U Assessment

HISTORY. The focus of the assessment should be on gathering data that differentiate bone cancer from arthritic or traumatic pain. The patient usually reports the gradual onset of pain described as a dull ache. The patient often notices a swelling or the inability to move a joint as before. A distinctive trait of bone cancer pain is its tendency to be worse at night. Generally, it is a localized, aching pain, but it may also be referred from the hip or spine. The sudden onset of pain does not rule out bone cancer, however, because a pathological fracture may be present. If the cancer has spread, the patient may report weight loss and fatigue.

PHYSICAL EXAMINATION. Inspect for any unusual swellings or dilated surface vessels. The patient may walk with a limp or have weakness of the affected limb. If the tumor has progressed, you may note weight loss or cachexia, fever, and decreased mobility. Perform gentle range-of-motion exercises of all the extremities, and document any limitations in joint movement. Note any firm, nontender enlargements in the affected area when it is palpated. Consider, however, that bone tumors are not always visible or palpable. The tumor site may also be tender.

PSYCHOSOCIAL. Although some cancers can be cured with treatments that leave no visible signs, primary bone cancer often requires extensive surgical reconstruction or amputation of the affected limb as part of the treatment. Determine the patient's view of his or her body image and assess whether the impact of the treatment may lead to a body image disturbance.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Serum alkaline phosphatase

X-rays and computed tomography (CT)

4.5-13 units/dL No lesions

Elevated

Visualization of lesions; malignant lesions often have poor margina-tion, irregular new bone growth

Elevations occur with formation of new bone by increasing osteoblastic activity

Each tumor type has its own characteristic pattern; CT shows extent of soft tissue damage

Other Tests: In Ewing's sarcoma and metastatic bone lesions, increases occur in erythrocyte sedimentation rate as well as in leukocytosis and normocytic anemia. Bone biopsy, bone scan, serum calcium, magnetic resonance imaging (MRI).

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