Delay in Diagnosis of High-Grade Osteosarcoma of the Extremities. Has it any Effect on the Stage of Disease?

Abstract

In 965 patients with high-grade osteosarcoma of the extremities, we investigated the correlation between diagnostic delay and the stage of the tumor at presentation. The mean interval between the onset of first symptoms and the final diagnosis was significantly shorter in patients with metastatic disease than in patients with localized disease at the time of the diagnosis. The difference was due to a late presentation of patients with localized disease to the physician and not to delays in performing radiologic examinations or in referring patients to a specialized hospital for biopsy and treatment. We conclude that in high-grade osteosarcoma of the extremity the shorter interval between onset of symptoms and diagnosis observed in patients with disseminated disease at the time of the diagnosis reflects a more aggressive behavior of tumors that are metastatic at presentation.

Prognostic Factors in High-Grade Osteosarcoma of the Extremities or Trunk: An Analysis of 1,702 Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

“…Results similar to ours have been reported from the Memorial Sloan-Kettering Cancer Center, where only 11% of 62 patients with clinically detectable metastasis at initial presentation survived, 44 and the Rizzoli Institute, where the chance for 44 patients with primary lung metastases to be alive after 5 years was only 14%. 45 Other than Bacci et al, 46 who recently reported primary spread to be associated with shorter prediagnostic symptom duration and hypothesized about a more aggressive biologic behavior, we found primary metastases to be associated with prolonged symptoms before diagnosis and large size of the primary tumor, which is another indicator of advanced disease. Identical age and sex distributions again argue against basic biologic differences between primary metastatic and seemingly localized osteosarcomas.…”

Metastatic cancer mimicking mechanical low back pain: a case report

“…Total pack years has been found to be correlated with a higher risk of developing lung cancer. 31,34 Our patient's 25.5 pack year history placed her at a 3.5 times higher risk of developing lung cancer compared to a non-smoker. 35 Overall, persons who have smoked any amount are at 2.7-8.2 times higher risk of developing lung cancer compared to those who have never smoked.…”

“…39 Research has shown that lung cancer risk in former smokers is inversely proportional to number of years since quitting. 31 Despite recommendations from multiple medical providers, our patient never pursued smoking cessation. While several components of this patient's history and physical examination were consistent with a mechanical musculoskeletal dysfunction, the location of the patient's symptoms (upper lumbar spine) was concerning.…”

“…25,29 These data may have a patient selection bias, however, as patients with more advanced and deadly stages of cancer tend to be diagnosed and treated more rapidly. [29][30][31] Considering the advanced stage of our patient's cancer, it is unlikely that the final outcome would have changed greatly with a more expedient diagnosis. However, providing a timely diagnosis in this case may have provided a psychosocial benefit to the patient and her family.…”

“…35 Overall, persons who have smoked any amount are at 2.7-8.2 times higher risk of developing lung cancer compared to those who have never smoked. 31,34 Recent trends in the literature have found total pack years to be of lesser importance in cancer risk and mortality when compared to current smoking status and daily intensity. 36,37 Active female smokers have a 5.2 times higher probability of contracting lung cancer compared to female non-smokers.…”