prior to diagnosis and would have been treated with painkillers and managed for a sports injury . X-rays are useful but they are not definitive and may miss early signs of osteosarcomas . After a period of persistent symptoms , a magnetic resonance imaging ( MRI ) scan is performed with the expectation of finding some sprained ligament or muscle tear . But lo and behold , the scan shows a large bone cancer instead .
Treatment of osteosarcoma involves chemotherapy and surgery . In at least 60 to 70 percent of the time , we are successful in eradicating all traces of the cancer and curing the patient . But at what cost ? And is it a false choice that one has to make between cure from cancer and limb preservation ?
Life and limb are equally important to everyone . Thus , doctors undertake this decision to amputate only after the most careful considerations and only if we have absolutely no other choice . And there are times when the cancer is too extensive and the entire tumor cannot be completely removed without sacrificing critical structures like nerves and major blood vessels . Or when the resulting limb , after a more limited surgery , does not give the patient good limb function , or the limb is weak and the patient is not able to walk , they may be better off with an amputation followed by use of an artificial prosthetic limb .
Thankfully , a multi-disciplinary approach to osteosarcoma treatment including surgery and chemotherapy has avoided the need for an amputation for the vast majority of our patients – including Miss Z – without compromising on cancer survival .
Chemotherapy , using a cocktail of drugs , is a key cornerstone in the treatment of osteosarcoma , and one that triples the survival of patients . Chemotherapy is given before surgery and after surgery . The purpose of chemotherapy is to directly kill the cancer in the bone as well as to mop up any traces of cancer that may have escaped to the other body organs like the lungs .
After an initial period of chemotherapy , patients undergo surgery , and in about half of these patients , more than 90 percent of the tumor cells would be destroyed by chemotherapy alone . This group of patients would go on to do extremely well . Surgical advancements and implant technology have also improved significantly . The considerations surgeons have not only include removal of cancer but also the reconstruction of the affected limb in order to preserve function . At the end of the day , doctors strive not only to beat the cancer but to return the patient to as normal a life as we possibly can .
While the treatment was long and arduous , with its many ups and downs , Miss Z successfully completed all her treatment . Surgery was performed in which the tumor was completely removed and her leg preserved . She is now back in school and firmly in control of her life .
Dr Richard Quek is a Senior Consultant in Medical Oncology at Parkway Cancer Centre in Singapore .
*( Details of the patient had been masked to protect their identity )
Multi-disciplinary approach to osteosarcoma treatment including surgery and chemotherapy has avoided the need for an amputation .
GlobalHealthAsiaPacific . com NOVEMBER 2020
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