{"id":175,"date":"2019-01-29T13:51:21","date_gmt":"2019-01-29T13:51:21","guid":{"rendered":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/osteosarcoma\/"},"modified":"2020-01-22T15:30:32","modified_gmt":"2020-01-22T15:30:32","slug":"osteosarcoma","status":"publish","type":"chapter","link":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/osteosarcoma\/","title":{"raw":"Osteosarcoma","rendered":"Osteosarcoma"},"content":{"raw":"<h1 id=\"ze34f795a7e7a\" class=\"in-list\">Background<\/h1>\r\nOsteosarcoma (OS) occurs in the general population about 3 in every 1 million persons per year whereas in children \/ adolescents the incidence rate increases from 3 to 10 in every million. OS is the most common malignant bone tumor.\r\n<h1 id=\"z9c3f69461c62\" class=\"in-list\">Pathophysiology<\/h1>\r\nOS can occur in any bone however it most commonly occurs in long bones: upper leg (40%), lower leg (20%), hip (30%), and shoulder (10%). If metastasis occurs, 80% of cases show travel to the lungs and 20% to other bones.\r\n\r\nThe cell or origin of OS is unknown but it could be an osteoblast precursor.\r\n<h1 id=\"z7fabf33e4183\" class=\"in-list\">Clinical Course<\/h1>\r\n<h2 id=\"z9f54ec0783cd\" class=\"in-list\">Symptoms<\/h2>\r\n<ul>\r\n \t<li>Pain<\/li>\r\n \t<li>Swelling<\/li>\r\n \t<li>Fractures<\/li>\r\n \t<li>Hypercalcemia<\/li>\r\n \t<li>Bone marrow suppression<\/li>\r\n<\/ul>\r\n<h2 id=\"ze5a2c6cb0bfd\" class=\"in-list\">Diagnosis<\/h2>\r\nDiagnosis of OS requires histologic evaluation. The different subtypes of OS are dependent on grade and anatomical location. Conventional OS is subdivided into osteoblastic (50%), chondroblastic (25%), and fibroblastic (25%). To diagnose as OS, a pathologist must find malignant mesenchymal spindle-shaped cells and osteoid production. If there is no osteoid production, then it is some other disease.\r\n\r\n[caption id=\"attachment_655\" align=\"aligncenter\" width=\"300\"]<a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist.jpg\"><img id=\"z3d236f934e7e\" class=\"in-list wp-image-173 size-medium\" src=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-300x226.jpg\" alt=\"\" width=\"300\" height=\"226\" \/><\/a> Histological image of a high grade osteoblastic OS.[\/caption]\r\n\r\nIn addition to histology, radiography can identify OS. Pathological bone remodeling can lead to increased fracture risk.\r\n\r\n<a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography.jpg\"><img id=\"z72f9826272c3\" class=\"aligncenter size-large wp-image-174 in-list\" src=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-1024x611.jpg\" alt=\"\" width=\"1024\" height=\"611\" \/><\/a>\r\n<h1 id=\"z43f3144edf2a\" class=\"in-list\">Treatment Options<\/h1>\r\nAs described in <a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/bone-and-cancer\/\">Bone Cancer<\/a>, the therapy options for OS are tumor removal with pre- and post-surgery chemotherapy, and depending on the size or location, amputation or rotationplasty may be required.\r\n\r\nIn OS there are gross genetic rearrangements. This results in too much heterogeneity and it is difficult to extract one single marker. This means that it is unlikely that a targeted therapy will work for a large group of patients. Hence we are limited to \"untargeted\" chemotherapy.\r\n<h2 id=\"z92b6ed004fd4\" class=\"in-list\">Prognosis<\/h2>\r\nThe 5-year survival rate for patients diagnosed between 1974 and 1994 was 63%. Once metastasis occurs, prognosis reduces to 20% for 5-year survival rate.\r\n\r\n&nbsp;\r\n<div class=\"textbox tbverweis\">\r\n\r\nReferences:\r\n<ul>\r\n \t<li>Medscape: <a href=\"https:\/\/emedicine.medscape.com\/article\/1256857-overview\">Osteosarcoma<\/a><\/li>\r\n<\/ul>\r\n<\/div>\r\n<div class=\"textbox tbexkurs\">\r\n<h1 class=\"not-in-list\">Related Topics<\/h1>\r\n<a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/bone-cancer\/\">Bone Cancer<\/a>\r\n\r\n<\/div>\r\n<p style=\"text-align: right\">Chapter material provided by Dr. Botter<\/p>","rendered":"<h1 id=\"ze34f795a7e7a\" class=\"in-list\">27.1 \u2013 Background<\/h1>\n<p>Osteosarcoma (OS) occurs in the general population about 3 in every 1 million persons per year whereas in children \/ adolescents the incidence rate increases from 3 to 10 in every million. OS is the most common malignant bone tumor.<\/p>\n<h1 id=\"z9c3f69461c62\" class=\"in-list\">27.2 \u2013 Pathophysiology<\/h1>\n<p>OS can occur in any bone however it most commonly occurs in long bones: upper leg (40%), lower leg (20%), hip (30%), and shoulder (10%). If metastasis occurs, 80% of cases show travel to the lungs and 20% to other bones.<\/p>\n<p>The cell or origin of OS is unknown but it could be an osteoblast precursor.<\/p>\n<h1 id=\"z7fabf33e4183\" class=\"in-list\">27.3 \u2013 Clinical Course<\/h1>\n<h2 id=\"z9f54ec0783cd\" class=\"in-list\">27.3.1 \u2013 Symptoms<\/h2>\n<ul>\n<li>Pain<\/li>\n<li>Swelling<\/li>\n<li>Fractures<\/li>\n<li>Hypercalcemia<\/li>\n<li>Bone marrow suppression<\/li>\n<\/ul>\n<h2 id=\"ze5a2c6cb0bfd\" class=\"in-list\">27.3.2 \u2013 Diagnosis<\/h2>\n<p>Diagnosis of OS requires histologic evaluation. The different subtypes of OS are dependent on grade and anatomical location. Conventional OS is subdivided into osteoblastic (50%), chondroblastic (25%), and fibroblastic (25%). To diagnose as OS, a pathologist must find malignant mesenchymal spindle-shaped cells and osteoid production. If there is no osteoid production, then it is some other disease.<\/p>\n<div id=\"attachment_655\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-655\" id=\"z3d236f934e7e\" class=\"in-list wp-image-173 size-medium\" src=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-300x226.jpg\" alt=\"\" width=\"300\" height=\"226\" srcset=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-300x226.jpg 300w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-768x578.jpg 768w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-1024x771.jpg 1024w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-65x49.jpg 65w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-225x169.jpg 225w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist-350x263.jpg 350w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_hist.jpg 1500w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\"><\/a>\n<p id=\"caption-attachment-655\" class=\"wp-caption-text\">Figure 27.1 \u2013 Histological image of a high grade osteoblastic OS.<\/p>\n<\/div>\n<p>In addition to histology, radiography can identify OS. Pathological bone remodeling can lead to increased fracture risk.<\/p>\n<p><a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography.jpg\"><img loading=\"lazy\" decoding=\"async\" id=\"z72f9826272c3\" class=\"aligncenter size-large wp-image-174 in-list\" src=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-1024x611.jpg\" alt=\"\" width=\"1024\" height=\"611\" srcset=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-1024x611.jpg 1024w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-300x179.jpg 300w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-768x458.jpg 768w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-65x39.jpg 65w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-225x134.jpg 225w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography-350x209.jpg 350w, https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-content\/uploads\/sites\/137\/2019\/01\/os_radiography.jpg 1190w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\"><\/a><\/p>\n<h1 id=\"z43f3144edf2a\" class=\"in-list\">27.4 \u2013 Treatment Options<\/h1>\n<p>As described in <a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/bone-and-cancer\/\">Bone Cancer<\/a>, the therapy options for OS are tumor removal with pre- and post-surgery chemotherapy, and depending on the size or location, amputation or rotationplasty may be required.<\/p>\n<p>In OS there are gross genetic rearrangements. This results in too much heterogeneity and it is difficult to extract one single marker. This means that it is unlikely that a targeted therapy will work for a large group of patients. Hence we are limited to \u201cuntargeted\u201d chemotherapy.<\/p>\n<h2 id=\"z92b6ed004fd4\" class=\"in-list\">27.4.1 \u2013 Prognosis<\/h2>\n<p>The 5-year survival rate for patients diagnosed between 1974 and 1994 was 63%. Once metastasis occurs, prognosis reduces to 20% for 5-year survival rate.<\/p>\n<p>\u00a0<\/p>\n<div class=\"textbox tbverweis\">\n<p>References:<\/p>\n<ul>\n<li>Medscape: <a href=\"https:\/\/emedicine.medscape.com\/article\/1256857-overview\">Osteosarcoma<\/a><\/li>\n<\/ul>\n<\/div>\n<div class=\"textbox tbexkurs\">\n<h1 class=\"not-in-list\">Related Topics<\/h1>\n<p><a href=\"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/chapter\/bone-cancer\/\">Bone Cancer<\/a><\/p>\n<\/div>\n<p style=\"text-align: right\">Chapter material provided by Dr. Botter<\/p>\n","protected":false},"author":7,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-175","chapter","type-chapter","status-publish","hentry"],"part":160,"_links":{"self":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapters\/175","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/wp\/v2\/users\/7"}],"version-history":[{"count":3,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapters\/175\/revisions"}],"predecessor-version":[{"id":372,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapters\/175\/revisions\/372"}],"part":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/parts\/160"}],"metadata":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapters\/175\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/wp\/v2\/media?parent=175"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/pressbooks\/v2\/chapter-type?post=175"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/wp\/v2\/contributor?post=175"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/wp-prd.let.ethz.ch\/WP0-CIPRF9685\/wp-json\/wp\/v2\/license?post=175"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}