basis of results of additional researches: a X-ray analysis, scanning of a bone and a biopsy of the fabric taken from an affected area. For identification of metastasises in other bodies the computer tomography and a X-ray analysis is carried out.
In an initial stage on roentgenograms osteoporosis and a smazannost of contours of a tumor is defined. In the subsequent defect of a bone tissue comes to light. The characteristic picture of peeling of a periosteum with formation of "peak" is quite often observed. Often it is found in children needle periostit – thin bone educations (spikula) located perpendicularly in relation to a bone. In a x-ray picture such educations create a typical picture of "sunshine".
At a research of a bioptat cells of sarokomatozny connecting fabric which part forms osteoidny and atypical bone cages come to light. Serious violations of structure of a bone are found. In many cases osteogenesis (formation of a bone) is poorly expressed and is observed only on the periphery of osteosarcoma. Osteosarcoma is differentiated with osteoblastoklastomy, cartilaginous ekzostoza, an eozinofilny granuloma and hondrosarkomy.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Tactics of treatment is chosen taking into account the location of osteosarcoma, a stage of a disease, age of the patient, his general state, existence of a recurrence etc. Treatment of osteosarcoma is carried out in office of oncology and includes three stages:
- Preoperative chemotherapy for reduction of primary tumor and suppression of small metastasises. It is used , a methotrexate, , and also platinum medicines (cisplatinum, ).
- Surgical treatment for removal of a tumor. In the past at osteosarcomas carried out amputation and an exarticulation. Now in most cases perform the sparing organ-preserving operation – a segmentary resection of an affected area with its replacement with an implant from metal, plastic, own bone of the patient or a cadaveric bone. Amputation is necessary only at the big size of osteosarcoma, a pathological change, germination of soft fabrics or a neurovascular bunch. In the surgical way not only primary tumor, but also large metastasises in lungs can be removed. At damage of lymph nodes their expeditious removal (limfoadenektomiya) is also carried out.
- Postoperative chemotherapy for final suppression of malignant cages which could remain in the field of metastasises or the location of primary tumor.
Radiation therapy at osteosarcoma is ineffective and is carried out only in the presence of absolute contraindications to operation.
The forecast at osteosarcoma depends on certain factors both to, and after treatment. The factors influencing the forecast prior to treatment of osteosarcoma:
- Size and location of a tumor.
- Osteosarcoma stage (the localized tumor, existence of metastasises in other bodies).
- Age and general state of health of the patient.
After treatment the forecast is defined by efficiency of chemotherapy and result of operation. More optimistical forecast – at considerable reduction of mestastaz and primary center after chemotherapy, and also during full removal of a tumor.
In the past osteosarcoma was among malignant tumors with the most adverse forecast. Even while during treatment heavy mutilating operations – amputation and an exarticulation of extremities were performed, five-year survival did not exceed 5-10%. Now, in communication by emergence of new methods of treatment and application of effective organ-preserving operations, chances of patients of a happy end significantly increased even in the presence of metastasises in lungs. Five-year survival at the localized osteosarcoma makes more than 70% today, and in group with the osteogene sarcomas sensitive to chemotherapy, this indicator is even higher – 80-90%.