Tumor
Overview:
-Osteosarcoma and Ewing sarcoma are the most common types of bone cancer in children and adolescents. Osteosarcoma's occur in the metaphysis of the bone. It usually present with pain, swelling and decreased joint motion. The patient may present with a fracture at the tumor site. Symptoms may be present for several months before diagnosis is made. Also known as osteoid sarcoma, it is a small, benign but painful tumor and is relatively common. 20% of lesions occur in proximal femur and 10% in pelvis. Patients are usually in 2nd decade of life, complains of chronic dull hip, thigh, or knee pain that is worse at night and is alleviated by activity or aspirin. Antalgic gait, point tenderness over lesion with restricted hip range of motion are also common findings.
Causes:
-Unknown, irradiation and genetic influences have been implicated
Risk Factors:
-Age, younger than 20 years old
-Affects males more than females
-Affects blacks more than whites
Pathogenesis:
-"Two suppressor genes, p53 and Rb, have major roles in tumorigenesis in osteosarcoma. Approximately 3-4 percent of children with osteosarcoma carry constitutional germline mutations in p53. The majority of these cases with germline p53 mutations occur in patients with a strong family history of cancer or with family histories suggestive of the Li-Fraumeni syndrome (a familial cancer syndrome) or in patients with multiple cancers."
Examination:
--History
-Pain in 80-90% of cases
-Usually begins as intermittent pain and increases in severity over time
-Pain with Ewing Sarcoma may spontaneously disappear for weeks or months
--Possible Findings
-Bone pain, especially with weight bearing
-Antalgic gait
-Local tenderness
-Night pain (constant, intense, unrelieved by change in position)
-Pain relieved disproportionately by aspirin
-Fever, weight loss, bleeding, skin lesions
-Vaginal/penile discharge
-Painless, progressive enlargement of inguinal and/or popliteal lymph nodes
--Diagnostic Tests/Imaging/Tests and Measures:
-Radiographs (X-rays), Blood tests, MRI, CT scan, Bone scan, Biopsy
-Bone marrow examination to differentiate from arthritis
Assessment/Outcome Measures:
-Special Tests: Positive heel strike test
Clinical Bottom Line:
-Patients with histories positives for the clinical signs and symptoms listed above need referral to their primary care provider or physician for imaging and lab testing. Patients under 20 years of age with pain of unexplained origin is a red flag signaling need for medical referral.
References
-Osteosarcoma and Ewing sarcoma are the most common types of bone cancer in children and adolescents. Osteosarcoma's occur in the metaphysis of the bone. It usually present with pain, swelling and decreased joint motion. The patient may present with a fracture at the tumor site. Symptoms may be present for several months before diagnosis is made. Also known as osteoid sarcoma, it is a small, benign but painful tumor and is relatively common. 20% of lesions occur in proximal femur and 10% in pelvis. Patients are usually in 2nd decade of life, complains of chronic dull hip, thigh, or knee pain that is worse at night and is alleviated by activity or aspirin. Antalgic gait, point tenderness over lesion with restricted hip range of motion are also common findings.
Causes:
-Unknown, irradiation and genetic influences have been implicated
Risk Factors:
-Age, younger than 20 years old
-Affects males more than females
-Affects blacks more than whites
Pathogenesis:
-"Two suppressor genes, p53 and Rb, have major roles in tumorigenesis in osteosarcoma. Approximately 3-4 percent of children with osteosarcoma carry constitutional germline mutations in p53. The majority of these cases with germline p53 mutations occur in patients with a strong family history of cancer or with family histories suggestive of the Li-Fraumeni syndrome (a familial cancer syndrome) or in patients with multiple cancers."
Examination:
--History
-Pain in 80-90% of cases
-Usually begins as intermittent pain and increases in severity over time
-Pain with Ewing Sarcoma may spontaneously disappear for weeks or months
--Possible Findings
-Bone pain, especially with weight bearing
-Antalgic gait
-Local tenderness
-Night pain (constant, intense, unrelieved by change in position)
-Pain relieved disproportionately by aspirin
-Fever, weight loss, bleeding, skin lesions
-Vaginal/penile discharge
-Painless, progressive enlargement of inguinal and/or popliteal lymph nodes
--Diagnostic Tests/Imaging/Tests and Measures:
-Radiographs (X-rays), Blood tests, MRI, CT scan, Bone scan, Biopsy
-Bone marrow examination to differentiate from arthritis
Assessment/Outcome Measures:
-Special Tests: Positive heel strike test
Clinical Bottom Line:
-Patients with histories positives for the clinical signs and symptoms listed above need referral to their primary care provider or physician for imaging and lab testing. Patients under 20 years of age with pain of unexplained origin is a red flag signaling need for medical referral.
References