Osteosarcoma – Definition and Physiotherapy Management

Osteosarcoma is the most common type of cancer that starts in the bones. The cancer cells in these tumours look like early forms of bone cells that normally help make new bone tissue, but the bone tissue in osteosarcoma is not as strong as that in normal bones. Osteosarcoma is the most common type of cancer that begins in the teenage bones, usually in the arms or legs. 

Osteosarcoma most often affects long bones, such as those in the arms and legs. It usually occurs near the ends of your bones (the metaphyses) and near your knee where the fastest growth is taking place (if you’re a teenager). The bones and areas most often affected include the:

• The femur (thigh bone) near your knee.
• Tibia (shin bone) near your knee.
• Humerus (upper arm bone) near your shoulder.
• Rarely, in the soft tissues or organs in your abdomen or chest.

Other less common locations for osteosarcoma include your:

• Pelvis.
• Skull.
• Jaw.

Classifications of Osteosarcoma

Based on how the cancer cells look under the microscope, osteosarcomas can be classified as high grade, intermediate grade, or low grade. The grade of the tumour tells doctors how likely it is that cancer will grow quickly and spread to other parts of the body.

High-grade osteosarcomas

These are the fastest-growing types of osteosarcoma. When seen with a microscope, they do not look like normal bone, and many of the cancer cells are in the process of dividing into new cells. Most osteosarcomas that occur in children and teens are high grade. There are many types of high-grade osteosarcomas (although the first 3 are the most common).

• Osteoblastic
• Chondroblastic
• Fibroblastic
• Small cell
• Telangiectatic
• High-grade surface (juxtacortical high grade)

Intermediate-grade osteosarcomas

These uncommon tumours fall between high-grade and low-grade osteosarcomas. (They are usually treated the same way as low-grade osteosarcomas.)

Low-grade osteosarcomas

These are the slowest-growing osteosarcomas. The tumours look more like normal bone and have few dividing cells when seen with a microscope.

• Parosteal (juxtacortical low grade)
• Intramedullary or intraosseous well-differentiated (low-grade central)

Symptoms

Signs and symptoms of osteosarcoma may include, among others:

• Bone pain or tenderness.
• A mass or lump (tumour) that is warm and might be felt through your skin.
• Swelling and redness at the site of your tumour.
• Increased pain with lifting (if it affects your arm).
• Limping (if it affects your leg).
• Limited movement (if it affects a joint).
• Unexplained fever.
• Broken bone

Risk factors

These factors increase the risk of osteosarcoma:

• Rapid bone growth: The risk of osteosarcoma increases during a child and adolescent’s growth spurts.
• Exposure to radiation: This might have occurred from treatment for another type of cancer. This can take a few or several years to occur.
• Genetic factors: Osteosarcoma is one of several types of rare cancers in young people. This may be related to the retinoblastoma gene, which can be associated with eye cancers in young children or with other tumours in children and young adults in which a mutation of the p53 gene is involved.
• Bone infarction: This happens when there’s a lack of blood supply to your bone tissue. This destroys the cells.

Physiotherapy Management

Osteosarcoma should be treated at large medical centres where a multi-disciplinary team including physiotherapists, occupational therapists, paediatricians, surgeons, psychologists and nursing staff will help manage the patient care. In an oncology setting, physiotherapists manage the patient’s musculoskeletal, neuromuscular, integumentary and cardiopulmonary rehabilitation needs.

Physiotherapy interventions will consist of:

1. Early postsurgical
2. Mobility training
3. Strength and endurance restoration
4. Pain control, and education
5. Training of family members in helping patients with limited mobility. 

Physiotherapists will also help to correct balance and coordination impairments, make recommendations for home modifications that will enhance the patient’s independence, and educate and train the family members to assist and enable the patient to function independently. In addition, physiotherapists will train the patient in stump management and training with the prostheses for those patients who undergo amputation.

PCA expert physiotherapists can explore many other variables that could be of tremendous help and prescribe treatment specific to your needs.

Call PCA for a consultation today on 0813 028 0496!