Osteogenic Sarcoma; Chondroblastic Osteocarcoma; Multifocal Osteosarcoma; Metastatic Osteosarcoma; Fibroblastic Osteosarcoma; Central Osteosarcoma; Conventional Central Osteosarcoma; Classical Osteosarcoma; Osteoblastic Sarcoma; Central Osteogenic Sarcoma; Sclerosing Osteosarcoma
Osteosarcoma is the most common bone cancer in children and adolescents, with peak onset in the second decade. It tends to occur in the long bones (particularly distal femur, proximal tibia, and proximal humerus), but can occur in any bone. The lungs are the most common site of metastasis. Kidneys, adrenal gland, brain, and heart can also be sites of metastasis.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Diagnostic testing for osteosarcoma includes surgical biopsy, X-rays, CT scan, MRI scan, and radionuclide bone scans.
Physical findings: Clinical findings may include swelling or pain at site of tumor or with activity, limping (if tumor is in leg), limitation of motion of the affected area, and pathologic fractures.
ICD 9: 170
ONSET AND PROGRESSION
The prognosis of osteosarcoma depends on age at presentation, the extent of the disease (size and location of tumor, presence or absence of metastasis), and the response to therapy. Long-term survival rates are better if the cancer has not spread to the lungs (pulmonary metastasis). If the cancer has spread to other parts of the body, prognosis is better and there is still a chance of cure with effective treatment.
Treatment may include chemotherapy, radiation, surgery, bone grafting, limb-amputation, and limb-saving (salvage) surgery.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation: The adjudicator needs medical evidence from treating sources and hospitals. It should include clinical examination, imaging tests, biopsies, pathology reports, surgical procedures, pertinent treatment records, and up-to-date progress notes.
Suggested Listings for Evaluation:
Osteosarcoma that is inoperable or unresectable meets listing 13.11.
Osteosarcoma that has distant metastases meets listing 13.11C.
Osteosarcoma in adults treated with multimodal therapy meets 13.11D without regard to effectiveness of treatment.
Pediatric osteosarcoma meets 113.03 (solid tumors); only a pathology report is needed.
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