Carcinoma in which surgery is rarely indicated
Correct Answer: Osteosarcoma
Description: Osteosarcoma An osteosarcoma (OS) or osteogenic sarcoma (OGS) (or simply bone cancer) is a cancerous tumor in a bone. Specifically, it is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid. Treatment A complete radical, surgical, en bloc resection of the cancer, is the treatment of choice in osteosarcoma. Although about 90% of patients are able to have limb-salvage surgery, complications, paicularly infection, prosthetic loosening and non-union, or local tumor recurrence may cause the need for fuher surgery or amputation. Mifamuide is used after a patient has had surgery to remove the tumor and together with chemotherapy to kill remaining cancer cells to reduce the risk of cancer recurrence. Also, the option to have rotationplasty after the tumor is taken out exists. Patients with osteosarcoma are best managed by a medical oncologist and an ohopedic oncologist experienced in managing sarcomas. Current standard treatment is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection. The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regimen should be altered after surgery. Standard therapy is a combination of limb-salvage ohopedic surgery when possible (or amputation in some cases) and a combination of high-dose methotrexate with leucovorin rescue, intra-aerial cisplatin, adriamycin, ifosfamide with mesna, BCD (bleomycin, cyclophosphamide, dactinomycin), etoposide, and muramyl tripeptide. Rotationplasty may be used. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. Despite the success of chemotherapy for osteosarcoma, it has one of the lowest survival rates for pediatric cancer. The best repoed 10-year survival rate is 92%; the protocol used is an aggressive intra-aerial regimen that individualizes therapy based on aeriographic response. Three-year event-free survival ranges from 50% to 75%, and five-year survival ranges from 60% to 85+% in some studies. Overall, 65-70% patients treated five years ago will be alive today. These survival rates are overall averages and vary greatly depending on the individual necrosis rate. Filgrastim or pegfilgrastim help with white blood cell counts and neutrophil counts. Blood transfusions and epoetin alfa help with anemia. Computational analysis on a panel of Osteosarcoma cell lines identified new shared and specific therapeutic targets (proteomic and genetic) in Osteosarcoma, while phenotypes showed an increased role of tumor microenvironments Ref : Internet sources
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