1. Bone Cancer

2. Groups Group 1: Primary Cancer and Primary Bone Cancer Group 2: Osteosarcoma Facts and Causes Group 3: Osteosarcoma Symptoms, Treatment, and Diagnosis Group 4: Ewing’s Sarcoma Group 5: Chondrosarcoma Group 6: Limb-Salvage Surgery Group 7: Amputation

3. Primary Cancer Remember that a Primary Cancer means a cancer that originated in that organ –EX: primary brain cancer started in the brain; the cancer did not travel to the brain Metastatic Cancer means that the cancer originated in one area and spread to another area –EX: metastatic brain cancer that began in the breast –What’s really cool about metastatic cancers is that the cancers cells always look like the tissue they began in So cancer cells from a metastatic brain tumor that originated in the breast will look like breast cancer cells!

4. Primary Bone Cancer Primary Bone Cancer is very rare –Less that 2,500 people are diagnosed with primary bone cancer each year More people diagnosed are children than adults The 3 most common types of primary bone cancer are: 1.Osteosarcoma 2.Chrondrosarcoma 3.Ewing’s Sarcoma

5. Osteosarcoma Osteo = Bone Sarcoma = cancer of connective tissue Most common type of bone cancer 6 th most common type of cancer in children Develops from osteoblasts (these are cells that create bones) Because it comes from osteoblasts, osteosarcomas are more common in teens experiencing a growth spurt More common in boys than girls More common in boys who are taller than average

6. Cause of Osteosarcoma Cancer comes from random mutations in the DNA that occur when bones are growing very quickly Remember when you had that huge growth spurt in middle school, or even at the beginning of high school? During this growth spurt, your bones were growing very very fast –When bones are growing this fast, it means those osteoblasts are doing a ton of mitosis –Lots of mitosis means there is a lot of DNA synthesis, lots of DNA synthesis means that there is a much greater chance of error occurring in the DNA

7. Symptoms of Osteosarcoma Most common symptoms are pain and swelling in arms and legs –Especially around the long bones in the appendicular skeleton –The pain can get worse at night and during exercise Often the bones become weak so they break much easier than they should Also, osteosarcoma is more common in the knee, so an unexplained limp may develop bones become

8. Treatment of Osteosarcoma Usually treatment begins with chemotherapy to shrink the tumor, surgery to remove the tumor, and then more chemotherapy to make sure no cancer cells remain In very serious cases where the cancer has begun to metastasize, amputation may be the only way to completely remove the cancer A newer treatment is a bone graft –Doctors will remove the cancerous bone and replace it with a donated bone or a metal prosthetic

9. Diagnosis Patients with osteosarcomas in the knee area and long bones in the arms and legs have a much better chance of survival Tissue biopsy to determine cancer Osteosarcoma in the areas that are difficult to do surgery on and in areas like the pelvic bone, shoulder, and jaw are more deadly

10. Ewing’s Sarcoma Bone tumor also common in children Peak ages are between 10 and 20 Can occur in any bone in the body –More common in pelvis, legs, upper arm, ribs, and femur The tumor is actually composed of small, round, blue cells

11. Ewing’s Sarcoma Symptoms Pain around the site of the tumor Swelling and redness around the site of the tumor Fever Weight loss and decreased appetite Fatigue Paralysis and incontinence if the tumor is in the spinal region Symptoms related to nerve compression from a tumor such as numbness, tingling and paralysis

12. Ewing’s Sarcoma Treatment Usually a mix of surgery and either chemotherapy and radiation –Responds better to radiation than other bone cancers Treatment depends on the bone affected and whether the tumor has metastasized Newest therapy is called Myeloablative Therapy –This treatment utilizes stem cells –This treatment targets cells that divide quickly (such as fast growing bone cells) –The biggest problem is that these cells also include hair, skin, and bone cells

13. Chondrosarcoma Chondro = cartilage So this is a tumor in the cartilage of bones Accounts for 26% of all primary bone cancers; 2 nd most common type of bone cancer Usually occurs in legs, arms, and pelvis cartilage cells in people between 50-70

14. Symptoms of Chondrosarcoma In the more aggressive and fast-spreadind tumors, there is usually excruciating pain The lower grade tumors usually produce swelling and some pain Chondrosarcomas in the pelvic region can affect the bladder, so one symptom may be frequent urination

15. Treatment and Survival Rates Because this is a tumor of cartilage cells, radiation and chemotherapy are not very effective –It’s very difficult to target just those specific cells and often they lie deeper in the bone matrix Treatment is usually a wide excision of the tumor and surrounding soft tissue and bone Surgical excision of the lower grade tumors usually leads to a relatively high survival rate The higher grade tumors, which usually metastasize early, have a much lower survival rate

16. Limb-Salvage Surgery Limb-salvage surgery: It is sometime necessary to remove all or part of a limb. In most cases, however, limb-salvage surgery, sometimes referred to as limb-sparing surgery, is used to avoid amputation. This however is considered only if the orthopaedic surgeon determines that it is possible that the tumor, and wide margins of healthy tissue surrounding the tumor, can be removed. Through limb-sparing surgery, all of the bone and cartilage involved with the tumor, including some degree of muscle surrounding it, is removed, while nearby tendons, nerves and vessels are saved. The bone that is removed is replaced with a bone graft or with a metal Prosthesis. Subsequent surgery may be needed to repair or replace rods, which can become loose or break. Patients who have undergone limb-sparing surgery need intensive rehabilitation. It may take as long as a year for a patient to regain full use of a limb following limb- sparing surgery. Rarely, patients who undergo limb sparing surgery may eventually have to have the limb amputated Because of a severe complication or tumor recurrence.

17. Amputation Amputation - In certain cases, if your child's orthopaedic surgeon determines that the tumor cannot be removed because, for example, it involves important nerves and blood vessels, amputation is the only surgical option. During the operation, doctors ensure that muscles and skin form a cuff around the amputated bone. A cast may be applied in the operating room that permits a temporary artificial leg (prosthesis) to be applied during the first few post- operative days for walking. Crutches are used for several weeks. As the swelling decreases, (10 to 14 days) the patient is fitted for a plastic, temporary socket and prosthesis, which is used for 2 to 4 months until the stump is healed sufficiently to accept a permanent artificial leg. The advantages of an amputation are that it is a simple operation with minimal chances of surgical complication and it definitively removes the local tumor. The functional outcome is good with the modern prostheses available today and with "immediate-fit" prostheses applied in the operating room. Although the patient will probably have a limp with above-the-knee amputations, the procedure is functional and stable. He/she will be able to walk, climb stairs, swim (with the prosthesis on or off) and participate in many sports such as skiing, basketball, baseball, and tennis although running will be limited. The functional limitations are left to the imagination and determination of the patient.