5- orthopaedic oncology Flashcards
what are 3 bone cancer risk factors?
- previous radiotherapy
- predisposing conditions e.g. pagets, fibrous dysplasia, multiple enchondromas
- genetic predisposition like Li fraumeni (p53) or familial retinoblastoma (RBI)
what is general presentation for bone cancer?
- persistent increasing pain, not associated with movement & worse at night
- swelling & erythema over joint
- palpable mass
- pathological fracture
what investigations can be used to diagnose bone cancers?
- x-ray, from 2 views = AP & lateral
- CT
- MRI
- bone scan
what is neoadjuvant?
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
what is adjuvant?
type of cancer treatment given after the initial treatment to reduce the risk of the cancer returning
= can be chemo, radiotherapy or hormone
what is the most common and 2nd most common type of malignancy (sarcoma) in children?
- osteosarcoma
- ewing’s sarcoma
who is commonly affected by osteosarcoma?
children & young adults
- also another peak in elderly due to pagets
where on the bone does osteosarcoma affect?
usually around distal femur and proximal tibia
what is appearance of osteosarcoma on x-ray?
periosteal reaction with sunburst appearance
what is common metastases of osteosarcoma?
10-20% present with pulmonary metastases
what is treatment of osteosarcoma?
chemo & limb salvage
what is location of ewing’s sarcoma?
diaphysis of long bones, and again distal femur and proximal tibia - it’s tumour of endothelial cells in bone marrow
what ages have ewing’s sarcoma?
5-25 yrs
what is treatment of ewing’s sarcoma?
chemo & limb salvage & adjuvant radiation
what is chondrosarcoma?
= malignancy of chondrocytes
- lytic or blastic lesion with reactive cortical thickening, majority arise de novo (few from benign)
what is common area for chondrosarcoma?
pelvis, proximal & distal femur
what is common age for chondrosarcoma?
40-75 yrs
what is appearance of chondrosarcoma on xray?
popcorn appearance, lots of bubble look
which tumour is not responsive to radio or chemo therapy?
chondrosarcoma
what are 3 examples of malignant & 3 examples of benign tumours?
malignant = osteosarcoma, ewing’s sarcoma, chondrosarcoma
benign = osteoid osteoma, osteochondroma, enchondroma
what is location of osteoid osteoma?
painful, benign tumour of long bones (central nodule of woven bone with osteoblastic rim)
what is age for osteoid osteoma?
5-25 yrs
what is treatment of osteoid osteoma?
usually resolve spontaneously, can treat with radiofrequency ablation, can take aspirin to relieve pain (worse at night)
what is most common and 2nd most common benign bone tumour?
- osteochondroma (abnormal cartilage capped ossified pedicle)
- enchondroma (intramedullary cartilage lesion)
what age is osteochondroma?
in young adults, can be caused by trauma
what is unusual presentation of enchondroma?
it’s usually asymptomatic and presents as incidental finding
what age is common for enchondroma and what is treatment?
20-50 yrs
= conservative treatment, bone grafting is symptomatic
what are 5 commonest sites of metastases?
vertebra, pelvis, ribs, femur, skull
what are red flags that suggest bone tumours?
increasing pain, persistent, worse at night, atraumatic
what are radiological features of malignancy?
wide zone transition, periosteal reaction, cortical destruction
- they can have neocortex (new layer)
why might lesion not show on x-ray?
might not show on x-ray until >50% cortical bone lost
what is presentation of ewing’s sarcoma?
hot, swollen, tender joint or limb, raised inflammatory markers. can mimic infection. be suspicious - ask about night pain
in general what pace do benign tumours grow?
generally slow growing and painless with no tender
what does ewing’s sarcoma look like on radiograph?
onion peel
