Bone and Soft Tissue Tumours

Question 1

How common are benign and malignant tumours of the skeleton?

Answer 1

Benign- extremely common
Malignant- rare

Question 2

If there is a bone tumour in a patient >50 yrs, what is the likely cause?

Answer 2

Metastasis from another tumour

Question 3

Sarcoma?

Answer 3

Malignant tumour arising from connective tissue

Question 4

How and where do sarcomas spread?

Answer 4

Spread along fascial planes Haematogenous spread to lungs
Rarely spread to lymph nodes

Question 5

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?

Answer 5

Osteoid osteoma
Osteoblastoma

Question 6

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?

Answer 6

Osteosarcoma

Question 7

How do patients with begin bone-forming tumours often present?

Answer 7

Night pain which is relived by NSAIDs

Question 8

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?

Answer 8

Enchondroma
Osteochondroma

Question 9

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?

Answer 9

Chondrosarcoma

Question 10

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?

Answer 10

Fibroma

Question 11

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?

Answer 11

Fibrosarcoma
Malignant fibrous histiocytoma

Question 12

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?

Answer 12

Haemangioma
Aneurysmal bone cyst

Question 13

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?

Answer 13

Angiosarcoma

Question 14

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?

Answer 14

Lipoma

Question 15

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?

Answer 15

Liposarcoma

Question 16

Bone marrow tumours tend to only be malignant. Give some examples.

Answer 16

Ewing’s sarcoma
Lymphoma
Myeloma

->okayyyy to recap, if it has sarcoma in it, it’s malignant

Question 17

In which age group do bone marrow tumours tend to affect?

Answer 17

Children

Question 18

What is the most common primary malignant bone tumour in the UK?

Answer 18

Osteosarcoma

->even though most common, only affects 3 per million per yr

Question 19

What is the most common primary malignant bone tumour in:
a. younger patients
b. older patients

Answer 19

a. osteosarcoma
b. myeloma

Question 20

Presenting history of tumours?

Answer 20

Pain- need to be aware of this
Mass
Abnormal x-rays- incidental findings - often benign tumours found like this

Question 21

Describe pain caused by bone tumours

Answer 21

Activity related
Progressive at rest and at night

Question 22

How can benign tumours present?

Answer 22

May present with activity related pain if large enough to weaken bone

Question 23

When may a swelling be a tumour?

Answer 23

Rapidly growing
Hard, fixed, craggy surface
Indistinct margins
Non-tender to palpate but associated with deep ache, especially at night
Reoccurrence after previous excision

Question 24

Investigations for bone tumours?

Answer 24

X-rays

->also useful for synovial sarcomas as there is calcification

Question 25

How do benign tumours appear on x-ray?

Answer 25

Clear margins Surrounding rim of reactive bone ->cortical expansion can occur with aggressive bone lesions

Question 26

How do malignant tumours of bone look on x-ray?

Answer 26

Cortical destruction Less well defined zone of transition between lesion and normal bone ->if there is cortical destruction, it's malignant

Question 27

When is CT useful for bone tumours?

Answer 27

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)

Question 28

When are isotope bone scans useful for bone tumours?

Answer 28

Staging for skeletal metastasis as van show how many metastasis in one scan Useful when there are multiple lesions

Question 29

What is the investigation of choice for primary bone tumours and primary soft tissue tumours?

Answer 29

MRI

Question 30

How can the type of tumour be determined?

Answer 30

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

Question 31

What may treatment of bone tumours involve?

Answer 31

Chemo Radiotherapy Reconstruction

Question 32

Who is more likely to get an osteosarcoma?

Answer 32

Male>female Aged 10-30

Question 33

Which bones are the majority of osteosarcomas seen?

Answer 33

Distal femur and proximal tibia

Question 34

Clinical features of bone tumours?

Answer 34

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!!

Question 35

What symptom would you be especially suspicious of in a child which could suggest a bone tumour?

Answer 35

Back pain or stiffness

Question 36

What can tumours cause to happen?

Answer 36

Pathological fractures ->these are fractures caused by very little activity but tend to occur in osteoporotic bone

Question 37

Investigations for osteosarcoma?

Answer 37

MRI

Question 38

Bone is the most common site for metastases after which other two sites?

Answer 38

Lung and liver

Question 39

For all secondary bone tumours which have metastasised, where are the most common sites?

Answer 39

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

Question 40

What are the commonest primary cancers which spread to bone? ->apparently one of the most common questions relating to this the lecturer has seen

Answer 40

Lung Breast Prostate Kidney Thyroid GIT Melanoma

Question 41

Which scoring system can be used to assess the risk of pathological fractures from bone tumours?

Answer 41

Mirel's Scoring System

Question 42

What is the most common soft tissue tumour?

Answer 42

Lipoma- will see hundreds over lifetime as a doctor

Question 43

When should you be suspicious that a lipoma is a liposarcoma?

Answer 43

When it gets greater than 5cm, after 5cm, the risks of it being malignant are a lot higher

Question 44

Symptoms of soft-tissue tumours?

Answer 44

Swelling or mass Painless

Question 45

Primary investigation for soft tissue tumours?

Answer 45

MRI