Osteosarcoma etiology

Written by Wang Cheng Lin
Orthopedics
Updated on February 15, 2025
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Currently, in clinical practice, the pathogenesis of osteosarcoma is not fully understood. However, it may be related to genetics, exposure to radioactive materials, and viral infections. It can also be secondary to other deformative osteitis, fibrous dysplasia, and some benign tumors transforming into malignant bone tumors. Osteosarcoma primarily occurs in the metaphysis of long bones. The tumor spreads along the marrow cavity, extending towards both the metaphysis of the long bones and the diaphysis of the bones. Once the tumor breaks through the bone shaft, it rapidly destroys the cortical bone, spreads under the periosteum, and invades the surrounding soft tissues outside the eardrum, damaging the surrounding muscles and soft tissues.

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Written by Wang Cheng Lin
Orthopedics
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Does osteosarcoma require amputation?

Do osteosarcomas require amputation? In the past, the likelihood of amputation for treating osteosarcoma was very high. However, currently, the rate of amputation is very low, and the limb-salvage rate is very high. This is due to a new chemotherapy protocol in medical practice, which involves initial chemotherapy followed by surgery, and then continued chemotherapy post-operatively. The limb-salvage rate with this treatment plan can reach about 75% to 80%. Therefore, currently, most osteosarcoma patients do not require amputation. Unlike the past, where amputation rates were very high, today's medical approach is very advanced, generally resulting in a very high rate of limb preservation for osteosarcoma patients.

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Written by Na Hong Wei
Orthopedics
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What are the symptoms of osteosarcoma?

The main symptom of osteosarcoma is localized pain, primarily at the distal end of the femur, the proximal end of the tibia, and the proximal end of the humerus. This pain tends to worsen continuously, with nighttime pain often more severe than during the day, which is a significant characteristic of osteosarcoma. The second symptom is the presence of a local mass, which is often spindle-shaped and generally located near a joint. This mass often leads to limited joint mobility, and the skin over the mass typically has a high temperature. Sometimes, it may also be accompanied by visible swelling of superficial veins. The third symptom involves systemic cachexia, which includes unexplained weight loss, generalized weakness, and even an anemic condition. The fourth point pertains to osteolytic osteosarcoma, which often leads to bone destruction, reduced bone strength, and consequently, even minor external forces can cause fractures. These are called pathological fractures. Thus, the symptoms of osteosarcoma generally include these four points.

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Written by Fang Da Zheng
Orthopedics
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Are osteosarcomas sensitive to radiotherapy and chemotherapy?

Osteosarcoma is generally insensitive to radiotherapy, hence radiation therapy is not used for such diseases in clinical settings. Similarly, these diseases have a moderate sensitivity to chemotherapy, necessitating the use of relatively high doses of chemotherapy during treatment. The main mechanism of chemotherapy involves using a series of cytotoxic drugs to inhibit tumor growth. Although high-dose chemotherapy can effectively kill tumor cells, it can also damage some of the patient's normal cells, leading to severe reactions. If radical surgery is viable for these patients, then curative surgery is the preferred method of treatment.

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Written by Wang Cheng Lin
Orthopedics
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The common sites of osteosarcoma

Osteosarcoma commonly occurs in the long tubular bones of the limbs, such as the femur, tibia, and humerus, especially near the joints of these long bones where the incidence is highest. In children, the distal femur and proximal tibia account for about three-quarters of all bone tumors. Osteosarcoma can also occur in the proximal humerus, the spine, and the ribs, although it is less common in these locations. The most frequent sites remain the long tubular bones in the limbs.

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Written by Cheng Bin
Orthopedics
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Is osteosarcoma highly malignant?

First of all, it is certain that osteosarcoma is very malignant. Once osteosarcoma is detected, it is necessary to actively prepare for surgery, rule out surgical contraindications, and then proceed with surgical treatment. During the surgery, efforts should be made to perform an extended resection, and if necessary, amputation may be required. After the surgery, the excised specimen must be sent for pathological examination to determine the pathological type. Then, based on the examination results, effective radiotherapy and chemotherapy should be chosen to control the possibility of recurrence or metastasis of osteosarcoma and to extend the patient's life as much as possible.