NARRATIVE PATHOPHYSIOLOGY Osteosarcoma occurs mainly in the metaphysic of the long bones.

Most tumors arise in bones involved with the knee joint at the distal end of the femur or proximal distal end of the tibia. As a tumor of the mesenchymal cells, osteosarcoma demonstrates production of osteiod tissue. The tumor borders are distinct and merge into adjacent normal bone. The etiology is unknown. Predisposing factors include, Age- (10-25), Gender-(male),Family history, Teenage growth spurt, Tall for age, Previous treatment with radiation, Benign &noncancerous bone tumor, Lack of exercise, Smoking and drinking ,DNA mutation, Familial susceptibility, Injury and Metabolic/hormonal disturbance. Once there is mutation of tha DNA,it activates the oncogene which leads to a deactivation of the suppressor gene which causes a malignant osteoblast that leads to proliferation of abnormal osteoblasts. This causes formation of osteiod tissue. The osteiod tissue causes uncontrolled growth of the tumor in the bone and therefore overcrowding of the bone. There is then suppression of red bone marrow which leads to decreased production of blood cells. a decrease in RBC leads to anemia while a decrease in WBC leads to a lowered infection resistance. The overcrowding also causes pressure inside the bone which is a main cause of pain and fractures. The cancer then metastasizes spreading to other parts of the body especially the lungs,kidneys, CNS, liver and the spleen.

PATHOPYSIOLOGY OF OSTEOSARCOMA Predisposing factors

Age- (10-25) Gender-(male) Family history Teenage growth spurt Tall for age Previous treatment with radiation Benign &non-cancerous bone tumor Lack of exercise Smoking and drinking DNA mutation Familial susceptibility Injury Metabolic/hormonal disturbance

Etiology Unknown Osteoblast

Mutations in DNA

Activate Oncogene

Deactivation of tumor suppressor gene

Malignant osteoblast

Proliferation of abnormal osteoblast

Formation of osteiod tissue

Uncontrolled growth of tumor in bone Overcrowding of the bone

Supression of red bone marrow

Cancer cells metastasize spread to other parts Organ infiltration

Increased pressure inside bone Fractures

-pain -swelling

Decreased production of blood

Decreased RBC
Anemia

Decreases WBC

Decreased platelets

Lowered infection resistance

-aneroxia -fatigue -SOB -diziness

kidneys

CNS

Liver/spleen

lungs

Disturbances in renal filtration Kidney failure

Leucocyte cells impair circulation of CSF Leukocyte cells compress spinal/cranial nerves Progress to coma

Invasion and overcrowding of the liver/spleen Hepatomegaly/spleenome galy Extra cells cause liver/spleen to rapture bleeding -dysphagia

Overcrowding of cancer cells in lungs

Bronchial /tracheal obstruction

- Little or no UO -Increased RR -Flank pain -edema

Severe hypoxia

-Weakness -Blurred vision -Balance difficulty -Vomiting -lethargy

Hypovolemic shock -hypotension -tachypnea -tachycardia

-Cough -wheeze -SOB -chest pain hoarseness -

CONCLUSION In most cases, by the time osteosarcoma is discovered and diagnosed in a patient, it has already metastasized and most commonly into the lungs. Patients are either terminal or are waiting to be amputated. we should do our best As nursing students by doing some of the following: provide quiet environment and calm activities to prevent or lessen pain, Provide comfort measure such as back rub, change position and use of heat or cold application, Encourage diversional activities, Administer analgesics as indicated to maximal dose as needed, Encourage the patient to increase fluid intake, Encourage rest periods to prevent fatigue, Provide accurate information about the situation, medication and treatment, Assess muscle strength, gross and fine motor coordination, Provide pillows for cushion and support. This study gives us information and knowledge about the Osteosarcoma and way on how to deal with these kinds of patients. Proper management and treatment and specially ensuring that the patient is kept comfortable and that he receives support and understanding.