Bone and Soft Tissue Malignancy Flashcards
Give examples of benign bone-forming tumours
Osteoid Osteoma
Osteoblastoma
Give examples of malignant bone-forming tumours
Osteosarcoma
Give examples of cartilage-forming benign tumours
Enchondroma
Osteochondroma
Give examples of cartilage-forming malignant tumours
Chondrosarcoma
Give examples of benign fibrous tissue tumours
Fibroma
Give examples of malignant fibrous tissue tumours
Fibrosarcoma
Malignant Fibrous Histiocytoma (MFH
Give examples of benign vascular tumours
Haemangioma
Aneurysmal Bone Cys
Give examples of malignant vascular tumours
Angiosarcoma
Give examples of benign adipose tissue tumours
Lipoma
Give examples of malignant adopose tissue tumours
Liposarcoma
Give examples of malignant marrow tissue tumours?
Ewing’s Sarcoma
Lymphoma
Myeloma
What is the most common primary malignant bone tumour in younger patients?
Osteosarcoma
What is the most common primary malignant ‘bone’ tumour in older patients?
Myeloma
What is the most common soft tissue tumour?
Lipoma
What is the most common benign bone/soft tissue tumour?
Osteochondroma
How can soft tissue tumours present?
Rapidly growing
Hard, fixed, craggy surface, indistinct margins
Non tender to palpitation but associated with deep ache, particularly worse at night
May be painless
Recurred after previous excision
How can bone tumours present?
Unlike soft tissue tumours, bone tumours are likely to be painful
- Progressive pain
- Unexplained pain
- Deep-seated boring nature
- Activity related
- Night pain
Mass
Difficulty weight-bearing
Deep swelling
How common is bone malignancy?
Primary bone tumours are rare
Seconday bone tumours are common, and is the 3rd most common secondary site after lung and liver
List the order of frequency of secondary bone malignancy sites
Vertebrae
Proximal femur
Pelvis
Ribs
Sternum
Skull
What are the most common primary cancers that spread to bone?
Lung
Breast
Prostate
Kidney
Thyroid (Medullary cancer)
GI
Melanoma
What is the most common primary cancer thats spreads to bone?
Breast
Where does osteosarcoma arise from?
Osteoblasts
What site of the bone does osteosarcoma occur?
Often takes place in metaphysis where cell proliferation is occurring
How does osteosarcoma present?
Pain
- Cardinal feature
- Increasing pain, especially in lower limb
- Analgesics eventually ineffective
- Not related to exercise
- Deep boring ache, worse at night
Loss of function
- Limp
- Reduced joint movement
- Stiff back especially in a child
Swelling
- Generally diffuse in malignancy
- Generally near the end of long bone
- Once reaching noticeable size, enlargement may be rapid
- Warmth over swelling + venous congestion = active
- Pressure effects
Pathological fracture
Joint effusion
Deformity
Neurovascular effects
Systemic effects of neoplasia
What investigations are used in bone tumour diagnosis?
X-Ray: Most useful for bone lesions
CT: Assesses ossification and calcification
Isotope Bone Scans: Staging for skeletal metastasis
MRI: Identify resection margins, determines size, extent and anatomical relationships
PET: Investigating response to chemo
Biopsy
What X-ray sign is seen in osteosarcoma?
unburst pattern and Codman’s triangle (periosteum is lifted)
What X-ray sign is seen in Ewing’s sarcoma?
Onion skin appearance
What X-ray sign is seen in chondrosarcoma?
Moth eaten cloth appearance
What X-ray sign is seen in osteochondroma?
Lytic bone lesions
What scoring system assess risk of pathological fracture in malignancy?
Mirel’s scoring system
Describe Mirel’s score 1
Upper limb
Mild pain
Blastic lesion
<1/3
Describe Mirel’s score 2
Lower limb
Moderate pain
Mixed lesion
1/3-2/3
Describe Mirel’s score 3
Peritrochanter
Functional pain
Lytic lesion
>2/3
How is metastatic bone pain managed?
Analgesia
Biphosphonates
Radiotherapy
