Bone and Soft Tissue Tumours Flashcards
What is a sarcoma?
Malignant tumour arising from connective tissues
Spread along fascial planes
Haematogenous spread to lungs
Rarely to regional lymph nodes
What are bone tumours?
Benign are more common compared to malignant
Bony secondaries very common
Bone tumour in patient > 50 years likely metastatic
What are some bone-forming tumours?
Benign - osteoid osteoma and osteoblastoma
Malignant - osteosarcoma
What are some cartilage forming tumours?
Benign - enchondroma and osteochondroma
Malignant - chondrosarcoma
What are some fibrous tissue tumours?
Benign - fibroma
Malignant - fibrosarcoma and malignant fibrous histiocytoma
What are some vascular tissue tumours?
Benign - haemangioma and aneurysmal bone cyst
Malignant - angiosarcoma
What are some adipose tissue tumours?
Benign - lipoma
Malignant - liposarcoma
What are some marrow tissue tumours?
Malignant - Ewing’s sarcoma, lymphoma and myeloma
What are giant cell tumours (GCT)?
Benign and are locally destructive
Can rarely metastasise
What is the incidence of primary bone tumours in the UK?
Osteosarcoma is commonest primary malignant bone tumour in younger patients
Myeloma - commonest primary bone tumour in older patient
What is the patient history of bone tumour?
Pain - activity related and progressive at rest/ night
Mass
Abnormal x-rays - incidental
Bone tumours - PAIN
What is looked for when examining a patient with bone tumour?
General health, measurements of mass, location, shape, consistency, mobility, tenderness, local tenderness and neuro-vascular deficits
What investigations are used for bone tumours?
Pain x-rays
Calcification - CT
Myositis officans
Phleboliths in haemangioma
Isotope bone scan
What does an inactive tumour look like on x-ray?
Clear margins, surrounding rim of reactive bone and cortical expansion can occur with aggressive benign lesions
What does an aggressive tumour look like on x-ray?
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
What are isotope bone scans used for?
Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia and histiocytes
Frequently negative in myeloma
Benign also demonstrates increased intake
What are other investigations used?
Angiography (embolization of vascular tumours) and PET
Biopsy
What are the cardinal features of malignant primary bone tumours?
Increasing pain, unexplained pain, deep-seated boring nature, night pain, difficulty weight-bearing and deep swelling
What are the clinical features of osteosarcoma?
Pain, loss of function, swelling, pathological fracture, joint effusion, deformity, neurovascular effects and systemic effects of neoplasia
Describe pain in osteosarcoma
Cardinal feature, increasing pain and impending fracture, analgesics eventually ineffective and not related to exercise
Deep boring ache which is worse at night
Describe loss of function in osteosarcoma
Limp, reduced joint movement and stiff back (esp. child)
Describe swelling in osteosarcoma
Generally diffuse in malignancy, near end of long bone, enlargement may be rapid, warmth over swelling and venous congestion
What is the investigation of choice for osteosarcoma?
MRI
Very good for showing intraosseous extent of tumour, extraosseous soft tissue extent, joint involvement, skip metastases and epiphyseal extension
What is the treatment for osteosarcoma?
Chemotherapy, surgery and radiotherapy
What is the surgery for osteosarcoma?
Limb salvage is possible in most cases
Consider involvement of neurovascular structures
Pathological fractures
Poorly performed biopsy
What are the suspicious signs of malignant soft tissue tumour?
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
What type of swelling is suspicious of malignant soft tissue tumour?
Rapidly growing, hard, fixed, craggy surface, indistinct margins, non-tender, deep ache, worse at night and beware as may be painless
What is the incidence of metastatic bone disease?
Secondary bone tumour 25x more common than primary
Breast commonly goes to bone and melanoma commonly goes to lung
Bone most common secondary site
What are the common sites of metastatic bone disease?
Vertebrae> proximal femur> pelvis> ribs> sternum> skull
What are the 7 most commonest primary cancers which metastasise to bone?
Lung, breast, prostate, kidney, thyroid, GI tract and melanoma
Describe survival rate and pathological fracture
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
What is the prevention for pathological fracture?
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
What is used for fracture risk assessment?
Mirel’s scoring system
Possible max. score of 12
Site, pain, lesion, and size
What is required if surgery is indicated for spinal metastases?
Decompression and stabilisation
What is the treatment for solitary renal metastases?
Radically excised
Describe soft tissue tumours
Lipoma is most common
<5cm 150:1 for sarcoma
>5cm then 20:1
>10cm then 6:1
Deep seated tumour 4:1
What is the presentation of soft tissue tumours?
Painless, mass deep to deep fascia, any mass over 5cm, any fixed/ hard or indurated mass, and any recurrent mass
What imaging is used for soft tissue tumours?
MRI
What is a summary for bone tumours?
Pain is persistent, increasing, non-mechanical and nocturnal
Deep seated mass
X-rays
