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MSK > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

What is a sarcoma?

A

Malignant tumour arising from connective tissues
Spread along fascial planes
Haematogenous spread to lungs
Rarely to regional lymph nodes

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2
Q

What are bone tumours?

A

Benign are more common compared to malignant
Bony secondaries very common
Bone tumour in patient > 50 years likely metastatic

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3
Q

What are some bone-forming tumours?

A

Benign - osteoid osteoma and osteoblastoma
Malignant - osteosarcoma

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4
Q

What are some cartilage forming tumours?

A

Benign - enchondroma and osteochondroma
Malignant - chondrosarcoma

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5
Q

What are some fibrous tissue tumours?

A

Benign - fibroma
Malignant - fibrosarcoma and malignant fibrous histiocytoma

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6
Q

What are some vascular tissue tumours?

A

Benign - haemangioma and aneurysmal bone cyst
Malignant - angiosarcoma

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7
Q

What are some adipose tissue tumours?

A

Benign - lipoma
Malignant - liposarcoma

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8
Q

What are some marrow tissue tumours?

A

Malignant - Ewing’s sarcoma, lymphoma and myeloma

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9
Q

What are giant cell tumours (GCT)?

A

Benign and are locally destructive
Can rarely metastasise

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10
Q

What is the incidence of primary bone tumours in the UK?

A

Osteosarcoma is commonest primary malignant bone tumour in younger patients
Myeloma - commonest primary bone tumour in older patient

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11
Q

What is the patient history of bone tumour?

A

Pain - activity related and progressive at rest/ night
Mass
Abnormal x-rays - incidental
Bone tumours - PAIN

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12
Q

What is looked for when examining a patient with bone tumour?

A

General health, measurements of mass, location, shape, consistency, mobility, tenderness, local tenderness and neuro-vascular deficits

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13
Q

What investigations are used for bone tumours?

A

Pain x-rays
Calcification - CT
Myositis officans
Phleboliths in haemangioma
Isotope bone scan

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14
Q

What does an inactive tumour look like on x-ray?

A

Clear margins, surrounding rim of reactive bone and cortical expansion can occur with aggressive benign lesions

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15
Q

What does an aggressive tumour look like on x-ray?

A

Less well defined zone of transition between lesion and normal bone
Cortical destruction
Periosteal reactive new bone growth
Codman’s triangle, onion skinning or sunburst pattern

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16
Q

What are isotope bone scans used for?

A

Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia and histiocytes
Frequently negative in myeloma
Benign also demonstrates increased intake

17
Q

What are other investigations used?

A

Angiography (embolization of vascular tumours) and PET
Biopsy

18
Q

What are the cardinal features of malignant primary bone tumours?

A

Increasing pain, unexplained pain, deep-seated boring nature, night pain, difficulty weight-bearing and deep swelling

19
Q

What are the clinical features of osteosarcoma?

A

Pain, loss of function, swelling, pathological fracture, joint effusion, deformity, neurovascular effects and systemic effects of neoplasia

20
Q

Describe pain in osteosarcoma

A

Cardinal feature, increasing pain and impending fracture, analgesics eventually ineffective and not related to exercise
Deep boring ache which is worse at night

21
Q

Describe loss of function in osteosarcoma

A

Limp, reduced joint movement and stiff back (esp. child)

22
Q

Describe swelling in osteosarcoma

A

Generally diffuse in malignancy, near end of long bone, enlargement may be rapid, warmth over swelling and venous congestion

23
Q

What is the investigation of choice for osteosarcoma?

A

MRI
Very good for showing intraosseous extent of tumour, extraosseous soft tissue extent, joint involvement, skip metastases and epiphyseal extension

24
Q

What is the treatment for osteosarcoma?

A

Chemotherapy, surgery and radiotherapy

25
Q

What is the surgery for osteosarcoma?

A

Limb salvage is possible in most cases
Consider involvement of neurovascular structures
Pathological fractures
Poorly performed biopsy

26
Q

What are the suspicious signs of malignant soft tissue tumour?

A

Deep (deep to fascia) tumours of any size
Subcutaneous tumours > 5cm
Rapid growth, hard, craggy and non-tender
All suspected tumours are referred to specialist tumour centre

27
Q

What type of swelling is suspicious of malignant soft tissue tumour?

A

Rapidly growing, hard, fixed, craggy surface, indistinct margins, non-tender, deep ache, worse at night and beware as may be painless

28
Q

What is the incidence of metastatic bone disease?

A

Secondary bone tumour 25x more common than primary
Breast commonly goes to bone and melanoma commonly goes to lung
Bone most common secondary site

29
Q

What are the common sites of metastatic bone disease?

A

Vertebrae> proximal femur> pelvis> ribs> sternum> skull

30
Q

What are the 7 most commonest primary cancers which metastasise to bone?

A

Lung, breast, prostate, kidney, thyroid, GI tract and melanoma

31
Q

Describe survival rate and pathological fracture

A

Depends on type of tumour
In breast - median survival with bone metastases hugely increased and soft tissue is 12-24 months
50% of patients with fractures will survive more than 6 months and 30% more than 1 year

32
Q

What is the prevention for pathological fracture?

A

Early chemotherapy/ DXT
Prophylactic internal fixation - lytic lesion and increasing pain and/ or 2.5cm diameter/ 50% cortical destruction
Possible use of bone cement
Embolization
Conservatively if non-weight bearing skeleton

33
Q

What is used for fracture risk assessment?

A

Mirel’s scoring system
Possible max. score of 12
Site, pain, lesion, and size

34
Q

What is required if surgery is indicated for spinal metastases?

A

Decompression and stabilisation

35
Q

What is the treatment for solitary renal metastases?

A

Radically excised

36
Q

Describe soft tissue tumours

A

Lipoma is most common
<5cm 150:1 for sarcoma
>5cm then 20:1
>10cm then 6:1
Deep seated tumour 4:1

37
Q

What is the presentation of soft tissue tumours?

A

Painless, mass deep to deep fascia, any mass over 5cm, any fixed/ hard or indurated mass, and any recurrent mass

38
Q

What imaging is used for soft tissue tumours?

A

MRI

39
Q

What is a summary for bone tumours?

A

Pain is persistent, increasing, non-mechanical and nocturnal
Deep seated mass
X-rays

MSK (39 decks)

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