Bone and Soft Tissue Tumours Flashcards
What is a sarcoma?
Malignant tumour arising from connective tissues
What are some benign bone-forming tumours?
Osteoid osteoma
Osteoblastoma
What are some malignant bone-forming tumours?
Osteosarcoma
What are some benign cartilage-forming tumours?
Enchondroma
Osteochondroma
What are some malignant cartilage-forming tumours?
Chondrosarcoma
What are some benign fibrous tissue tumours?
Fibroma
What are some malignant fibrous tissue tumours?
Fibrosarcoma
Malignant fibrous histiocytoma (MFH)
What are some benign vascular tissue tumours?
Haemangioma
Aneurysmal bone cyst
What are some malignant vascular tissue tumours?
Angiosarcoma
What are some adipose tissue tumours?
Lipoma
What are some malignant tissue tumours?
Liposarcoma
What are some malignant marrow tissue tumours?
Ewing’s sarcoma
Lymphoma
Myeloma
What symptoms and signs of bone tumours may present on history taking?
Pain, progressive at rest and night
Mass
What should an examination for bone tumours involve or look for?
Measurement of mass Location Shape Consistency Mobility Tenderness Local temperature Neuro-vascualr deficits
What investigations should be used for bone tumours?
X rays CT MRI Isotope bone scan Angiography PET scan Biopsy
What would you expect to see on an inactive x ray?
Clear margins
Surrounding rim of reactive bone
What would you expect to see on the x ray of an aggressive tumour?
Less well defined zone of transition between lesion and normal bone (permeative growth)
Cortical destruction
Codman’s triangle, onion-skinning or sunburst pattern
What can a CT scan be used to assess in bone tumours?
Assessing ossification and calcification
Integrity of cortex
Staging
What can an isotope bone scan be used to assess in bone tumours?
Staging for skeletal metastasis
Multiple lesions
What are the cardinal features of malignant primary bone tumours?
Increasing pain Unexplained pain Deep-seating boring nature Night pain Difficulty weight-bearing Deep swelling
What are the clinical features of osteosarcoma?
Pain Loss of function Swelling Pathological fracture Joint effusion Deformity Neurovascular effects Systemic effects of neoplasia
What are the specific features of pain associated with osteosarcoma?
Increasing pain, impending fracture (esp lower limb)
Analgesics eventually ineffective
Not related to exercise
Deep, boring ache worse at night
What are the specific features of swelling associated with osteosarcoma?
Generally diffuse in malignancy
Generally near end of long bone
Once reaching noticeable size, enlargement may be rapid
Warmth over swelling and venous congestion
What are the treatment options available for bone tumours?
Surgery
Chemotherapy
Radiotherapy
What are the suspicious signs of a soft tissue tumours being malignant?
Deep tumours of any size
Subcutaneous tumours >5cm
Rapid growth, hard, craggy, non-tender
What suspicious signs of swelling should be noted?
Rapidly growing
Hard, fixed, craggy surface, indistinct margins
Non-tender to palpation but associated with deep ache etc
May be painless
Recurred after previous excision
What are the most common cancers which metastasise to bone?
Lung Breast Prostate Kidney Thyroid GI tract Melanoma
What are the prevention strategies for bone mets?
Early chemotherapy
Prophylactic internal fixation
Use of bone cement
Aim for early painless weight bearing and mobilisation
What is the system used to asses the risk of fracture?
Mirel’s scoring system
