Bone and soft tissue tumours

Question 1

Are melignant primary tumours of the skeleton common?

Answer 1

No! very rare, so you always have to think about secondary. Also more common in younger people, so if the patient is older then is even more likely to be seconday

Question 2

What sis a sarcoma? How do they spread?

Answer 2

Malignant cancer of connective tissue. Can spread up fascial planes.

Question 3

Where do sarcomas spread to?

Answer 3

The LUNGS!!! Rarely to lymp (unless from the synovial/rhabdomyosarcoma (young children - in muscle)/epithelioid (small lumps in soft tissue, almost under the skin)

Question 4

What tumours are within the synovium?

Answer 4

synovial sarcomas

Question 5

Malignant name?

Answer 5

sarcoma

Question 6

What is a haemangioma? aneurysmal bone cyst?

Answer 6

Both types of benign vascular tissue tumours.

Haemangioma = blood vessels, way too many grow
aneurysmal bone cyst = blood filled cyst within the bone

Question 7

lipoma vs liposarcoma?

Answer 7

Lipoma = benign tumour in the fat. Liposarcoma = metastatic tumour in fat tissue

Liposarcomas are more rare, but the bigger it is the less rare they are, anything deep seeted, craggy, hard, over 5cm has a good chance of being a liposarcoma

Question 8

Ewing’s sarcoma is what?

Answer 8

Cancer of the marrow tissues.

Most common: Osteosarcoma, chondrosarcoma, ewings tumour,

Question 9

are bone tumours common?

Answer 9

Secondary metastases, yes

Question 10

old vs young tumours?

Answer 10

Young = osteosarcoma
Old = Myeloma

Question 11

Symptom of bone tumours

Answer 11

PAIN, like a dull background ache, may wake up at night time.

May feel a mass (late stage) along with typical cancer symptoms.

Question 12

What do we take note of especially in examination?

Answer 12

The size of it and consistancy etc, really important to help us see if it is rapidly changing or getting worse, which would indicate more of a malignant tumour.

So: Measurements, location, shape, consistency, mobility, tenderness, local tempreature, and any neuro deficits

Question 13

ARE TUMOURS PAINFUL ON PALPATION?

Answer 13

not always no.,

Question 14

WHAT INVESTIGATION do we want to do?

Answer 14

XRay, especially initially!!

Want to see what it is like

Question 15

do we see synovial sarcoma in xrays?

Answer 15

Yes it will show up as calcified

Question 16

benign vs aggressive on xray

Answer 16

may be able to tell, if it has well defined boarders and is in a confined space then it is likely to be benign.

If it looks like a bushy tree then it is malignant. Also, if there is coritcal destruction. If you can see “Codmans triangle, onion-skinning or a sunburst pattern”

Question 17

best investigation for osteoid osteoma and staging of lungs

Answer 17

MRI

Question 18

Why is MRI good, what can’t we tell?

Answer 18

V helpful in being able to see the full extent of invasion etc (often much bigger than it was on the xray.). We can’t tell if it is benign or malig

Question 19

So… what investigations are we going to do?

Answer 19

Xray -> effected limb and chest
MRI of lesion,
CT Chest abdo and pelvis (looking for lymph node involvement)
Bone scan
Bloods inc. fbc and lft
BIOPSY*

Question 20

Key to benign vs malig = biopsy. Why do ew have ot be careful how we take the biopsy. Why? WHat else can we use to help us decide malig or benign?

Answer 20

Becuase there is potential for the cancer to spread up the biopsy tract, so we need to make sure that you consult a specialist tumour surgeon who can decide the best way in.

WE also use the history, and radiological features as well as clinical findings

Question 21

Most common place for osteosarcoma?

Answer 21

distal femur

Question 22

Pain descriptoin and other symptoms of malignant Osteosarcoma? BAck pain in children?

Answer 22

Deep-seated boring pain.

increasing, unexplained, night pain. difficulty weight bearing and deep swelling all indicate a malignant primary bone tumour.

Question 23

Maonstay scan for osteosarcoma

Answer 23

MRI

(goof to show:
intraosseous (intramedullary) extent of tumour
extraosseous soft tissue extent of tumour
joint involvement
skip metastases
epiphyseal extension)

Question 24

What is the treatment of the osteosarcoma?

Answer 24

Preoperative chaemo,
surgery
post operative radiotherapy

Question 25

WHich cancer spreads to the bone most commonly?

Answer 25

Breast

Question 26

Most common places for metatstatoc bone disease?

Answer 26

lung, liver, bone

Question 27

Most common primary cancer metastacises to bone

Answer 27

Lung
Breast
Prostate
Kidney
Thyroid
GI
Melanoma

(Lets Beat Prostate Kancer Today, Go Me!)

In under 4s = neuroblastoma of adrenal medulla

Question 28

Kidney -> have to cut off blood supply, although ususally can actulaly get rid of the whole thing. Also for thyroid have to cut off and embolise prior to surgery.

To see if it is primary of secondary, what investigations do we need to do to look for cancers?

Answer 28

Lungs -> CXR, sputum cytology
Breast -> examine
Prostate -> PR exam, PSA. 2ndry = osteosclerotic
Kidney -> IVP and US, Angiography
Thyroid -> Ca, examine
GI -> function of bowels, endoscope, ba study, markers
Melenoma -> examine

Question 29

What is mirels coreing and why is it important?

Answer 29

It helps us to decide the fracture risk

Question 30

kidnesy and thyroid

Answer 30

Are both v vascular and so need to be embolised prior to surgery

Question 31

Meastases in the hip in breast cancer. Do what?

Answer 31

Replace the hip.

Question 32

Benign vs malignany lipoma vs lipossarcoma size matters?

Answer 32

YES!!

Under 5cm, 150:1 lipoma:sarcoma
>5cm = 20:1
>10cm 6:1
Deep seated = 4:1

Question 33

large and deep seated sarcoma/mass >5cm then what? What else could suggest malignancy?

Answer 33

liposarcoma!

Hard, fixed, craggy, recurrant mass. WIll probs be painless

Question 34

Sarcoma, what scan?

Answer 34

MRI

Question 35

are soft tissue injuries painful or painless?

Answer 35

Painless