Bone & Soft Tissue Sarcoma

Most common bone cancers

Osteosarcoma & Ewing tumor

Osteosarcoma most common sites

Distal femur, proximal tibia, proximal humerus

Ewing tumor most common sites

Chest wall, pelvis, legs

Soft tissue sarcoma

Develops in fat, nerves, muscle, fibrous tissues, blood vessels, or deep skin tissues; usually arms and legs

Bone cancer incidence per year

3910

Bone cancer mortality per year

2100

Bone cancer 5 year survival

68-73%

Soft tissue sarcoma incidence

13190

Soft tissue sarcoma mortality

5130

Soft tissue sarcoma incidence

13190

Primary tumors spread to bone

Prostate, Uterus, Thyroid, Lung, Breast, Thyroid, Melanoma, Kidney, Bladder

Risk factor for soft tissue sarcomas

Radiation, family syndromes, damaged lymph system, exposure to certain chemicals

Osteosarcoma risk factors

Age 10-30, taller for age, males, African and Hispanics ethnicity, radiation, Paget, hereditary multiple osteochondromas fibrous dysplasia, retinoblastoma, Li-Fraumeni Syndrome, Rothmund-Thomson syndrome, Bloom syndrome, Diamond-Blackfan anemia

No lifestyle factors

Ewing risk factors

White & Hispanic, male, teens

Kapoks Sarcoma risk

KSHV or human herpesvirus 8; same family as Epstein Barr virus; HIV, AIDs

Clinical bone symptoms

Painful or painless swollen mass; soft or warm, unexplained fever, pathological fracture

Soft tissue sarcoma clinical symptoms

New pump anywhere on body, worsening retroperitoneal abdominal pain, blood in urine or vomit

Bone and soft tissue cancer physical exam

Visible or non visible mass, palpable, firm, nontender, warm, note size, limited range of motion

Diagnostic Imaging

Bone scan, act of chest & abnormal area, MRI, PET, angiogram, Chest xray(if CT not done), xray (done first)

Biopsy for Bone Cancer

Needle biopsy, excisional biopsy, incisional biopsy

Lab values associated with bone and soft tissue cancers

Alkaline phosphatase and lactate dehydrogenase

Sarcoma classification

Histology (not location)

Musculoskeletal Tumor Society staging system

Grade, Extent of tumor, and metastasis

Grade 1 (MTS)

Low grade; look like normal cell and grows/spreads slowly

Grade 2 (MTS)

High; looks abnormal and is likely to grow and spread fast

T1 (MTS)

Intracompartamental (within bone)

T2 (MTS)

Extracompartmental (spread outside of bone)

American Joint Committee staging system

Tumor, Nodes, Metastasis, Grade

Sarcoma prognosis

Poor with metastasis

Sarcoma metastasis

Lung, breast, colon, pancreas, kidney, thyroid, prostate, stomach, testes, spine, ribs, pelvis

Ewing sarcoma (reticuloendothelial tissue, EFT) survival rate

65%

Kaposi sarcoma survival rate

85% on chemotherapy

Osteosarcoma survival rate (adolescents)

66%

Soft tissue sarcomas prognosis & survival

highly malignant, 65%

Soft tissue sarcoma incidence

13190

Soft tissue sarcoma mortality

5130

Treatment goals

Survival, removal, preserve functioning

Osteosarcoma, fibrosarcoma, chondrosarcoma treatment of choice

Amputation, limb salvage, or rotationplasty

Radiation follows after what surgery

Limb salvage

Bone Reconstruction utilizes:

Autografts, allografts

Soft Tumor Reconstruction utilizes:

Arthodesis, Arthroplasty for joints, and allografts

Use of adjuvant external beam radiation

before or after surgery, when tumor is localized, removed, or debulked

Use of adjuvant chemotherapy/immunotherapy

especially effective in EFT, rhabdomyosarcoma, and osteosarcoma

Approved chemotherapeutic agents

Doxorubicin

Cisplatin

Cyclophosphamide

Dacarbazine

Ifosfomide

Methotrexate

Vincristine

Cosmegen

Denosumab

Doxorubicin other name

Adriamycin

Doxorubicin alert

Cardiomyopathy

Test required prior to doxorubicin

Muga or Echo

Max cumulatively dose of doxorubicin

550mg/m2 (w/cytoxan → 450mg)

Doxorubicin Extravasation Category

Vesicant

Doxorubicin class

Anthracycline; Antitumor Antibiotic

Dacarbazine other name

DTIC-Dome

Dacarbazine class

Alkylating agent

AD combination regimen

Doxorubicin

Dacarbazine

Cisplatin other name

Platinol

Cisplatin class

Alkylating agent (platinum based)

Cisplatin extravasation class

Vesicant higher than 0.5mg/ml; irritant at lower concentrations

Cisplatin black box warning

severe renal toxicity

Peripheral neuropathy

severe nausea and vomiting

Myelosuppression

Cisplatin adverse side effects

Ototoxicity

Ocular toxicity

Secondary acute leukemia

Embryo-fetal toxicity

Dacarbazine extravasation class

Irritant

AIM combination regimen

doxorubicin

ifosfamide

Mesna

MAID combination regimen

Mesna

Doxorubicin

Ifosfamide

Dacarbazine

Unresectable or metastatic combination regimen

Gemcitabine and:

Docetaxel

Vinorelbine

or

Dacarbazine

Phantom limb pain onset and resolution

1-4 weeks

In a few months

Chronic also

Stump care

Keep elevated for 1-2 days

Unwrap every 4-6hrs for first two days, then daily

Intervention to limit contracture

Probe position 3-4 times a day for 15 minutes minimum; Q2 turns