12 your old male with osteosarcoma distal femur
Step 5: Communication
Communication with a specialist centre, the patient and parents is important
Because of your concerns, you call the radiologist to review the X-ray. He tells you this looks like an osteosarcoma.
What do you do now?
Send the patient to the Emergency RoomTip 1
No. While this gets the patient in hospital, it is not the most efficient way to have them seen by a specialist. This tumour is urgent, but not an emergency.Close
Refer for an image guided biopsyTip 1
No. Biopsy must be done in consultation with the treating surgeon as these tumours are very transplantable. Improper biopsy can severely compromise future treatment and result in amputation being necessary.Close
Urgently refer to a multidisciplinary sarcoma centreTip 1
Yes. The best outcomes for these complex tumours are achieved when they are managed by the appropriate subspecialists in a multidisciplinary setting.Close
Order an MRI and CT Chest and wait for the results before referringTip 1
No. While these investigations are important, valuable time can be lost waiting for the results. They can be done promptly at the multidisciplinary centre once the patient has been seen by the orthopaedic oncology surgeon and the diagnosis confirmed.Close
The mother asks you to tell her more about her son's possible diagnosis:
You should take time to acknowledge the parents’ concerns and anxiety, and show a caring attitude in this difficult time for them. It is important to reassure them that they will be seen quickly by the appropriate specialists.
Survival ratesTip 1
With modern treatment, non-metastatic osteosarcomas have a survival rate of about 70%. However, if a patient is found to have metastatic osteosarcoma at presentation, the survival rate is only 20% at 5 years.Close
The use of chemotherapy improves survival rates from 20% to 70%, and is an essential component of treatment. It will be tough for him, but there will be a lot of support.Close
Radiation TherapyTip 1
Radiation Therapy is not often used for osteosarcomas except in very unusual circumstances.Close
Surgical resection with wide margins is essential to achieve a cure. Modern techniques have led to greatly increased rate of successful limb salvage rather than amputations. The surgery should be performed by someone with the appropriate training and who does this kind of surgery on a regular basis.Close