PATHOPHYSIOLOGY

Osteosarcoma occurs mainly in the metaphysic of the long bones. Most tumors arise in bones involved with the knee joint at the distal end of the femur or proximal distal end of the tibia. As a tumor of the mesenchymal cells, osteosarcoma demonstrates production of osteiod tissue. The tumor borders are distinct and merge into adjacent normal bone. The etiology is unknown. Predisposing factors include, Age- (10-25), Gender(male),Family history, Teenage growth spurt, Tall for age, Previous treatment with radiation, Benign &non-cancerous bone tumor, Lack of exercise, Smoking and drinking ,DNA mutation, Familial susceptibility, Injury and Metabolic/hormonal disturbance. Once there is mutation of the DNA that activates the oncogene which leads to a deactivation of the suppressor gene which causes a malignant osteoblast that leads to proliferation of abnormal osteoblasts. This causes formation of osteoid tissue. The osteoid tissue causes uncontrolled growth of the tumor in the bone and therefore causes overcrowding of the bone. There is then suppression of red bone marrow which leads to decreased production of blood cells. a decrease in RBC leads to anemia while a decrease in WBC leads to a lowered infection resistance. The overcrowding also causes pressure inside the bone which is a main cause of pain and fractures. The cancer then metastasizes spreading to other parts of the body especially the lungs, kidneys, CNS, liver and the spleen.

Non-modifiable factors Age- (10-25) Gender-(male) Family history Teenage growth spurt Tall for age DNA mutation Familial susceptibility Metabolic/hormonal disturbance

Etiology Unknown Osteoblasts

Modifiable factors Previous treatment with radiation Benign &non-cancerous bone tumor Lack of exercise Smoking and drinking Injury Metabolic/hormonal disturbance

Mutations in DNA

Activate Oncogene

Deactivation of tumor suppressor gene

Malignant osteoblast Proliferation of abnormal osteoblast

Formation of osteoid tissue Uncontrolled growth of tumor in bone Overcrowding of the bone

Suppression of red bone marrow

Metastases and spreading to other parts of the body Organ infiltration

Increased pressure inside bone Fractures

-pain -swelling

Decreased production of blood cells

Decreased RBC Anemia -aneroxia -fatigue -SOB -diziness

Decreases WBC Lowered infection resistance

Decreased platelets

Kidneys Disturbances in renal filtration

CNS Leukocyte cells impair circulation of CSF Leukocyte cells compress spinal/cranial nerves Progress to coma -Weakness -Blurred vision -Balance difficulty -Vomiting -lethargy

Liver/spleen Invasion and overcrowding of the liver/spleen Hepatomegaly/spleenomegaly

Lungs

Overcrowding of cancer cells in lungs Bronchial /tracheal obstruction Severe hypoxia -Cough -wheeze -SOB -chest pain -hoarseness -dysphagia

Kidney failure

- Little or no urine output -Flank pain -edema

Extra cells cause liver/spleen to rapture Bleeding Hypovolemic shock -hypotension -tachypnea -tachycardia