What gender is more common for bone cancer
M>F
Most common sites for bone cancer
Distal femur
Prox Tibia
Prox Humerus
What is a characteristic on an x-ray of Osteosarcoma
Sunburst type, cloud-like, fluffy appearance
Characteristics on an x-ray of Ewings Sarcoma
Onion skin appearance
Treatments for Bone cancer
chemo, radiation and surgery
Treatment for Bone cancer
Effective chemo and radiation and improved radiographic and surgical techniques have:
increased survival and number of long term survivors
What did increased long-term survivors lead to the development of?
new limb sparing techniques to avoid amputations.
Limb salvage provides improved function and QOL over amputation
What percentage of bone tumor patients receive an amputation?
5-15%
When may an amputation be required after limb-saving surgery (LSS)?
When Limb Saving Surgery (LSS) produces an inadequate margin, a functional outcome that is worse than amputation w/ prosthesis, when it is not able to restore active function, when no adequate muscle remains, or when LSS is not able to obtain soft tissue coverage
Patients receiving an endoprosthesis will most likely have what kind of deficit?
ROM restrictions
Which age group has more cases of cancer: Children (0-14) or Young Adults (15-19)
Children = 8,700 cases
Young Adults = 3,700
What type of bone tumor make up 6% of all cancers diagnosed under the age of 20?
bone cancer
What are the 2 types the predominant types of bone cancer?
- Osteosarcoma
2. Ewings’ Sarcoma
Where is the most common area for osteocsarcoma/Ewings’ sarcoma to occur?
LE and Pelvis
In adult MALES, what are the top 3 types of cancer diagnosed?
- Prostate - 33%
- Lung & Bronchus - 13%
- Colon & Rectum - 10%
In adult FEMALES, what are the top 3 types of cancer diagnosed?
- Breast - 32%
- Lung & Bronchus - 12%
- Colon & Rectum - 11%
What are the top 4 causes of death in children under 20?
- Accidents
- Homicides
- Cancer
- Suicides
What are the top 2 causes of death in adults age 40-59?
- Cancer
2. Heart Disease
Malignant bone tumors make up ___% of all cancers diagnosed under the age of 20 (which represents approx 650-700 new diagnoses per year)
6%
In children, osteosarcoma makes up __% of bone tumors and Ewings’ Sarcoma makes up __%.
Osteosarcoma = 60%
Ewings’ Sarcoma = 34%
Which cancer is a primary malignancy of the bone and is derived from primitive bone forming, mesenchyme?
Osteosarcoma
Which cancer is derived from parasympathetic neural crest cells, aka “small round blue cell”?
Ewings’ Sarcoma
What do the studies show about function in limb salvage?
- tendency toward improved function but it’s not overwhelming
What do studies show about quality of life after a limb salvage?
- limited studies of children following bone tumors
- limb salvage not proven to be substantially superior
What are the four questions when thinking about Limb Salvage vs. Amputation?
- Will survival be the same?
- Will the immediate and late morbidities be the same?
- Will limb salvage improve function?
- Will limb salvage have psychosocial (QOL) benefits?
Children Special Issues: Physical Immaturity
- growth potential
- impacts the type of reconstruction: use expanding prosthesis w/multiple lengthening procedures and amputation
Children Special Issues: Psychological Immaturity & Multiple surgeries
- preadolescence vs adolescence: wide range of different impacts depending on age and maturity
- direct impact on function & QOL
- body image
- social interactions
- long life spans
Early complications with limb salvage
ST necrosis; deep infection; artery/vein/nerve damage; venous thrombosis; delay in chemotherapy
Late complications with limb salvage
nonunion; pathological fracture; aseptic loosening; leg length discrepancy; implant breakage
Early complications with amputations
Inadequate wound coverage and healing; infection; delay in chemotherapy
Late complications with amputations
Stump-prosthesis problems; stump pain; phantom limb pain; bone overgrowth