Country boy came to town
IN THE past few weeks, the Lancet Clinical Laboratories Cancer column has discussed several human cancers which may cause serious harm or death if not detected and treated in time. This week we are going to discuss a relatively rare cancer, that brought Tonderayi (not his real name) to the city for the first time at the age of 17 years.
Tonderayi is an experienced herd boy, well known in his village for his impressive ability to bring home every single cow every evening.
One late afternoon, in anticipation of the return to the village kraals, Tonderayi chases down a particularly obstinate calf but he does not make it far as his right leg suddenly gives way under him and sends him sprawling to the ground.
His dismay turns to amazement as he looks back and sees the thigh forming a perfect right angle he last saw on the teacher’s blackboard weeks ago!
Tonderayi eventually makes it to a public central hospital where X-rays are done, and a tissue biopsy is performed by an orthopaedic surgeon. In an example of a successful public-private partnership (PPP), the specimen is processed and read by a Lancet Clinical Laboratories Specialist pathologist, who makes a diagnosis of Osteogenic Sarcoma.
The skeleton is made up of bone, a very hard but living tissue which may give rise to cancer. One of the commonest types of cancer arising directly from the bony skeleton is called osteogenic sarcoma (derived from the Greek word sarkoun: fleshy tumour arising in bone).
This cancer usually occurs in young males between the ages of 10 and 25 years and frequently involves the knees and other bones of the legs and arms. The formation of the cancerous growth is not related to previous injuries and arises spontaneously in most cases. Hereditary cancers make up a small proportion of all osteogenic sarcomas.
If untreated, the cancer will eventually spread, by a process called metastasis, to the lungs, other bones, and other organs like the liver and the brain. Death normally intervenes in such advanced cases.
Tonderayi was lucky to survive the cancer, but his lost most of his right lower limb. Bone cancer is one of the most common reasons leading to amputation of upper and lower limbs. Prevention of the cancer is not possible but in cases where it is caught early, treatment with anti-cancer drugs known as chemotherapy may allow the surgeon to spare the limb and remove only the residual cancer.
There are a few non-cancerous growths of the skeleton which mimic and may be confused with the osteogenic sarcoma cancer.
It is therefore very important, that the diagnosis of osteogenic sarcoma must be confirmed by a Specialist Pathologist.
A tissue specimen from the cancer called a biopsy (Greek bios and opsis: to sight during life) is obtained by a surgeon and sent to a medical laboratory where the pathologist will make the diagnosis.
He or she will also do further tests which help characterise the aggressiveness of the cancer (prognosis) and the potential responsiveness to various chemotherapy regimens (predictive factors).Osteogenic sarcoma has a generally good survival compared to other cancers with 70% of affected individuals alive 5 years after diagnosis. This good prognosis is largely dependent on the diagnosis being made in time with adequate treatment instituted as soon as possible. I
t is important therefore, to have all new growths examined by a qualified medical practitioner and have appropriate investigations performed as necessary.
A young male with a large osteogenic sarcoma cancer involving the right thigh bone (femur).
Medical Disclaimer. The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content contained in or is available through this article is for general information purposes only.
It is not possible to write exhaustively about osteogenic sarcoma cancer in this article. Any comments and questions may be forwarded to the author via the electronic mail (email) addresses below.
About the author: Dr Blessing Zambuko is a Consultant Specialist Pathologist who is registered with the Medical and Dental Practitioners’ Council of Zimbabwe (MDPCZ) and practises with Lancet Clinical Laboratories. He may be contacted on info@lancet.co.zw <mailto:info@lancet.co.zw> or blessing. zambuko@lancet.co.zw <mailto:blessing.zambuko@lancet.co.zw>