After returning to the office, Xu Qiu added all examinations to the patient, and in addition, he added angiography.

If the tumor is really discovered by the bone scan, then further angiography can be performed. This examination can better show the extent of the external bone part and blood vessel displacement of the tumor.

Although it is of little significance to diagnosis and differentiation, angiography can provide the tumor profile and surrounding blood vessel compression, which is an important basis for evaluating whether surgery can be performed, surgical methods and intraoperative bleeding.

Two days later, the result came out.

First, PET-CT: It shows that the axillary pleural nodules have metastasized.

The results of genetic testing are very gratifying: EGFR19 is missing!

At the same time as the diagnosis was confirmed, Xu Qiu immediately prescribed the targeted drug osimertinib.

If the effect is good and the lesions can be reduced to 50% now, there is still a chance of surgery.

Now I need to see a bone scan...

Xu Qiu adjusted the diagnosis interface and his face immediately became slightly darker.

The worst result appeared - radionuclide scans found abnormal concentrations in the upper part of the left tibia of the lower limb.

The subsequent angiography, pathological biopsy, etc. gave a more clear diagnosis:

"A large number of tumor bone structure infiltration with thick beam-shaped or thick reticular tumors with good differentiation can be seen in the upper part of the left tibia, which destroys the bone marrow cavity and normal trabecular bone; tumor tissue infiltration destroys the bone cortex; the marrow cavity margin sent for examination, self-examination

There was no tumor tissue infiltration in the fibula margin and joint capsule. There was tumor tissue infiltration in the tibia margin by self-examination; tumor tissue infiltration was seen in the fibula head...

Diagnostic comments:

1. Low-grade central osteosarcoma in the upper left tibia.

2. There was no tumor tissue infiltration in the medullary cavity margin, fibula margin and joint capsule, and tumor tissue infiltration in the tibial margin."

After seeing this report, Xu Qiu understood why there was no prompt for CT...

Jiang Donger's osteosarcoma is too tricky, with deep location and no extensive infiltration. In this case, it is very difficult to discover osteosarcoma based on CT alone.

If the patient had lung adenocarcinoma, it would take several days for Xu Qiu to undergo bone scan.

...

"It turned out to be osteosarcoma." Although Xu Qiu had expected it, he was still surprised when he was diagnosed correctly.

The incidence of osteosarcoma is only 0.2%, and only two to three cases occur in almost every million individuals.

Nevertheless, it is also the most common malignant bone tumor, ranking second only to plasma cell myeloma in primary bone tumors.

For osteosarcoma, traditional treatments are very effective. Whether it is amputation or chemotherapy, the five-year survival rate is less than 20%, and only a small number of people have the opportunity to live for more than five years.

However, chemotherapy and surgery are now innovating, and new clinical guidelines are adopted, which may increase the five-year survival rate to more than 50%.

"This is still a rare small cell osteosarcoma." Xu Qiu sighed slightly.

Osteosarcoma also has many subtypes, such as typical osteosarcoma, which accounts for about 80% of all osteosarcoma. The clinical manifestations are very typical, namely pain, swelling, limited movement, and increased skin temperature. Tumors mostly occur in the femur

Distal end, proximal tibia, etc., and can penetrate through the epiphyseal and invade the joints.

Secondly, the tumor manifests as a large blood-filled sac cavity with spaces inside, and the osteopathic stroma is rarely vasodilated osteosarcoma; the microscopic tumor consists of a spindle-shaped fibroblastic stroma, and the nucleus is mild

Typically, low-grade malignant central osteosarcoma is produced by osteoid matrix.

In addition, there are paracortical osteosarcoma, periosteal osteosarcoma, highly malignant bone surface osteosarcoma, and small cell osteosarcoma, etc.

Among them, the best prognosis is low-grade malignant central osteosarcoma, which has a very slow growth and a low incidence of metastasis, which is much better than the prognosis of traditional osteosarcoma.

Highly malignant osteosarcoma are similar to traditional osteosarcoma, with similar treatment methods and prognosis.

The most dangerous thing is small cell osteosarcoma.

Its incidence is only about one percent in osteosarcoma, and it is mainly composed of small round cells, with a morphology similar to Ewing sarcoma or other malignant round cell tumors.

According to literature records, even after the new treatment methods are adopted, the five-year survival rate of patients with small cell osteosarcoma is only 28%.

Much less than 50% of other subtypes.

"And, the location is too deep." Xu Qiu frowned.

Osteosarcoma in the tibial marrow has complex location and many factors of uncertainty in anatomical position. This alone can discourage many orthopedic doctors. Few people dare to undergo surgery, and basically they can only rely on chemotherapy drugs to support them.

He immediately held a multidisciplinary consultation.

The plan was also confirmed after the consultation:

1. Large dose chemotherapy.

2. Combined surgery to cure it.

Large-dose chemotherapy is an effective method for systemic treatment of osteosarcoma. Chemotherapy can kill tiny metastases in the lungs and the whole body. Today's neoadjuvant chemotherapy can cause necrosis of tumor cells, shrink tumors, and promote edema and regeneration in the reaction area.

The tumorous blood vessels disappear and the opportunity to operate is obtained.

Of course, tiny lesions are more sensitive to chemotherapy. For example, the lung adenoma in Jiang Donger's right upper lobe is a metastasis of osteosarcoma, but they can only be reduced by osimertinib, and the lesions need to be removed later.

As for the primary lesions of osteosarcoma in the left tibia, it is necessary to consider whether to use amputation or limb preservation.

This is not only judged based on the results of chemotherapy and various information of the patient, but also the wishes of the family and the patients themselves...

After the consultation, Xu Qiu had a conversation with Jiang Donger's family and informed him of the discussion results.

Compared to when I first learned about osteosarcoma, the family of three has calmed down a lot at this moment.

Jiang Dong'er chased her hair and whispered: "What a pity. I usually cherish my hair so much that I will shave my head in the future..."

It is more acceptable to just shave your head directly than to see your hair fall off hand by hand.

Jiang Dong'er was silent for a while and asked, "Doctor Xu, do you think you have a chance to protect my left leg?"

Xu Qiu didn't dare to make a promise and said: "If you do limb protection surgery, you must also evaluate the biological behavior of the tumor and chemotherapy to be controlled, and whether the tumor itself can undergo extensive local resection."

Limb preservation is the least recommended surgical method.

In addition to Jiang Donger's complex location, there are also various reconstructions and soft tissue repairs that need to be done. This is a huge surgical project that is not dared to take, so it is directly excluded and will not give patients a chance to choose.

Only Xu Qiu dared to give a plan for limb protection.

He reminded: "However, limb preservation surgery is also the most expensive and risky way. Direct removal of the limb is very safe and the lesions can be completely removed."

"But if this happens, I won't even have legs..." Jiang Dong'er lowered her head.

Neither Jiang’s mother nor Jiang’s father spoke. The daughter had her own choice. All they had to do was to become a solid backing.

A long time later, Jiang Donger asked, "If you have amputation, the probability of my life for five years is about 30%?"

“That’s how the data is.”

"If you do limb protection surgery, the probability of recurrence is higher, and the chance of living for five years has dropped to 20%..." Jiang Dong'er muttered.

She slowly raised her head and suddenly asked, "Doctor Xu, I want to know, if it were you for the surgery, how much chance I would have lived for more than five years?"

——
Chapter completed!