ABCs' Home! American-Born Cats

12/22/2019 醫生打電話來了

經過活體股頭切片確認是骨肉瘤

醫生建議截肢

可憐的小屁屁

從她腳開始痛到橅錢都是右後腳就一直不自然

雖說她可以跳上椅子 但是他寧願不走路

啊  這小姐是我家最急躁的貓  很少看到她走路  她都是用跑的

安靜看風景的時間增加

愛被摸肚子的狀況增加

沒關係  只要把右後腳(應該大腿會留著吧?)

還沒跟醫生討論到截肢計畫  醫生12/22跟我講完電話 (她說她會在會一次腫瘤科醫生會完後會再打電話給我 且說截肢手術應該在下周  )還說會給我估價單(啊我醫生已經了解我了  會問我有需要看估價單嗎?  我的答案都是不用  確定要治療 就沒啥好看了 付錢就是了)

可是顯然她急著放假去  當天ˊ沒接到電話

12/23打電話問她助理 才知道 她大小姐放假去了 要到12/30才回來 啊 勒

醫生估計術後存活約兩三年

因骨肉瘤會痛  不能長期靠止痛藥 所以截肢會讓她做

股頭切片後的藥有兩種一種就是常建德止痛藥另外一種也是但是比較是神經性的止痛藥

阿屁原來醫生開得止痛藥 因為是擦耳朵內側  會讓阿屁聲音不見(掃聲) 

開刀醫生用的一樣的止痛藥 但是是口服型的 阿屁聲音沒問題

所以我又開始翻譯了

這篇翻譯主要是辜大嬸(google)幫忙

也是我自既要用的  若對文章有問題 請自己想辦法

若是要討論阿屁  可以的

原文在這裡

https://www.acvs.org/small-animal/bone-tumors

今天早上班路上醫生打電話來了  證實是骨癌 截肢是最好的建議

Overall

Bone tumors can involve either the appendicular (limbs) or axial (spine, ribs, pelvis, scapula, and skull) skeleton. These tumors are classified as either primary (i.e., arise directly in bone) or secondary (i.e., spread from an adjacent site, such as multiple myeloma of the bone marrow or metastasize from a distant site, such as transitional cell carcinoma of the urinary bladder). The four primary bone tumors are osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma. Osteosarcoma is the most common primary bone tumor and accounts for over 95% of all bone tumors. In dogs, appendicular osteosarcoma is a highly aggressive disease and curative-intent treatment involves surgical resection of the tumor followed by chemotherapy to minimize the risk of tumor cells spreading (metastasizing) to other areas, particularly the lungs and other bones.

骨腫瘤可能會發生在闌尾(四肢)或是軸向骨架 (脊椎,脊柱，肋骨，骨盆，肩骨和顱骨).  這些腫瘤被分類為原發性（即直接在骨中產生）或續發性（即從相鄰部位擴散，例如骨髓多發性骨髓瘤或從遠端轉移，例如膀胱移行細胞癌） ）。四種主要的骨腫瘤是骨肉瘤，軟骨肉瘤，纖維肉瘤和血管肉瘤。骨肉瘤是最常見的原發性骨腫瘤，佔所有骨腫瘤的95％以上。在狗裡面，闌尾骨肉瘤是一種高度侵襲性疾病，根治性治療為對腫瘤進行手術切除，然後進行化學療法，化療是為了使腫瘤細胞擴散（轉移）到其他區域（尤其是肺和其他骨骼）的風險降至最低。

The majority of primary bone tumors, particularly osteosarcoma, arise spontaneously with no known or apparent cause. Scottish Deerhounds are genetically predisposed to developing osteosarcoma and this tumor also occurs frequently in other large breed dogs, particularly the Rottweiler. Large or giant, and particularly tall, dogs are at a greater risk for the development of osteosarcoma compared to the general dog population, although small dogs (less than 15 kg) can also be affected. Older dogs are most commonly affected; however, bone tumors can occur in young dogs as well.

大多數原發性骨腫瘤，特別是骨肉瘤，是自發性的，沒有已知或明顯的原因。蘇格蘭獵鹿犬在遺傳基因上容易產生骨肉瘤，這種腫瘤在其他大型犬尤其是羅威納犬中也經常發生。雖小型狗 (體重小於15公斤)也會有骨肉瘤 但相較大型狗或是巨大的狗，特別是高大的狗患骨肉瘤的風險更高。較老的狗最常見, 然而，骨腫瘤也可能發生在年輕狗中。

Primary bone tumors are uncommon in cats. Unlike dogs, where the majority of primary bone tumors are malignant, up to a third of feline bone tumors are benign. Osteosarcoma is also the most common bone tumor in cats, but the behavior of this tumor type is less aggressive than in dogs.

原發性骨腫瘤在貓中並不常見。與狗不同之處為, 大多數狗的原發性骨腫瘤都是惡性的，但多達三分之一的貓骨腫瘤是良性的。骨肉瘤也是貓中最常見的骨腫瘤，但是這種腫瘤類型的行為不像狗那樣具有侵略性。

Tumors can occur at sites of previous bone damage. The types of bone damage, which have been linked with the development of primary bone tumors include fractures, orthopedic implants (used for fracture repair and total hip replacement), radiation therapy, and bone diseases (i.e., benign bone tumors, bone cysts, and infarcts [areas of bone without a blood supply]). It must be stressed, however, that the risk of developing a bone tumor after fracture, fracture repair, or total hip replacement is rare and the vast majority of primary bone tumors develop spontaneously with no apparent predisposing cause.

腫瘤可能發生在先前的骨損傷部位。骨損傷的類型與原發性骨腫瘤的發展有關，包括骨折，骨科植入物（用於骨折修復和全髖關節置換），放射療法和骨疾病（例如，良性骨腫瘤，骨囊腫和梗塞[沒有血液供應的骨骼區域])。然而，必須強調的是，因骨折，骨折修復或全髖關節置換術後發展成骨腫瘤的風險並不大，並且絕大多數原發性骨腫瘤自發發展，沒有明顯的誘因。

Signs and Symptoms: 

Lameness and swelling of the affected bone are the most common presenting complaints in cats and dogs with tumors of the appendicular skeleton. The onset and degree of lameness is variable: a slow, insidious onset of a mild to moderate weight-bearing lameness is more common, but an acute, non-weight-bearing lameness is possible if a fracture occurs where a tumor has weakened the bone (i.e., pathologic fracture) (Figure 1). Dogs with metastasis (spread the tumor) to the lungs may present with a diffuse swelling of all four limbs (hypertrophic osteopathy), generalized weakness, or respiratory (breathing) difficulties. Systemic illness is rare in cats and dogs with primary bone tumors that have not spread.

腫脹與拖行患骨是貓狗在四肢有骨肉瘤最常見的主訴.  緩慢腳步拖行的發生與程度是不同的:由輕度到中度可負重拖行比較常見,但若是骨折發生在已被腫瘤侵襲衰弱的骨頭那麼就會發生嚴重的不可負重的拖行(病理骨折)(詳原文圖一).   腫瘤已轉移（擴散腫瘤）至肺部的狗可能出現四肢擴散性腫脹（肥大性骨病），全身無力或呼吸（呼吸）困難。在患原發性骨腫瘤的貓和狗中全身性疾病很少見。

The clinical signs associated with primary bone tumors of the axial skeleton depend on the bone involved. In most cases, a swelling or mass is the first sign of a tumor, particularly in the skull, jaw, and ribs. Other signs may include:

• difficulty eating with jaw tumors (see oral tumors)
• neurologic signs with skull or vertebral tumors (e.g., seizures or wobbly gait)
• respiratory difficulties or lameness with rib tumors

原發性軸向骨骼的骨肉瘤臨床徵狀取決於所發生部位的骨骼.  在大部分的狀況下,腫脹或是腫塊是第一個出現的徵狀,尤其是顱骨與頜骨和肋骨中。其他跡象可能包括：

* 頜骨腫瘤會難以進食（見口腔腫瘤）
* 顱骨或椎骨腫瘤的會有神經系統體徵（例如癲癇發作或走路不穩）
* 呼吸困難或拖行則會發生在肋骨腫瘤
 

Clinical signs associated with secondary bone tumors depend on the bone affected. However, differentiating primary bone tumors from secondary bone tumors can be difficult unless the primary tumor causes clinical signs (e.g., urinary difficulties in dogs with tumors of either the urinary bladder or prostate).

與繼發性骨腫瘤相關的臨床體徵取決於受影響的骨骼。但是，區分原發性骨腫瘤與繼發性骨腫瘤區可能是困難的，除非原發性腫瘤引起臨床體徵（例如，患有膀胱或前列腺腫瘤的狗的泌尿困難）。

Diagnostics: 

Diagnostic evaluation of a suspected tumor is called “staging”. Your primary-care veterinarian, sometimes with the help of specialists in oncology or surgery, may perform the following diagnostic tests to define what tumor type is present in the bone, where a tumor may have spread in the body, and to assess the overall health of your pet:

對懷疑是腫瘤的診斷評估稱為 "staging" (分期? 階段性?)  你的主要醫生,有時候會借由腫瘤專家或是外科專家的協助,來進行下列診斷檢測來確定骨骼中腫瘤型態,及腫瘤是否擴散於身體其他部位與評估身體健康狀況:

• physical and orthopedic examination
• blood tests (complete blood count and serum biochemistry)
• radiographs of the affected bone
• chest radiographs or computed tomography (CT) scans
• whole body bone scan or radiographs (a radioactive marker is put in the bloodstream that can highlight bone tumors with a special imaging technology) or survey radiographs of other body parts
• biopsy or fine needle aspiration

* 身體和骨科檢查
* 驗血（全血細胞計數和血清生化）
* 患骨的X光片
* 胸部X光片或計算機斷層掃描（CT）掃描
* 全身骨掃描或X光片檢查（在血液中放有放射性標記，可以通過特殊的成像技術突出顯示骨腫瘤）或對其他身體部位進行X光片檢查
* 活檢或細針穿刺

Physical examination is necessary to assess general health status and identify any other concomitant problems. Orthopedic examination is important to identify the affected bone, rule-out other causes of lameness (particularly cranial cruciate ligament rupture, hip dysplasia, and neurologic disease), and evaluate the potential for adapting to life on three legs if limb amputation is being considered. Blood tests are recommended to assess general health status, as many cats and dogs with primary bone tumors are older and may have other problems, which need to be considered when developing a treatment plan. Urinalysis may be added to assess kidney function. If a limb-sparing procedure is being considered, then radiographs, bone scans, and advanced imaging (i.e., CT or magnetic resonance imaging) of the limb should be considered to evaluate the extent of local tumor involvement and plan the limb-sparing surgery (Figure 2 and 3).

體格檢查對於評估總體健康狀況和發現其他伴隨問題是必要的。骨科檢查對於確定受影響的骨骼，以排除其他導致脫行的原因（尤其是顱骨十字韌帶破裂，髖關節發育不良和神經系統疾病），並評估考慮考慮截肢而適應三腿生活的潛力非常重要。建議進行血液檢查以評估總體健康狀況，因為許多患有原發性骨腫瘤的貓和狗年齡較大，並且可能存在其他問題，在制定治療計劃時需要考慮這些問題。可能可以加入尿液分析以評估腎功能。如果正在考慮保留肢體的程序，則應考慮對肢體進行射線照相，骨掃描和高級成像（即CT或磁共振成像），以評估局部腫瘤累及的程度併計劃保留肢體的手術（詳見原文圖2和3）。

A biopsy (sampling of the suspected tumor itself) is important to determine the best treatment plan for your pet, because different tumor types respond differently to different treatments. The biopsy may indicate other causes of bony destruction. Biopsy is recommended if the presentation is not typical (e.g., small dog, middle aged, multiple lesions, lesions in the middle rather than the end of long bones, or systemic illness) or another disease process is suspected, such as a fungal bone infection, on the basis of presentation and either travel through or living in certain geographical regions.

活體切片檢驗（對可疑腫瘤本身進行採樣）對於確定寵物的最佳治療計劃很重要，因為不同的腫瘤類型對不同的治療會有不同的反應。藉由活體切片檢驗可能看出骨破壞的其他原因。如果腫瘤表現非典型（例如，小狗，中年，多處病變，在中間不肺而不是長骨末端的病變或全身性疾病），或懷疑有正在發展存的其他疾病過程基於其展現方式及或是正在蔓延至其他區域，例如真菌性骨感染，建議進行活檢，基於展示方式. 

For patients where destruction of the bone is extensive, a presurgical biopsy may not change the course to treatment and pathologic evaluation after amputation or limb sparing procedures may be elected. Fine needle aspiration may be used in some patients as a screening test for cancer, but often, a bone biopsy [where a core sample of the suspected tumor is obtained for review by a pathologist] is needed.

對於廣泛破壞骨骼的患者，術前活檢可能不會改變在選擇截肢或保留肢體的程序後治療的過程和進行病理評估。細針穿刺術可能在某些患者中用作癌症的篩查測試，但通常需要進行骨活檢（從中獲取可疑腫瘤的核心樣本以供病理學家檢查）。

Appendicular osteosarcoma is a highly malignant and metastatic disease in dogs. The lungs and other bone are the two most common metastatic sites, occurring in approximately 10% of dogs at the time of diagnosis (but up to 90% of dogs during the course of the disease). Chest radiographs or CT scans are necessary for the evaluation of metastasis to the lungs. The incidence of bone metastasis, which often does not cause clinical signs, is approximately the same as lung metastasis but has a much greater impact on management options as there is a high risk of fracture through the metastatic lesion as a result of increased weight bearing after limb amputation. A whole-body bone scan is the most effective technique to evaluate for the presence of metastatic disease in another bone, although nuclear medicine facilities are not widely available (Figure 4). Whole-body radiographs are an alternative to bone scan but are more time consuming and costly, and metastases may be missed with radiographic evaluation because they are not as sensitive for picking up bone changes as a bone scan.

闌尾骨肉瘤是狗的高惡性和轉移性疾病。在診斷時約有10％的狗發生（但在疾病過程中高達90％的狗）移轉,肺和其他骨骼是兩個最常見的轉移部位，。胸部X光片或CT掃描對於評估肺轉移是否是必要的。骨轉移的發生率通常不引起臨床症狀，與肺轉移幾乎相同，但對治療選擇的影響更大，因為由於轉移後負重增加，通過轉移性病變導致骨折的風險增高。儘管核醫學設施尚不廣泛，但全身骨掃描是評估另一顆骨中是否存在轉移性疾病的最有效技術（圖4）。全身射線照相是骨掃描的一種替代方法，但更耗時且成本更高，並且放射線評估可能會遺漏轉移灶，因為它們對拾取骨變化的敏感性不如骨掃描。

Advanced imaging, particularly CT scans, are recommended for many tumors of the axial skeleton as the cross-sectional and three-dimensional images provide better information for the ACVS board-certified veterinary surgeon to assess whether surgery is possible and, if so, the extent of surgery required for achieving a favorable outcome.

對許多軸向骨骼腫瘤會建議進行高級成像，尤其是CT掃描，因為其橫截面和三維圖像可為ACVS認證的獸醫提供更好的信息，以評估是否可以手術，如果可以，手術可達到理想結果。

Following limb amputation or limb-sparing surgery, the tumor should be submitted to a veterinary pathology laboratory for assessment of tumor type and, if applicable, tumor grade (i.e., osteosarcoma and chondrosarcoma), whether the surgical margins are free of tumor cells (for limb-sparing surgery), and whether the tumor has spread to a regional lymph node.

肢體截肢或保留肢體手術後，應將腫瘤提交獸醫病理實驗室評估腫瘤類型，如果可能並評估腫瘤等級（如骨肉瘤和軟骨肉瘤）手術邊緣是否無腫瘤細胞 (對於保留肢體手術），以及腫瘤是否已擴散到局部淋巴結。

Treatment: 

Treatment for primary bone tumors of the appendicular skeleton is divided into palliative and curative-intent. Palliative treatment is intended to provide pain control and improve quality of life but not necessarily prolong life. In contrast, the aim of curative-intent treatment is to provide a good quality of life while controlling the local tumor and minimizing the risk of metastasis in an effort to cure the tumor. However, it must be stressed that cure for dogs with appendicular osteosarcoma is achieved in less than 25% of cases.

原發性闌尾骨腫瘤的治療區分為治標與治本.  治標治療是要防止疼痛與增加生活品質但非延長生命.  相反的,治本的目標是要在試圖治癒種留下控制腫瘤與減低擴散風險狀況並要提供好的生活品質.  但是,必須要強調的是狗得治癒尤其是大約只有25%患友闌尾性骨腫瘤的狗可以被治癒

Palliative treatment options include pain-killing drugs, radiation therapy, and surgery. Many drugs have pain-killing (analgesic) properties, but the degree of analgesia provided by these drugs can vary. Non-steroidal anti-inflammatory drugs are usually effective initially, although stronger analgesic drugs or drug combinations may be required as the tumor progresses. Radiation therapy can be used to reduce pain and inflammation and can be used in combination with pain-killing drugs and chemotherapy drugs. The bone tumor is irradiated using various protocols; the most common are either once weekly radiation for 3 to 4 weeks or once monthly radiation. Lastly, the affected limb can be amputated if the bone tumor is very painful or fractured. However, it should be noted that limb amputation without chemotherapy is palliative and does not prolong survival time.

姑息治療選擇包括止痛藥，放射療法和手術。許多藥物具有止痛（鎮痛）特性，但是這些藥物提供的鎮痛程度可能會有所不同。非類固醇抗炎藥通常最初起效，儘管隨著腫瘤的進展可能需要更強的鎮痛藥或藥物組合。放射療法可用於減輕疼痛和炎症，並可與止痛藥和化學療法藥物聯合使用。骨腫瘤使用各種方案進行輻照;最常見的情況是每週一次放射3至4週或每月一次放射。最後，如果骨腫瘤非常疼痛或骨折，可以切除患肢。但是，應注意的是，未經化學療法而截肢是姑息性的，不會延長生存時間。

For dogs with appendicular osteosarcoma, curative-intent treatment is aimed at treating the local bone tumor and minimizing the risk of metastatic disease. Limb amputation is recommended for treatment of the local bone tumor (Figures 5 and 6). If a tumor involves the hip or pelvis, a portion of the pelvis may be removed as well. The vast majority of dogs will adapt very well after limb amputation, even if arthritic in other joints, overweight, or a large dog breed. The adaptation period is approximately 4 weeks and is improved if pet owners have a positive attitude towards their dog and the treatment. Limb-sparing surgery preserves the anatomy and function of the affected limb and is a viable alternative to limb amputation (Figure 7). A number of different limb-salvage techniques are now available, but most are only amenable to the distal radius (bone adjacent to the carpus or wrist). Non-surgical limb-sparing techniques, such as stereotactic radiation, may be suitable for tumors in other locations. However, apart from preservation of limb function, there are no advantages of limb-sparing surgery compared to limb amputation. The decision to pursue limb-sparing surgery is usually a pet owner preference as there are few medical conditions, which would make limb amputation unfeasible. Furthermore, limb-sparing surgery is not widely available and the complication rate is relatively high. Following limb amputation or limb-sparing surgery, the tumor should be submitted to a veterinary pathology laboratory for assessment of tumor type and, if applicable, tumor grade (i.e., osteosarcoma and chondrosarcoma), whether the surgical margins are free of tumor cells (for limb-sparing surgery), and whether the tumor has spread to a regional lymph node.

對於患有闌尾骨肉瘤的狗，旨在治癒的治療旨在治療局部骨腫瘤並使轉移性疾病的風險降至最低。建議截肢以治療局部骨腫瘤（詳原文圖5和6）。如果腫瘤涉及臀部或骨盆，則也可以切除一部分骨盆。絕大部分的狗在肢體截肢後都會很好地適應，即使其他關節有關節炎，超重或大型犬種也是如此。適應期約為4週，如果寵物主人對其狗和治療持積極態度，則適應期會有所改善。保肢手術保留了患肢的解剖結構和功能，是肢體截肢的可行替代方案（詳原文圖7）。現在有許多不同的肢體挽救技術，但是大多數只能適應遠端的骨（與腕骨或腕骨相鄰的骨頭）。非手術保留肢體的技術，例如立體定向放射，可能適用於其他位置的腫瘤。但是，除了保留肢體功能外，與截肢相比，保肢手術沒有任何優勢。進行保肢手術的決定通常是寵物主人的偏愛，因為幾乎沒有醫療條件使截肢變得不可行。此外，保留肢體手術尚不廣泛且複雜性較高。肢體截肢或保留肢體手術後，應將腫瘤提交獸醫病理實驗室評估腫瘤類型，並評估腫瘤等級（如骨肉瘤和軟骨肉瘤）（手術切緣是否無腫瘤細胞）保留肢體手術，以及腫瘤是否已擴散到局部淋巴結。

Surgery, whether limb amputation or limb-sparing, is the only necessary treatment for cats with any type of primary bone tumor and dogs with primary bone tumors other than osteosarcoma or hemangiosarcoma. The majority of primary bone tumors in cats have a low potential to metastasize and hence do not require postoperative chemotherapy. In dogs, appendicular chondrosarcoma does have the potential to metastasize (less than 25%) but metastasis usually occurs late in the course of disease and chemotherapy has not been shown to affect the metastatic rate or improve survival time. Chemotherapy is recommended for dogs with appendicular osteosarcoma as survival time is significantly improved compared to surgery alone. Chemotherapy is usually started at suture removal (about 10 to 14 days after surgery). A number of different chemotherapy protocols have been used to treat dogs with osteosarcoma. The side effects and costs of these drugs vary and a consult with a medical oncologist is recommended to discuss these options.

手術,不論是截肢或是非截肢手術,對於貓患油源發行骨腫瘤與狗非骨肉瘤或血管瘤的原發行骨腫瘤都是必要的.  患主要原發性腫瘤的貓因移轉的可能行非常低所以不需要做化療.  然而在狗中,闌尾軟骨肉瘤的確會有移轉的可能性(低於25%)但一旦移轉通常在晚期及化療看不出對是否移轉有影響(控制?)或是能延長生存時間.  患有闌尾軟骨肉瘤的狗會被建議化療是因為存活時間的倒明顯改善相較於只有進行手術.  化療通常在除去縫合線(約手術後10-14天)開始.  多種不同的化療方案已使用在患有骨肉瘤狗的身上.  副作用與藥物成本都不同建議與相關腫瘤科醫生討論這些選擇

The treatment for primary bone tumors of the axial skeleton is dependent on the size and location of the tumor. Surgery is the main treatment for axial bone tumors (i.e., mandibulectomy or maxillectomy for jaw tumors (see oral tumors), craniectomy for skull tumors, partial vertebrectomy for vertebral tumors (Figure 8), chest wall resection and reconstruction for rib tumors. Subtotal or total scapulectomy (removing part or all of the shoulder blade) may be performed for scapular tumors. Hemipelvectomy (removing a portion of the pelvis along with amputation) is indicated for many pelvic tumors. Analgesic drugs and radiation therapy can be used for palliation if surgery is not wanted or possible. Chemotherapy may be indicated following surgery however the metastatic potential for axial bone tumors, even osteosarcoma, is lower than the same tumor in the appendicular skeleton. Chemotherapy is recommended for dogs with osteosarcoma of the ribs, scapula, and pelvis because of a high metastatic rate and a biologic behavior similar to appendicular osteosarcoma. Chemotherapy should also be considered for mandibular osteosarcoma.

治療方式對患有原發性軸向骨腫瘤的取決於腫瘤大小與腫瘤所在位置.  手術是一個主要治療軸向骨腫瘤（例如　颌股腫瘤或是上颌股切除術）盧骨腫瘤的顱骨切除術，追骨腫瘤的部分錐體切除術（詳原文圖８），胸壁切除術與樂骨腫瘤的重建．對於肩骨腫瘤，可進行全肩骨蓋切除術（切除部分或全部肩骨）；許多盆腔腫瘤則需行半骨盆切除術（切除一部分骨盆並進行截肢術）。如果手術被排除或是認為不可能，可使用止痛藥和放療來緩解，但是軸向骨腫瘤（甚至是骨肉瘤）的轉移潛力低於闌尾骨骼中的相同腫瘤，建議對肋，肩骨和骨盆骨肉瘤的狗進行化學療法由於其高轉移率和類似於闌尾骨肉瘤的生物學行為，因此也應考慮化療下頜骨肉瘤

Limb amputation is considered the gold standard for the surgical treatment of primary bone tumors and the complication rate is very low. The most common complications, which occur in less than 5% of cases, are wound infection, wound breakdown, and accumulation of fluid underneath the surgical site (i.e., seroma formation). In contrast, the complication rate with limb-sparing surgery can be high. The most common complications are infection, implant failure, and local tumor recurrence. Implant failure is seen in 10% to 40% of dogs. Local recurrence of the tumor is diagnosed in 10% to 25% of dogs and this rate can be lowered with careful case selection and the use of locally-released chemotherapy implants (which are not widely available). Infection is the biggest problem with limb-sparing surgery and is seen in over 40% of dogs with limb sparing procedures. Antibiotics can control but rarely cure these infections. Other options for the treatment of limb-sparing-related infections include implantation of antibiotic-impregnated bone cement beads, isolated arterial perfusion of antibiotics, reconstructive surgery with skin and muscle flaps, and limb amputation. There are a number of different limb-sparing techniques, some of which may decrease the risk of infection.

截肢被認為是治療原發性骨腫瘤的黃金準則且複雜程(併發症?)度低.  最常見的併發症是少於5%的發生機會是傷口感染,傷口破裂與在手術處發下方生液體累積(即發生血種狀況).  相反的,肢體保存手術複雜程度高(併發症高?).  最常見的併發症為感染與移植失敗,與原除在發生腫瘤.  移植失敗率狗在10$-40%中間. 原處復發的狗約10%-25%且可以通過謹慎地選擇病例和使用局部釋放的化療植入物（目前尚不廣泛使用）來降低該比率.  感染是肢體保存最主要的問題,且在狗中超過40%.  抗生素可以控制但很少能治癒感染.  其他肢體保存的感染治療選項包刮包括植入浸有抗生素的骨水泥珠，抗生素的單獨動脈灌注，皮膚和肌肉皮瓣的重建手術以及截肢。有很多不同的保肢技術，其中一些可以降低感染的風險

The aim of chemotherapy is to kill the tumor while maintaining quality of life. The majority (more than 85%) of pets will progress through their chemotherapy protocol with no to minimal problems. However, 5% to 15% of dogs may require hospitalization to treat chemotherapy-associated problems, such as bone marrow suppression, infection, and dehydration from vomiting and diarrhea. The risk and severity of chemotherapy complications or side-effects are often dependent on the drug used and should be discussed with a medical oncologist.

化學療法的目的是在維持生活質量的同時殺死腫瘤。絕大多數（超過85％）的寵物將通過其化學治療方案進展，而沒有任何問題。但是，有5％到15％的狗可能需要住院以治療與化療相關的問題，例如骨髓抑制，感染以及嘔吐和腹瀉引起的脫水。化學療法並發症或副作用的風險和嚴重性通常取決於所用藥物，這應與腫瘤內科醫生討論。

For axial bone tumors, the complications are dependent on location of the tumor and the type and extent of surgery performed to remove the tumor. The type and risk of these complications should be discussed with your veterinary surgeon.

對於軸向骨腫瘤，併發症取決於腫瘤的位置以及為切除腫瘤而進行的手術的類型和程度。這些並發症的類型和風險應與您的獸醫討論。

Aftercare and Outcome: 

The majority of dogs are able to walk unassisted within 12 to 24 hours of limb amputation. Dogs should be encouraged to walk and exercise to improve the speed of recovery. The surgical wound should be checked twice daily for signs of infection or breakdown (called dehiscence). These signs include redness, swelling, watery to purulent discharge, and pain.

多數的狗在手術後12-24小時可以不需要幫助的走路.  應鼓勵狗走路和運動，以提高恢復速度。手術傷口應每天檢查兩次，看是否有感染或破裂的跡象（稱為裂開）。這些跡象包括發紅，腫脹，水樣膿性分泌物和疼痛。

After limb-sparing surgery, the limb should be lightly bandaged and the bandages should be changed frequently for 2 to 3 weeks. Exercise is started immediately after surgery but should be restricted to leashed walks for the first 4 weeks. Exercise is important in preventing toe contracture and minimizing swelling of the foot and toes, both of which can occur as a consequence of excising certain muscles and blood vessels during surgery.

保肢手術後，應將肢體輕輕包紮，並在2至3週內經常更換繃帶。手術後立即開始運動，但在開始的4週內應僅限於有有牽繩的散步。運動對於預防腳趾攣縮和最大程度地減小腳和腳趾的腫脹非常重要，因為在手術過程中切除某些肌肉和血管會導致腳和腳趾的腫脹。

For dogs with appendicular osteosarcoma, the median survival time for following palliative treatment is 90 to 175 days, with 45-50% of dogs alive at 6 months and 15-20% alive at 12 months after diagnosis. However, median survival times of approximately 300 days have been reported following treatment with palliative radiation therapy and chemotherapy. In contrast, the median survival time following curative-intent treatment is 235 to 366 days, with up to 33-65% of dogs alive at 12 months and 16-28% alive at 2 years. Alkaline phosphatase is an enzyme analyzed in the preoperative blood tests, which has been shown to be associated with the duration of survival following surgery and chemotherapy. The median survival time for dogs with a normal alkaline phosphatase level is approximately 12.5 months compared to 5.5 months if alkaline phosphatase is increased at the time of diagnosis. Other factors that may influence prognosis in dogs with appendicular osteosarcoma include tumor size and location and histologic grade.

對於患有闌尾骨肉瘤的狗，姑息治療後的中位生存時間為90至175天，診斷後6個月有45-50％的狗活著，而12個月有15-20％的狗活著。然而，據報導，使用姑息放療和化學療法治療後，中位生存時間約為300天。相比之下，根治性治療後的中位生存時間為235至366天，多達33-65％的狗在12個月時存活，而16-38％的狗在2年時存活。鹼性磷酸酶檢測是一種在術前血液測試中分析的酶，已顯示與手術和化療後的生存時間有關。鹼性磷酸酶水平正常的狗的中位生存時間約為12.5個月，而診斷時鹼性磷酸酶水平升高則為5.5個月。可能會影響闌尾骨肉瘤犬預後的其他因素包括腫瘤大小，位置和組織學分級。

For dogs with appendicular chondrosarcoma, the survival time following limb amputation alone (i.e., no chemotherapy) ranges from a median survival time of 540 days to a mean survival time of 2618 days (median was not reached because less than 50% of dogs died as a result of their tumor). Grading of chondrosarcoma is important to determine prognosis because the median survival times for dogs with grade I, II and III chondrosarcomas are significantly different at 6 years, 2.7 years, and 0.9 years, respectively. Metastasis is reported in approximately 30% of dogs with chondrosarcoma, but this usually occurs late in the course of the disease and chemotherapy does not decrease the metastatic rate or improve survival time in dogs with chondrosarcoma.

對於患有闌尾軟骨肉瘤的狗，僅肢體截肢後的生存時間（即不進行化學療法）的中位生存時間為540天到平均生存時間為2618天（未達到中位數，因為不到50％的狗死於腫瘤的結果）。軟骨肉瘤的分級對確定預後很重要，因為患有I，II和III級軟骨肉瘤的狗的中位生存時間分別在6年，2.7年和0.9年時顯著不同。據報導，約有30％的軟骨肉瘤犬發生轉移，但這通常發生在疾病的晚期，化學療法不會降低軟骨肉瘤犬的轉移率或延長生存時間。

Appendicular fibrosarcoma and hemangiosarcoma are rare and the prognosis is difficult to determine. However, metastasis is relatively common in dogs with hemangiosarcoma and, for this reason; survival times are generally poor with less than 10% of dogs alive at 12 months after limb amputation.

闌尾纖維肉瘤和血管肉瘤很少見，預後難以確定。但是，轉移在血管肉瘤犬中相對普遍，因此。肢體截肢後12個月時，存活時間通常很短，只有不到10％的狗活著。

In contrast to dogs, cats with appendicular osteosarcoma have a low metastatic rate (less than 10%) and the median survival time following amputation alone is over 350 days (and up to 4 years).

與狗相比，患有闌尾骨肉瘤的貓轉移率低（不到10％），僅截肢後的中位生存時間超過350天（最長4年）。

The prognosis for axial bone tumors is dependent on tumor type and location. In general, osteosarcoma of the scapula and pelvis has a similar prognosis to appendicular osteosarcoma following either palliative or curative-intent treatment. The median survival times reported for osteosarcoma of the head (i.e., mandible, maxilla, and skull) are poor with most less than 12 months. The most common reason for this poor survival time is local recurrence of the tumor and not metastasis. However, the importance of aggressive surgical treatment is highlighted by the fact that most dogs are cured, with a median survival time greater than 1,500 days, if the tumor is completely resected.

軸向骨腫瘤的預後取決於腫瘤的類型和位置。通常，在姑息性或治愈性治療後，肩骨和骨盆的骨肉瘤的預後與闌尾骨肉瘤的預後相似。據報導，頭部（下頜骨，上頜骨和顱骨）骨肉瘤的中位生存時間很短，大多數少於12個月。存活時間差的最常見原因是腫瘤的局部復發而不是轉移。但是，如果將腫瘤完全切除，大多數狗都可以治愈，中位生存時間超過1,500天，這一事實凸顯了積極外科治療的重要性。

Multilobular osteochondrosarcoma (multilobular tumor of bone) is a tumor of the axial skeleton and commonly affects the skull bones. The prognosis for dogs with multilobular osteochondrosarcoma depends on whether the tumor has been completely removed and on the histologic grade. Local tumor recurrence and metastasis are more common following incomplete tumor resection. The rate of local tumor recurrence is 30%, 47%, and 78% for grade I, II, and III multilobular osteochondrosarcoma, respectively. The metastatic rate of multilobular osteochondrosarcoma is also dependent on histologic grade, with metastasis, usually to the lungs, occurring in 30%, 60%, and 78% of grade I, II, and III tumors, respectively. The overall median survival time for dogs with multilobular osteochondrosarcoma is 669 to 797 days, with a median survival time greater than 897 days for dogs with grade I tumors, 520 days for dogs with grade II tumors, and 405 days for dogs with grade III tumors. Importantly, multilobular osteochondrosarcoma is a slow growing tumor and prolonged survival after diagnosis of metastatic disease is common (median, 239 days).

多葉骨軟骨肉瘤（骨的多葉腫瘤）是一種軸向骨骼腫瘤，通常會影響顱骨。患有多葉骨軟骨肉瘤的狗的愈後取決於腫瘤是否已完全切除和組織學分級。腫瘤切除不完全後，局部腫瘤復發和轉移更為常見。 I，II和III級多葉骨軟骨肉瘤的局部腫瘤復發率分別為30％，47％和78％。多葉骨軟骨肉瘤的轉移率還取決於組織學分級，轉移通常發生在肺部，分別發生於I，II和III級腫瘤的30％，60％和78％。多葉骨軟骨肉瘤狗的總中位生存時間為669至797天，I級腫瘤狗的中位生存時間大於897天，II級腫瘤狗為520天，III級腫瘤狗為405天。重要的是，多葉骨軟骨肉瘤是一種生長緩慢的腫瘤，在診斷出轉移性疾病後通常會延長生存期（中位數為239天）。

Rib osteosarcoma is an aggressive tumor. Metastasis is diagnosed at the time of death in 100% of dogs with osteosarcoma, 67% of dogs with hemangiosarcoma, and up to 100% of dogs with fibrosarcoma. Factors, which influence prognosis in dogs with rib tumors, include tumor type and completeness of surgical resection. Local recurrence of a rib tumor is over 5 times more likely if the rib tumor was not completely resected. The median survival time for dogs with rib osteosarcoma is 90 days with surgery alone and 240-290 days if surgery is combined with chemotherapy. In comparison, the median survival time for dogs with rib chondrosarcoma is 1,080 to greater than 3,750 days with surgery alone.

肋骨肉瘤是一種侵襲性腫瘤。在死亡時，有100％的骨肉瘤犬，67％的血管肉瘤犬和高達100％的纖維肉瘤犬被診斷出轉移。影響肋骨腫瘤犬愈後的因素包括腫瘤類型和手術切除的完整性。如果未完全切除肋骨腫瘤，則肋骨腫瘤的局部復發可能性高出5倍以上。肋骨骨肉瘤犬的中位生存時間為單獨手術90天，如果手術與化學療法相結合則為240-290天。相比之下，僅進行手術的肋骨軟骨肉瘤犬的中位生存時間為1,080至3,750天以上。

The prognosis for dogs with vertebral tumors is usually poor. Regardless of tumor type, the median survival time for malignant vertebral tumors is 135 days. Tumor type, tumor location, and postoperative treatment (i.e., chemotherapy or radiation therapy) do not improve survival time. However, using guidelines employed by human neurosurgeons, there are anecdotal reports of prolonged survival following aggressive surgical resection, with or without postoperative radiation therapy.

患有椎骨腫瘤的狗的愈後通常較差。不論腫瘤類型如何，椎骨惡性腫瘤的中位生存時間為135天。腫瘤類型，腫瘤位置和術後治療（即化學療法或放射療法）不能改善生存時間。但是，根據人類神經外科醫生的使用指南，有傳聞報導，無論是否進行術後放射治療，積極的外科手術切除術後存活時間均會延長。