Bone and Soft Tissue Tumours Flashcards
How common are benign and malignant tumours of the skeleton?
Benign- extremely common
Malignant- rare
If there is a bone tumour in a patient >50 yrs, what is the likely cause?
Metastasis from another tumour
Sarcoma?
Malignant tumour arising from connective tissue
How and where do sarcomas spread?
Spread along fascial planes Haematogenous spread to lungs
Rarely spread to lymph nodes
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the benign bone-forming tumours?
Osteoid osteoma
Osteoblastoma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the malignant bone-forming tumours?
Osteosarcoma
How do patients with begin bone-forming tumours often present?
Night pain which is relived by NSAIDs
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the benign cartillage-forming tumours?
Enchondroma
Osteochondroma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the malignant cartilage-forming tumours?
Chondrosarcoma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the benign fibrous tissue tumours?
Fibroma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the malignant fibrous tissue tumours?
Fibrosarcoma
Malignant fibrous histiocytoma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the benign vascular tissue tumours?
Haemangioma
Aneurysmal bone cyst
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the malignant vascular tissue tumours?
Angiosarcoma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the benign adipose tissue tumours?
Lipoma
Okay so the lecturer said we are not expected to remember all the different types of tumours.
But what are the malignant adipose tissue tumours?
Liposarcoma
Bone marrow tumours tend to only be malignant. Give some examples.
Ewing’s sarcoma
Lymphoma
Myeloma
->okayyyy to recap, if it has sarcoma in it, it’s malignant
In which age group do bone marrow tumours tend to affect?
Children
What is the most common primary malignant bone tumour in the UK?
Osteosarcoma
->even though most common, only affects 3 per million per yr
What is the most common primary malignant bone tumour in:
a. younger patients
b. older patients
a. osteosarcoma
b. myeloma
Presenting history of tumours?
Pain- need to be aware of this
Mass
Abnormal x-rays- incidental findings - often benign tumours found like this
Describe pain caused by bone tumours
Activity related
Progressive at rest and at night
How can benign tumours present?
May present with activity related pain if large enough to weaken bone
When may a swelling be a tumour?
Rapidly growing
Hard, fixed, craggy surface
Indistinct margins
Non-tender to palpate but associated with deep ache, especially at night
Reoccurrence after previous excision
Investigations for bone tumours?
X-rays
->also useful for synovial sarcomas as there is calcification
How do benign tumours appear on x-ray?
Clear margins
Surrounding rim of reactive bone
->cortical expansion can occur with aggressive bone lesions
How do malignant tumours of bone look on x-ray?
Cortical destruction
Less well defined zone of transition between lesion and normal bone
->if there is cortical destruction, it’s malignant
When is CT useful for bone tumours?
Staging- primarily of lungs
Good for assessing osteoid osteomas and guiding surgery to remove (they are tiny and benign but cause a lot of pain)
When are isotope bone scans useful for bone tumours?
Staging for skeletal metastasis as van show how many metastasis in one scan
Useful when there are multiple lesions
What is the investigation of choice for primary bone tumours and primary soft tissue tumours?
MRI
How can the type of tumour be determined?
Biopsy of the tumour
->all other investigations need to be done first though e.g. bloods, x-rays, MRI, bone scan and CT chest, abdo and pelvis
What may treatment of bone tumours involve?
Chemo
Radiotherapy
Reconstruction
Who is more likely to get an osteosarcoma?
Male>female
Aged 10-30
Which bones are the majority of osteosarcomas seen?
Distal femur and proximal tibia
Clinical features of bone tumours?
Pain- cardinal feature
Loss of function
Swelling
Joint effusion
Deformity
Systemic effects e.g. weight loss, malaise, temperature
->beware of returning patients with continuing pain!!
What symptom would you be especially suspicious of in a child which could suggest a bone tumour?
Back pain or stiffness
What can tumours cause to happen?
Pathological fractures
->these are fractures caused by very little activity but tend to occur in osteoporotic bone
Investigations for osteosarcoma?
MRI
Bone is the most common site for metastases after which other two sites?
Lung and liver
For all secondary bone tumours which have metastasised, where are the most common sites?
Vertebrae > proximal femur > pelvis > ribs > sternum > skull
What are the commonest primary cancers which spread to bone?
->apparently one of the most common questions relating to this the lecturer has seen
Lung
Breast
Prostate
Kidney
Thyroid
GIT
Melanoma
Which scoring system can be used to assess the risk of pathological fractures from bone tumours?
Mirel’s Scoring System
What is the most common soft tissue tumour?
Lipoma- will see hundreds over lifetime as a doctor
When should you be suspicious that a lipoma is a liposarcoma?
When it gets greater than 5cm, after 5cm, the risks of it being malignant are a lot higher
Symptoms of soft-tissue tumours?
Swelling or mass
Painless
Primary investigation for soft tissue tumours?
MRI
