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MSK > 5- orthopaedic oncology > Flashcards

5- orthopaedic oncology Flashcards

1
Q

what are 3 bone cancer risk factors?

A
  • previous radiotherapy
  • predisposing conditions e.g. pagets, fibrous dysplasia, multiple enchondromas
  • genetic predisposition like Li fraumeni (p53) or familial retinoblastoma (RBI)
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2
Q

what is general presentation for bone cancer?

A
  • persistent increasing pain, not associated with movement & worse at night
  • swelling & erythema over joint
  • palpable mass
  • pathological fracture
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3
Q

what investigations can be used to diagnose bone cancers?

A
  • x-ray, from 2 views = AP & lateral
  • CT
  • MRI
  • bone scan
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4
Q

what is neoadjuvant?

A

type of cancer treatment that involves administering therapeutic agents before the main treatment, aim is to make main therapy more successful
= can be chemo, radiotherapy or hormone

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5
Q

what is adjuvant?

A

type of cancer treatment given after the initial treatment to reduce the risk of the cancer returning
= can be chemo, radiotherapy or hormone

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6
Q

what is the most common and 2nd most common type of malignancy (sarcoma) in children?

A
  1. osteosarcoma
  2. ewing’s sarcoma
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7
Q

who is commonly affected by osteosarcoma?

A

children & young adults
- also another peak in elderly due to pagets

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8
Q

where on the bone does osteosarcoma affect?

A

usually around distal femur and proximal tibia

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9
Q

what is appearance of osteosarcoma on x-ray?

A

periosteal reaction with sunburst appearance

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10
Q

what is common metastases of osteosarcoma?

A

10-20% present with pulmonary metastases

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11
Q

what is treatment of osteosarcoma?

A

chemo & limb salvage

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12
Q

what is location of ewing’s sarcoma?

A

diaphysis of long bones, and again distal femur and proximal tibia - it’s tumour of endothelial cells in bone marrow

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13
Q

what ages have ewing’s sarcoma?

A

5-25 yrs

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14
Q

what is treatment of ewing’s sarcoma?

A

chemo & limb salvage & adjuvant radiation

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15
Q

what is chondrosarcoma?

A

= malignancy of chondrocytes

  • lytic or blastic lesion with reactive cortical thickening, majority arise de novo (few from benign)
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16
Q

what is common area for chondrosarcoma?

A

pelvis, proximal & distal femur

17
Q

what is common age for chondrosarcoma?

A

40-75 yrs

18
Q

what is appearance of chondrosarcoma on xray?

A

popcorn appearance, lots of bubble look

19
Q

which tumour is not responsive to radio or chemo therapy?

A

chondrosarcoma

20
Q

what are 3 examples of malignant & 3 examples of benign tumours?

A

malignant = osteosarcoma, ewing’s sarcoma, chondrosarcoma

benign = osteoid osteoma, osteochondroma, enchondroma

21
Q

what is location of osteoid osteoma?

A

painful, benign tumour of long bones (central nodule of woven bone with osteoblastic rim)

22
Q

what is age for osteoid osteoma?

A

5-25 yrs

23
Q

what is treatment of osteoid osteoma?

A

usually resolve spontaneously, can treat with radiofrequency ablation, can take aspirin to relieve pain (worse at night)

24
Q

what is most common and 2nd most common benign bone tumour?

A
  1. osteochondroma (abnormal cartilage capped ossified pedicle)
  2. enchondroma (intramedullary cartilage lesion)
25
Q

what age is osteochondroma?

A

in young adults, can be caused by trauma

26
Q

what is unusual presentation of enchondroma?

A

it’s usually asymptomatic and presents as incidental finding

27
Q

what age is common for enchondroma and what is treatment?

A

20-50 yrs
= conservative treatment, bone grafting is symptomatic

28
Q

what are 5 commonest sites of metastases?

A

vertebra, pelvis, ribs, femur, skull

29
Q

what are red flags that suggest bone tumours?

A

increasing pain, persistent, worse at night, atraumatic

30
Q

what are radiological features of malignancy?

A

wide zone transition, periosteal reaction, cortical destruction

  • they can have neocortex (new layer)
31
Q

why might lesion not show on x-ray?

A

might not show on x-ray until >50% cortical bone lost

32
Q

what is presentation of ewing’s sarcoma?

A

hot, swollen, tender joint or limb, raised inflammatory markers. can mimic infection. be suspicious - ask about night pain

33
Q

in general what pace do benign tumours grow?

A

generally slow growing and painless with no tender

34
Q

what does ewing’s sarcoma look like on radiograph?

A

onion peel

MSK (33 decks)

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