This article was written by our 2016-2017 University of Minnesota Sarcoma Scholars:
Aubrey Thyen, B.A., M.D. candidate class of 2018
Robert Gao, B.S., M.D. candidate class of 2018
Melissa White, B.S., M.D. candidate class of 2018
Osteosarcoma is a rare disease that affects only about five out of every one million children ages 19 and younger1. Although those numbers seem small, it is the third leading cause of pediatric cancer behind leukemia and lymphoma2. Osteosarcoma tends to target the metaphyses of long bones, often the distal humerus, distal femur, or proximal tibia1,2. The cancer is often difficult to diagnose because it presents with vague complaints that can often be wrongly chalked up to normal growth. These include pain that is worse during sleep and difficulty moving the affected joint2. Up to 10% of patients present for the first time with a pathologic fracture2. If the patient is first diagnosed with metastatic disease, they have a 30% chance at five year survival3. Here we present a patient, Julian Baultrippe, who experienced a tumultuous journey to diagnosis, and whose life may have been saved if there had been earlier detection of his osteosarcoma.
Julian’s story begins in the fall of 2006 as a freshman at the University of Minnesota. He loved staying active by working out and playing basketball at the rec center on campus. Shortly after the start of his freshman year, he began to experience pain in his right arm. He was seen at the campus health services twice over the next several months, where he was told the pain was due to tendinitis or adhesive capsulitis. He was subsequently referred to physical therapy when the pain continued to persist. The physical therapist suspected that, whatever Julian was experiencing, it appeared to be more serious than what his previous providers had diagnosed. It was only a few days later, now February 2007, when Julian’s pain became unbearable and he presented to the emergency room at Saint Joseph’s Hospital in Saint Paul. He had an array of tests performed which ultimately led to the diagnosis of osteosarcoma.
Due to this delay in diagnosis, Julian’s tumor was in an advanced stage by the time management was initiated. The next two and a half years were nothing short of a battle for Julian. He was referred to an orthopedic surgeon and underwent multiple surgeries, including an amputation and lung surgeries, along with chemotherapy and radiation. Through all of this, he maintained resilience and even returned to college in 2008. He also shared his story with students at the University of Minnesota Medical School, providing future physicians with his unique perspective and experience as a patient. In August 2009, after a long courageous battle, Julian passed away.
Julian’s story provides an opportunity for health care providers to reflect on the importance of clinical vigilance when it comes to diagnosing sarcoma. It is vital that physicians include sarcoma on their differential whenever they encounter a patient with bone pain or an unusual mass. This includes in young patients, where vague symptoms can easily be attributed to growing pains or minor injury from overuse. Heightened awareness will allow sarcoma to be caught early before it has advanced to an incurable stage.
1. Anderson, M. (2016). Update on Survival in Osteosarcoma. Orthopedic Clinics of North America, 47(1), 283-292.
2. Durfee, R, et. al. (2016). Review of Osteosarcoma and Current Management. Rheumatology and Therapy, 3(2), 221-243.
3. Kager, L, et. al. (2003). Primary Metastatic Osteosarcoma: Presentation and Outcome of Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols. Journal of Clinical Oncology, 21(10), 2011-2018.