Can osteosarcoma be detected by X-ray?

Written by Na Hong Wei
Orthopedics
Updated on September 10, 2024
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Osteosarcoma can be detected with an X-ray, which is a very important method for diagnosing osteosarcoma. Since osteosarcoma typically comes in three types—osteoblastic, osteolytic, and mixed—the appearances on the X-rays are generally different. Osteolytic osteosarcoma mainly involves bone destruction, osteoblastic is characterized by bone regeneration, and the mixed type has both bone destruction and regeneration. Secondly, osteosarcoma primarily erodes the bone quality, and the periosteal reaction is very apparent. Typical osteosarcomas often show signs like Codman's triangle or the sunburst appearance. Therefore, if symptoms such as redness and increased temperature of the skin, along with a bony lump, occur around the distal femur, proximal tibia, or proximal humerus, it is best to first go to the hospital for an X-ray. X-rays are currently the most economical and necessary diagnostic tool for osteosarcoma.

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Written by Na Hong Wei
Orthopedics
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How is osteosarcoma diagnosed?

Currently, the diagnosis of osteosarcoma in clinical settings primarily relies on a combination of clinical symptoms, imaging studies, and pathological findings. Clinically, osteosarcomas commonly occur in the distal femur, proximal tibia, and lower end of the humerus, manifesting as localized persistent pain, nocturnal pain, and swelling, often accompanied by superficial venous engorgement and increased skin temperature. Systemic symptoms of cachexia may appear, and even pathological fractures. Imaging is indispensable, revealing osteoblastic, osteolytic, or mixed osteolytic lesions, usually with a pronounced periosteal reaction, Codman's triangle (a common sign of malignancy), or sunburst patterns. Magnetic resonance imaging (MRI) is very important for diagnosing bone tumors as it can indicate the tumor's boundaries and the extent of erosion. Additionally, PET-CT and radioactive isotope scanning are considered crucial for tumor diagnosis. Pathological examination is currently regarded as the gold standard for diagnosing osteosarcoma. This involves a biopsy, usually taking a small part of the tumor for examination from a molecular biology perspective. However, when performing a biopsy, it is important to note two things: first, it is preferable to take the biopsy intraoperatively; second, if there is no plan for systematic treatment of osteosarcoma, it is best not to proceed with a biopsy to avoid potentially accelerating the spread or even hastening metastasis. Therefore, the diagnosis of osteosarcoma must be approached with caution, requiring a combination of clinical symptoms, necessary auxiliary examinations, and pathological analysis.

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Written by Wang Cheng Lin
Orthopedics
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What are the symptoms of osteosarcoma?

Symptoms of Osteosarcoma: The first is pain at the site of occurrence. This pain may be intermittent and not very pronounced in the early stages. As the condition progresses, the severity of the pain gradually increases, transitioning from intermittent to persistent pain; The second is the formation of a lump. You can feel a lump on the limb with your hand, and this lump is clearly tender to the touch; The third is limping, which is mainly caused by the pain in the limb; The fourth is the most common systemic symptoms. Patients with this malignant tumor will exhibit fever, weight loss, anemia, and pathological fractures. These are the main symptoms of osteosarcoma currently observed in clinical settings.

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Written by Wang Cheng Lin
Orthopedics
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What tests are done to diagnose osteosarcoma?

The most accurate diagnostic method for osteosarcoma is biopsy, where live tissue is extracted and sent for pathological examination. The positive rate of this method can reach over 90%. Besides biopsy, there are several other methods to examine such conditions. For example, X-rays can be taken to observe significant damage to the bone structure. Secondly, CT scans and MRI can be used to determine whether the bone tumor has infiltrated surrounding tissues. MRI can also detect if there are metastases to organs outside the lungs. The third method is radionuclide bone scanning, which primarily aims to check for distant metastases of osteosarcoma.

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Written by Na Hong Wei
Orthopedics
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Can osteosarcoma be felt?

Osteosarcoma can be felt by touch, and its main clinical manifestations include persistent progressive pain, which intensifies at night. Secondly, there are local lumps, commonly located at the distal femur, proximal tibia, and proximal humerus, which are high incidence areas for osteosarcoma. In such cases, you don't even need to touch it; you can see it with the naked eye because the swelling is quite severe. Additionally, the surrounding skin may appear reddened and warm, and superficial veins may become prominently swollen, indicating that the skin over the affected area looks different from normal skin. Moreover, in the area affected by osteosarcoma, the bone may show a spindle-shaped enlargement, looking like a spindle-shaped lump, causing the joint area and the surrounding normal joints to be clearly abnormal. Therefore, in cases of obvious symptoms of osteosarcoma, not only can you see the tumor, but you can also feel it. However, patients often will not let you touch it, as touching can cause pain and even force the joint and surrounding muscles into a forced state. This forced condition helps alleviate pain in the joint and surrounding areas. Thus, osteosarcoma can indeed be felt by touch.

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Written by Wang Cheng Lin
Orthopedics
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Will osteosarcoma cause the skin to turn red?

Patients with osteosarcoma will not have red skin. The early symptoms of osteosarcoma are generally not obvious, primarily involving localized swelling, with pain around the joints leading to limited joint mobility. As the condition progresses, this pain may shift from intermittent to constant, and the severity of the pain will increase as the disease worsens. The second patient will exhibit a noticeable lump that can be felt; this lump is usually accompanied by significant tenderness. The third symptom is intermittent limping, caused by pain from the tumor during walking, which prevents the patient from bearing weight for extended periods. The fourth aspect involves systemic symptoms common to patients with tumors, such as anemia, mild fever, and even pathological fractures.