NCLEX Review Guide: Osteosarcoma (Osteogenic Sarcoma)

Disease Overview

• Osteosarcoma is the most common primary bone malignancy in children and adolescents, typically arising from osteoblast cells that produce abnormal bone tissue.
• Peak incidence occurs during adolescent growth spurts (ages 10-20), particularly affecting rapidly growing long bones like the femur, tibia, and humerus.
• The tumor commonly develops in the metaphyseal region near the knee, which is the most frequent site of occurrence.

Signs & Symptoms

• Progressive bone pain that worsens at night and is not relieved by rest or position changes, often initially attributed to "growing pains."
• Localized swelling, warmth, and tenderness over the affected bone, with possible visible mass or deformity.
• Pathological fractures may occur with minimal trauma due to weakened bone structure from tumor invasion.
• Limited range of motion in adjacent joints and possible limping if lower extremity is affected.

Diagnostic Workup

1. Plain radiographs show characteristic "sunburst" or "Codman's triangle" appearance with bone destruction and new bone formation.
2. MRI provides detailed imaging of tumor extent, soft tissue involvement, and relationship to neurovascular structures.
3. Tissue biopsy is essential for definitive diagnosis and should be performed by an experienced orthopedic oncologist.
4. Staging studies include CT chest, bone scan, and PET scan to detect metastatic disease, particularly to lungs.

Multimodal Treatment Approach

• Neoadjuvant chemotherapy is administered before surgery to shrink the tumor and improve surgical outcomes, typically lasting 10-12 weeks.
• Surgical options include limb-salvage procedures (preferred when possible) or amputation, depending on tumor location and extent.
• Post-operative chemotherapy continues for approximately 6 months to eliminate micrometastases and prevent recurrence.
• Common chemotherapy agents include methotrexate, doxorubicin, cisplatin, and ifosfamide with specific monitoring requirements.

Priority Nursing Actions

• Pain management using multimodal approaches including opioids, NSAIDs, and non-pharmacological interventions like positioning and distraction.
• Monitor for chemotherapy side effects including myelosuppression, nephrotoxicity, ototoxicity, and cardiotoxicity requiring specific assessments.
• Provide psychosocial support addressing body image concerns, especially with limb-salvage surgery or amputation considerations.
• Educate family about infection prevention during neutropenic periods and signs/symptoms requiring immediate medical attention.

Differential Diagnosis

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