Generally, there is a lack of awareness in the AYA population and primary health care providers of signs and symptoms for early diagnosis of cancer in this group. Developmental, psychological and social factors may place AYA at higher risk of a delay in diagnosis.2 The following images highlight key signs and symptoms to be alert for in AYA.
The '7 symptoms' increase awareness of early clues to cancer diagnosis in AYA17. (Permission to reproduce images provided by author).
Early detection of cancer in AYAs: guidance for general practitioners and primary health care providers. Early detection of cancer in AYAs Working Group (2014)2
The clinical presentation of osteosarcoma commonly includes localised bone pain over several weeks or months, and a palpable tender soft tissue mass. Pain is often intermittent and symptoms may be confused with growing pains, which may delay thorough investigation.6, 18 There may also be a limp, loss of function, or even decreased range of motion.18
Osteosarcomas tend to form in areas of rapid bone growth or turnover, such as in the long bones of a developing adolescent.18, 19 The most common sites of disease are the femur, tibia and humerus.19 Incidence of osteosarcoma is higher in males than in females (2.7:1).5
Elevated alkaline phosphate or lactate dehydrogenase may be present and may correlate with poorer prognosis.6 Common metastatic sites are the lungs and other bones and overt metastases are present in 10%-20% of individuals at diagnosis.6, 19
Several risk factors and other conditions have been associated with increased risk of osteosarcomas, these include:19
- prior radiation therapy
- prior antineoplastic agents, particularly with alkylating agents or anthracyclines
- Paget's disease
- chronic osteomyelitis
- Fibrous dysplasia.
Diagnostic and staging investigations for osteosarcoma include:6, 7
- X-rays of the involved bone
- magnetic resonance imaging and/or computed tomography of the whole compartment with adjacent joints to evaluate the extent of disease
- bone scan to determine if other lesions are present
- core needle or open biopsy of suspected primary malignant bone tumour to confirm diagnosis prior to any surgical procedure.
Review the signs and symptoms which may indicate osteosarcoma, and explain why there may be a delay in diagnosis of this condition in AYA populations.
Identify how the developmental achievements across all domains of health that occur in adolescence may be influenced by a diagnosis of osteosarcoma. Use the following resources:
- onTrac at PeterMac.20 Victorian adolescent and young adult cancer service
- Strongbonds website: adolescent development section21
Case study: meet Justin
Justin is a 16-year-old male who was recently diagnosed with osteosarcoma.
Watch Justin's first video and work through the accompanying learning activities.
Justin’s story 1: diagnosis
Critically discuss the missed opportunities for diagnosis for Justin, and the reasons for these.
Discuss the role an SCN may have in addressing these missed opportunities in Justin's case.
Identify the symptoms Justin described that might indicate the need for further investigation.