What are the early symptoms of osteosarcoma? Can osteosarcoma be completely cured?

Osteosarcoma is the most common malignant bone tumor. It originates from mesenchymal cells with osteogenic potential. Malignantly proliferating sarcoma cells directly produce tumor bone-like tissue or immature bone. It is also called osteosarcoma, which refers to a malignant connective tissue tumor in which tumor cells can directly produce tumor bone and bone-like tissue. In 1993, the World Health Organization (WHO) referred to it as osteosarcoma to avoid confusion caused by the two meanings of "origin" and "production" of "osteogenesis". The most typical site of onset is the tubular bones of the limbs (accounting for 80%), especially the femur (40%), tibia (16%) and humerus (15%). The distal femur, proximal tibia and proximal humerus are the most common sites. 50% to 75% of osteosarcomas occur near the knee joint. Osteosarcoma in the fibula, hip, mandible, maxilla and spine is relatively rare. Osteosarcoma of the skull, ribs, scapula, clavicle, sternum, ulna, radius and small bones of the hands and feet is rare.

The prominent symptom of osteosarcoma is pain at the tumor site, which is caused by the tumor tissue eroding and dissolving the bone cortex. 1. Pain Pain of varying degrees at the tumor site is a very common and obvious symptom of osteosarcoma, caused by the expansion of tumor tissue destroying the bone cortex and stimulating the periosteal nerve endings. The pain can develop from intermittent in the early stage to continuous after a few weeks, and the degree of pain can be increased. Pain-avoiding claudication may occur in lower limb pain 2. Lump As the disease progresses, local swelling may occur. The lump can be touched at the painful part of the limb, accompanied by obvious tenderness. If the lump grows rapidly, the lump can be found from the appearance. The skin temperature of the lump surface increases and the superficial veins are exposed. There may be varying degrees of tenderness on the surface of the lump and the nearby soft tissue. Due to different degrees of ossification, the hardness of the lump varies. The enlargement of the lump causes limited joint movement and muscle atrophy. 3. Lameness Pain-avoiding claudication caused by limb pain worsens with the progression of the disease. Patients with a long illness may experience limited joint movement and muscle atrophy. 4. General condition: When the diagnosis is clear, the general condition is generally poor, manifested by fever, malaise, weight loss, anemia and even exhaustion. In some cases, the tumor grows very fast and metastasizes to the lungs at an early stage, causing the general condition to deteriorate. Pathological fractures at the tumor site make the symptoms more obvious.

1. Causes of Osteosarcoma There are several causes of osteosarcoma. 1. Chemical factors: such as hydrocarbons or azo substances, which can induce osteosarcoma in domestic rabbits and voles. 2. Radiation factors: Long-term irradiation can lead to tumor transformation. For example, 5 years after using radiation to treat breast cancer, osteosarcoma was found in the irradiated area. 3. Benign malignant transformation: such as deformed osteitis, which can become osteosarcoma. 4. Viral theory: Its basis is that injecting tumor extracts into voles can produce different types of sarcomas, and their special antigens can be detected. 5. Family inheritance: There are phenomena of parents and brothers having osteosarcoma. 2. Pathogenesis The pathogenesis of this disease is not very clear. Its histological feature is that the proliferating spindle-shaped tumor cells directly produce bone matrix or immature bone. But its hair type is different, and its histological features are also different. This article has been described in the overview. Osteosarcoma originates from primitive progenitor cells. This cell has multipotential characteristics and can differentiate into bone, cartilage and fiber. Therefore, in addition to malignant osteoblasts, osteosarcoma also has chondroblasts and fibroblasts. According to the amount of these three cell components, central osteosarcoma can be divided into osteoblastic type (osteoblastic type), chondroblastic type (cartilage-forming type) and fibroblastic type (fibroblastic type). 1. The tumor seen by the naked eye occurs in the medullary cavity and expands, destroys and penetrates the cortical bone into the soft tissue. The shape of the tumor varies depending on the location of the occurrence. The color and texture of the tumor section may vary due to different cell components, including grayish white, soft, fish-like, bluish white, brittle, cartilage-like, grayish white, tough, rubber-like and ivory-like tumor bones. The necrotic and hemorrhagic areas are grayish yellow and reddish brown distributed between the tumors. The cortical bone that was penetrated on one side of the tumor did not expand, and the periosteum was lifted up to reveal a triangular periosteal reaction.

2. Under the light microscope, the tumor cells are spindle-shaped, polygonal, or round, with obvious cell metaplasia. The cells are of different sizes and shapes. The nuclei are large and the nucleoli are obvious. Pathological nuclear division is common. In the well-differentiated areas, tumor cells can be seen to directly form tumor bone and bone-like tissue, which are pink-stained homogeneous cords and small pieces. The more mature the tumor is, the more bone and bone-like tissue it forms. Sometimes, osteoclast-type giant cells and hemorrhagic and necrotic areas can be seen. (1) Osteoblast type: It is mainly composed of malignant osteoblasts with obvious atypia, forming more tumor bone and bone-like tissue. The degree of cell differentiation varies. Some are more mature, with less atypia and more tumor bone, while others are poorly differentiated, with very obvious tumor cell atypia, easy to see nuclear division, and less tumor bone and bone-like tissue. (2) Chondroblast type: In addition to osteoblasts, half of the tumor tissue is chondrosarcoma structure. At the same time, tumor cells can be seen to directly form tumor bone and bone-like tissue. (3) Fibroblastic type: Tumor cells are spindle-shaped and arranged in a spoke-like pattern. Tumor cells can be seen directly forming tumor bone and bone-like tissue. The above three types often exist in combination. Currently, the above three types are called traditional types. 3. Electron microscopic observation shows that it is composed of five types of cells, the most basic of which is malignant osteoblasts, followed by chondroblasts, fibroblasts, myofibroblasts and undifferentiated cells. In addition to the five types of cells, there is also tumor bone-like tissue. (1) Malignant osteoblasts: The nucleus is irregularly round or oval. The nuclear membrane is serrated. The nuclear chromatin is slightly condensed, the nucleolus is obvious, the cell is filled with rough endoplasmic reticulum, there are few mitochondria, and it contains a small amount of cristae. The Golgi complex is relatively developed, there are protrusions on the cell surface, and there are no cell connectors between cells. (2) Malignant chondroblasts: The nucleus has obvious metaplasia, irregular microvilli on the surface, a clear zone around the cell, well-developed rough endoplasmic reticulum in the cytoplasm, oval mitochondria with obvious cristae, well-developed Golgi complex, vacuoles in the cytoplasm, and occasional lysosomes. (3) Malignant fibroblasts: The cells are spindle-shaped, the cytoplasm is irregular, the nucleus is long oval, the nuclear membrane surface has depressions, the chromatin is marginal, the cytoplasm contains abundant rough endoplasmic reticulum, and the mitochondria are moderate. (4) Undifferentiated cells: The cells have a relatively high nuclear-cytoplasmic ratio and few organelles, and are the main cell components of osteosarcoma. (5) Myofibroblasts: This cell can be seen in most osteosarcomas. The cells are long spindle-shaped, have abundant cytoplasmic microfilaments, and have abundant rough endoplasmic reticulum in the cytoplasm. The tumorous bone-like tissue is composed of collagen fibers and proteoglycans, and has different manifestations in different areas of the tumor. In the osteogenic area, the bone-like matrix is ​​dominant. In the chondroblast area, collagen fibers are formed and there are a large number of proteoglycans. In this fibroblast area, there is no obvious osteogenesis of the fibrocytes.

1. Population prevention Osteosarcoma ranks first or second in incidence among primary malignant bone tumors, and its malignancy is very high. It poses a great threat to the patient's quality of life and even life, so it should be given high attention. The earliest symptom of this disease is persistent pain. At this time, the lesion may have lasted for a period of time. Many patients always interpret the pain around the joints as joint sprains, and only come to see a doctor when persistent severe pain occurs or a lump is touched. Therefore, the focus of population prevention should be the popularization of relevant knowledge, so that people can increase their awareness and understanding of osteosarcoma and raise their vigilance. The improvement of sanitary conditions and the quality of medical care is the guarantee for early detection, and the popularization of population knowledge is the basis for early detection. Therefore, it should be emphasized that when adolescents find pain around the knee joint without obvious trauma, they should go to a hospital with a certain level for examination in the early stage, so as to facilitate early detection and early treatment, improve survival rate, and benefit both the people and themselves.

2. Individual prevention (1) Primary prevention: The disease may not cause any symptoms at the onset, and the earliest symptom is often pain. Once pain occurs, especially if there is no obvious history of trauma, such adolescents should seek medical attention as soon as possible. The occurrence of this disease may be related to some external stimuli, such as X-rays. Therefore, you should avoid contact with these risk factors. If you have to contact them due to certain factors, you should pay attention to protection and have regular checkups until you are 20 years old. Some benign lesions can also transform into osteosarcoma, such as osteochondroma, giant cell tumor, and fibrous dysplasia of bone. For patients with these diseases, you should be more vigilant and follow the doctor's advice for regular checkups. Be alert to signs of possible malignant transformation, such as pain that was not painful before, and sudden rapid growth of slow-growing bones. If these signs occur, you should see a doctor immediately for a detailed examination and, if necessary, a biopsy. (2) Secondary prevention: The prognosis of osteosarcoma patients is closely related to the early or late discovery of the disease. Therefore, when adolescents have unexplained pain symptoms around the knee joint, parents must not take it lightly and think that it is caused by their children's mischief. The emergence of monoclonal antibodies has made it possible to detect many tumors at an early stage, but the preparation of monoclonal antibody kits for osteosarcoma needs further study. At present, the staging of osteosarcoma also mostly follows the surgical staging system proposed by Enneking in 1980, namely the GTM surgical grading system. Among them, benign is G0, low-grade malignancy is G1, and high-grade malignancy is G2; tumors located in the capsule are T0, those located in the compartment are T1, and those located outside the compartment are T2; no local or distant metastasis is M0, and those with local or distant metastasis are M1. For low-grade malignant osteosarcomas and cortical sarcomas, local resection or tumor segment resection combined with chemotherapy can be used. If it is highly malignant, preoperative chemotherapy plus amputation plus postoperative chemotherapy should be used. Therefore, the early or late discovery of osteosarcoma and its nature are of great significance for the selection of surgical measures and prognosis. In the past, the traditional method of treating osteosarcoma was amputation plus radiotherapy, and the 5-year survival rate of this therapy was about 20%. The rise of chemotherapy has greatly improved the 5-year survival rate. The chemotherapy regimen currently used is mainly based on high-dose methotrexate. The various different regimens formed on this basis are similar. They are all based on the proliferation dynamics of tumor cells and select chemotherapy drugs for different cycles, but they have one thing in common, that is, high-dose methotrexate. In 1967, Djerassi first used high-dose methotrexate combined with calcium formylfolate detoxification to treat osteosarcoma. In 1968, Jaffe used this method to treat metastatic osteosarcoma and achieved success. It was called a revolution in the history of methotrexate dosage for the treatment of malignant tumors, which greatly improved the 5-year survival rate of osteosarcoma patients. Therefore, we emphasize that the completion of surgery is not the end of treatment. Patients should follow the doctor's advice and insist on regular chemotherapy in order to have a good prognosis and even cure. (3) Tertiary prevention: Because osteosarcoma is highly malignant, the current surgical method mostly uses amputation. During the operation, attention should be paid to tumor-free operation and try to avoid implantation or distant metastasis caused by surgery. For isolated lesions with local recurrence or distant metastasis, it is currently advocated that the regimen of preoperative chemotherapy plus surgical resection plus postoperative chemotherapy may still have a good prognosis. For widespread metastasis to distant sites, chemotherapy, supportive treatment, and radiotherapy of key sites can be used to support and minimize the patient's pain. The prognosis of such patients is extremely poor. Due to the improvement of prosthetic technology, the requirements for the stump after amputation are not as strict as before. Therefore, we mainly preserve the length of the affected limb as much as possible while ensuring the complete removal of the tumor tissue and not violating the principles of tumor surgery.

Western medicine treatment of osteosarcoma 1. Treatment After the diagnosis is clear, amputation or joint dissection should be performed as soon as possible. Chemotherapy and radiotherapy before and after surgery may improve the efficacy. Chemotherapy or radiotherapy alone is not very effective. The treatment of osteosarcoma is a comprehensive treatment based on surgery, that is, chemotherapy before surgery and chemotherapy after surgery. A considerable number of cases (about 66%) have satisfactory chemotherapy effects. Chemotherapy greatly improves the survival rate by inhibiting the occurrence of lung metastasis, and chemotherapy greatly increases the chance of limb-saving surgery without amputation. For typical osteosarcoma, if the preoperative chemotherapy is effective, extensive large-scale resection can be performed. However, if chemotherapy is ineffective, radical resection or amputation should be performed. Lung metastases can often be treated with resection. 1. Biopsy Only with a clear histological diagnosis can the treatment plan be determined. Preoperative biopsy is very important and is part of surgical treatment. It should be performed by experienced doctors, because inappropriate biopsy can lose the opportunity to preserve the limb. Needle aspiration biopsy has the advantages of little pollution and low risk, and its diagnostic positive rate can be as high as 80% or more in experienced hospitals. If needle biopsy fails, an incisional biopsy should be performed as soon as possible. The incision for the incisional biopsy is usually longitudinal and can be removed at the same time as the tumor is removed surgically.

2. Chemotherapy Chemotherapy is an important adjuvant treatment for osteosarcoma. High-dose chemotherapy combined with multiple drugs can kill local tumors. Preoperative chemotherapy (neoadjuvant chemotherapy) can cause tumor cell necrosis, tumor shrinkage, disappearance of edema in the reaction area and new tumor blood vessels, and clear tumor calcification boundaries. Clinically, the patient's pain is relieved or disappears, the tumor becomes smaller, the joint range of motion increases, and AKP can be reduced to normal. High-dose chemotherapy is also an effective method for systemic treatment of osteosarcoma. Chemotherapy can kill micro-metastases in the lungs and the whole body. This treatment should be performed early. Micro-lesions are more sensitive to chemotherapy than large tumors. Adjuvant chemotherapy can reduce the number of tumors in the lungs and delay their appearance. The key to prolonging the survival of patients with lung metastasis is to completely remove the metastasis. Chemotherapy can promote the radical cure of the entire disease and increase the cure rate. 20% to 40% of patients abroad can be cured through multiple treatments. If neoadjuvant chemotherapy cannot achieve tumor necrosis, delaying surgical treatment will affect the survival rate. Because when chemotherapy is ineffective, the tumor will continue in the reproductive period and micro-lesions in the lungs will develop. When chemotherapy is effective, postponing radical surgery for the tumor will not endanger the survival rate. Preoperative chemotherapy can increase the success rate of limb salvage, so it is safe and beneficial for patients preparing for limb salvage. The effect of preoperative chemotherapy can predict the cure rate. The successful chemotherapy not only improves the survival rate of osteosarcoma patients, but also preserves their limbs and has a certain joint function. Using cisplatin (DDP), doxorubicin (ADR), methotrexate-tetrahydrofolate (MTX-CF), BCD, ifosfamide (IFO), cyclophosphamide (CTX), etc., many foreign authors used preoperative and postoperative chemotherapy to treat osteosarcoma from 1982 to 1988, and the metastasis-free survival rate was 42% to 89%. For those followed up for more than 5 years, the metastasis-free survival rate of Jaffe (1988) was 56%, Takada (1986) was 56%, and Rossen (1982, 1985, 1986) was 77%. Many authors also used the above drugs to treat osteosarcoma with postoperative chemotherapy from 1982 to 1988, and reported the results. The metastasis-free survival rate was 24% to 65%. For patients with follow-up of more than 5 years, the metastasis-free survival rate of the French Bone Tumor Research Group (1988) was 41% (follow-up for 70 months), and that of Gasparin (1987) was 45%, with a follow-up of 84 to 132 months. 3. Limb-sparing treatment of osteosarcoma (1) The establishment of the surgical plan depends on the evaluation of various patient data: ① Surgical staging and blood supply status can be evaluated through X-rays, CT, MRI, chest X-rays, bone scans and DSA; ② By comparing various examination data before and after neoadjuvant chemotherapy, the biological behavior of the tumor and whether chemotherapy can control the tumor can be evaluated; ③ If the patient requires limb-sparing, it should also be evaluated whether the tumor can be safely subjected to extensive local excision, various reconstructions and soft tissue repairs such as flap transplantation, etc. (2) Selection of reconstruction materials: The selection of reconstruction materials depends on the doctor's experience, habits and objective conditions. For example, for young patients with relatively complete tumor shells and a certain strength, inactivated reimplanted tumor shells and bone cement filling and reinforcement can be used; allogeneic bone stored in a low-temperature bone bank can also be used for transplantation, but the patient should be informed that allogeneic bone reactions are likely to occur, resulting in limb salvage failure; artificial joint replacement can be used for the elderly. (3) Soft tissue repair: Soft tissue repair is the most important, and wound infection and skin edge and flap necrosis should be minimized as much as possible, which can lead to limb salvage failure. (4) Lung metastasis: For patients with lung metastasis, neoadjuvant chemotherapy can control the growth of metastatic lesions. Thoracic surgery can also perform limb salvage treatment for the primary tumor if it can perform surgical resection of metastatic lesions. (5) Huge tumors in the middle and lower femur: The nerves and blood vessels can be preserved to perform staged resection of the tumor, and the lower leg can be rotated 180 degrees and moved upward for replantation, with the lower leg replacing the thigh and the ankle replacing the knee joint. The patient can walk with the lower leg prosthesis on the forefoot with weight bearing, and the knee joint function can have a certain range of motion. (6) Soft tissue repair of knee tumors: Transplantation of gastrocnemius myocutaneous flap and latissimus dorsi free flap can make it possible for us to perform limb salvage surgery on patients who may have previously undergone amputation, especially for large lesions in the proximal tibia. (7) Lesions in the proximal humerus: Simple extensive resection of the proximal humerus can be used. When the lesion is close to the joint surface, large pieces of the humerus can be removed together with the glenoid fossa. The reconstruction method varies from person to person. Young people who need painlessness and stability can consider shoulder fusion, while the elderly can consider flail shoulder. As long as the neurovascular bundle is not invaded, the Tikhoff-Linberg surgery can be used for giant proximal humeral tumors. This surgery can preserve the function of the hand and elbow, which is significantly better than amputation. (8) Extensive resection of the proximal femur: It is relatively difficult. Limb-saving reconstruction can be performed using artificial prostheses or allogeneic bone-artificial prosthesis composites. (9) Spinal osteosarcoma: It is rare. Foreign literature reports that repeated surgical resections and high-dose adjuvant chemotherapy and radiotherapy can prolong the patient's survival, and some patients can be cured. (10) Pelvic osteosarcoma that is sensitive to chemotherapy: Wide pelvic resection, inactivation replantation, and total hip joint transplantation are feasible. 4. Amputation For patients who seek medical treatment late and are unable to undergo chemotherapy, amputation is still a better treatment method to relieve pain and prolong survival. Usually, a short course of chemotherapy should be given before surgery, and chemotherapy should be continued 2 weeks after surgery. 5. Other treatments The application of various biological treatments has been hot and cold, advancing in waves, and pessimistic and optimistic statements about their efficacy are unrealistic. Traditional Chinese medicine treatment can enhance immunity and reduce the toxicity of radiotherapy and chemotherapy. II. Prognosis 1. Among 16 patients with small cell osteosarcoma at Mayo Clinic, the cumulative 5-year survival rate was only 28.9%. 2. The histological manifestations and prognosis of highly malignant bone surface osteosarcoma are similar to those of traditional osteosarcoma. 3. The prognosis of periosteal osteosarcoma is better than that of traditional osteosarcoma through appropriate surgical treatment. 4. The prognosis of low-grade central osteosarcoma is much better than that of traditional osteosarcoma. 5. The treatment and prognosis of vascular dilatation osteosarcoma are similar to those of conventional osteosarcoma. 6. Juxtacortical osteosarcoma is a low-grade malignant subtype of osteosarcoma with a very good prognosis. If adequately and appropriately treated, more than 80% of patients can survive. Occasionally, after local recurrence of the tumor, the histological and cytological atypicality will be more obvious than when it first occurred. Traditional treatment methods (amputation, radiotherapy) have a poor prognosis for osteosarcoma, with a 5-year survival rate of no more than 20%. The most important factor affecting the prognosis of osteosarcoma patients is the degree of tumor tissue response to chemotherapy drugs, that is, the necrosis rate of tumor cells after chemotherapy. For patients with a necrosis rate of less than 90%, the prognosis is poor even if the chemotherapy regimen is changed. Some scholars have reported that the size of the tumor (those with a volume greater than 150 mm3 have a poor prognosis) and the levels of alkaline phosphatase and lactate dehydrogenase before surgery are also important for prognosis judgment. For osteosarcoma without lung metastasis, the cure rate can be as high as 60% to 80% through preoperative and postoperative chemotherapy and appropriate surgical treatment. The five-year cure rate of osteosarcoma treated in China is 52%, and 60% of patients have undergone limb-saving surgery, with a recurrence rate of 12.5%. Osteosarcoma Syndrome Differentiation and Treatment of Osteosarcoma Traditional Chinese Medicine Treatment Prescription for Osteosarcoma: ① 9g of Codonopsis pilosula, 9g of Astragalus membranaceus, 9g of Radix Angelicae Sinensis, 9g of Radix Paeoniae Rubra, 9g of Atractylodes macrocephala, 12.5g of Chuanduan, 31g of Parasitic Plant, 9g of Vaccariae Semen, 31g of Oyster, 12.5g of Prunella Vulgaris, 6g of Tangerine Peel, 5g of Aucklandia Root, 12.5g of Seaweed and Kelp (packaged and decocted). At the same time, take Erhuang Pills (5-cent package), and swallow one pill per week. Efficacy: Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine reported a case of osteolytic sarcoma cured. ② Oral prescription: 9g each of Xuanhu, frankincense, myrrh, Danshen, safflower, Liu Ji Nu, Achyranthes bidentata, Dipsacus asper, and Leonurus japonicus, 6g each of Su Mu and Sanguisorba officinalis, and 3g of Eupolyphaga sinensis, decocted in water. External application medicine: 12.5g of Angelica sinensis, 9g each of red peony root, catechu, realgar, Liu Ji Nu, and Sanguisorba officinalis, 6g each of frankincense and myrrh, 2g of saffron, 3g of borneol, and 0.15g of musk. Grind into powder and apply to the affected area, change it every 3 days, remove it and add a little new medicine to apply it again. Efficacy: Hunan Institute of Traditional Chinese Medicine reported a case of giant cell tumor of bone that was cured. Folk remedy: 30g of coix seed, 30g of mung bean, and 30g of red bean, cook it like porridge, eat the beans and drink the soup.

1. Eat more foods that have anti-bone marrow disease and osteosarcoma effects, such as kelp, laver, mussels, sea clams, wakame, almonds, peach kernels, and plums. 2. For bone pain, eat tortoise shell, turtle meat, pangolin, oyster, crab, shrimp, and walnut. 3. For spleen enlargement, eat soft-shelled turtle, loach, conger eel, hairy clam, kelp, and wakame. 4. For anemia, eat pork liver, mushrooms, sesame, bee jelly, yellow croaker, peanuts, sea cucumber, grass carp, and abalone. 5. For osteosarcoma diet, eat soft-shelled turtle and yellow eel during chemotherapy. To supplement white blood cells, chemotherapy requires enough white blood cells, and chemotherapy cannot be performed if it is not enough. Diet therapy for osteosarcoma (the following information is for reference only, please consult a doctor for details) 1. Diet therapy for osteosarcoma [Ingredients] 5g of raw Sichuan Aconitum, 100g of polished rice, 5ml of ginger juice, and appropriate amount of honey. [Preparation] Crush the aconite and grind it into very fine powder. First cook the japonica rice into porridge. After boiling, add the aconite powder and simmer over low heat. After it is cooked, add ginger juice and honey and stir well. Simmer for 1-2 boils. [Efficacy] Suitable for people with cold pain in bone and joint tumors. Do not take it for people with hot pain or cancer fever. 2. Osteosarcoma diet therapy recipe 2 [Ingredients] 1 black chicken, 30g raw rehmannia, 50g maltose. [Preparation] First remove the hair and intestines of the chicken, cut the rehmannia into small pieces, mix the rehmannia with sugar, put it into the chicken's belly, put it in a copper container, put it back in the steamer, and steam the chicken for about 1 hour. No salt or vinegar is needed. Only eat the chicken, and drink the chicken soup after eating. [Efficacy] Suitable for people with heat toxicity and dry body fluid pain in bone tumors. 3. Traditional Chinese medicine prescription for osteosarcoma (I) [Composition] Codonopsis pilosula 12g, Astragalus 12g, Atractylodes macrocephala 9g, Aucklandia lappa 6g, Chuanduan 15g, Cibotium barometz 12g, Viscum album 12g, Salvia miltiorrhiza 15g, Angelica sinensis 9g, Semen Ligustici ternata 9g, Earthworm powder (swallowed in portions) 9g, Scorpion powder (swallowed in portions) 4.5g, Oyster 30g, Prunella vulgaris 12g, Seaweed 12g. [Function] Strengthen the spleen and kidney, activate blood circulation and reduce swelling, attack the problem and disperse the knot. [Main indication] Osteosarcoma. [Use] Decoction in water, one dose per day. Decoction the earthworm powder and scorpion powder according to the head, and take them in two doses after decoction. 4. Chinese medicine prescription for osteosarcoma (II) [Composition] 15g of psoralea corylifolia, 15g of eucommia bark, 25g of walnut kernel, 50g of clematis root, 15g of qinjiao, 5g of asarum, 5g of chuanwu, 10g of cinnamon twig, 15g of angelica root, 8g of costus root. [Function] Warming the meridians and dredging collaterals, warming the kidneys and dispelling cold. [Main indications] Osteochondroma. [Use] Decoction in water, one dose per day. 5. Papaya [Prescription name] Papaya, papaya [Source] Papaya, a plant of the genus papaya of the family Carica family, is used as medicine for its fruit. The fruit with many seeds, oval, covered with pulp, and light yellow is preferred. [Nature and flavor and meridians] Sweet, flat. Enters the spleen and stomach meridians. [Functions and indications] Digestion and stomach, nourishing and lactation, relaxing muscles and activating collaterals, and cancer prevention. Treats gastric cancer, osteosarcoma, leukemia, etc. 【Usage and Dosage】Oral use: decoction, fresh 30-60g, decoction, 1.5-3g, grind into powder or squeeze juice to drink. External use: decoction water washing. 【Selected Prescription】Assisted anti-cancer: Cancer patients eat papaya and its products in moderation every day, which has an auxiliary effect in treating cancer. 6. Spare Rib Coriander Jelly 【Ingredients】500g fresh spare ribs, 250g coriander. 【Preparation】First chop the spare ribs and wash them, add 1500ml water, appropriate amount of sugar and vinegar. Simmer over low heat until it becomes a thick paste, remove the bones, take 500ml of paste, add appropriate amount of seasoning, then add the washed coriander, cool it into a thick paste, and it becomes spare rib coriander jelly. It is best to make it and eat it now. 【Efficacy】This jelly is suitable for the auxiliary treatment of chronic leukemia, Hodgkin's disease, osteosarcoma and digestive tract tumors.

(1) Avoid tobacco, alcohol and spicy food. (2) Avoid moldy, pickled, fried and greasy food. (3) Avoid irritating foods such as mutton, goose meat and pork head. (4) Avoid foods that easily cause bloating.