Bone and Soft Tissue Tumours Flashcards
Types of bone + soft tissue tumours
Bone
- Benign
- Malignant (primary + secondary)
Soft tissue
- Benign
- Malignant
What is a sarcoma
Malignant tumour arising from connective tissues
How does a sarcoma spread
- Spread along fascial planes
- Haematogenous spread to lungs
- Rarely to lymph nodes
How common are benign + malignant tumours of bones
- Benign = common
- Malignant = rare
- Bony secondaries are very common
When is a bone tumour in a patient likely to be metastatic
> 50 years old
Types of bone-forming tumours and cartilage forming tumours
Bone
- Benign = Osteoid osteoma, Osteoblastoma
- Malignant = Osteosarcoma
Cartilage
- Benign = Enchondroma, Osteochondroma
- Malignant = Chondrosarcoma
Types of fibrous tissue tumours
- Benign = Fibroma
- Malignant = Fibrosarcoma, Malignant Fibrous Histiocytoma (MFH)
Types of adipose + vascular tissue tumours
Adipose
- Benign = Lipoma
- Malignant = Liposarcoma
Vascular
- Benign = Haemangioma
- Malignant = Angiosarcoma
Types of marrow tissue tumours
-Malignant = Ewing’s sarcoma, lymphoma, myeloma
How likely are benign tumours to metastasise
- Unlikely
- Locally destructive
Commonest primary malignant bone tumour in young and older people
- Young = Osteosarcoma
- Old = Myeloma (bone marrow)
Cardinal features of primary bone tumours
- Increasing, unexplained, pain
- Deep-seated, boring, nature
- Night pain
- Difficulty weigh-bearing
- Deep swelling
- Progressive pain at night + rest
Presentation of benign bone tumours
May present with activity related pain if large enough to weaken bone
Examination of suspected bone tumours
- General health
- Location
- Shape, Consistency, Mobility (SCM)
- Tenderness + local temperature
- Neuro-vascular deficits
Investigations for suspected bone tumours
- Plain X-ray
- CT
- Isotope bone scan
- MRI (gold standard)
- Biopsy
What would be seen on a X-ray of an inactive tumour
- Clear margins
- Surrounding rim of reactive bone
What would be seen on a X-ray of an aggressive tumour
- Less well defined zone of transition + normal bone (permeative growth)
- Cortical destruction = Malignancy
- Periosteal reactive new bone growth occurs where the lesion destroys the cortex
- Codman’s triangle
(onion-skinning or sunburst pattern)
Limitation of isotope bone scanning
- Frequently -ve for myeloma
- Benign tumours also demonstrate increased uptake
What is MRI non-specific for
Malignant vs benign
When could PET scanning be useful for bone cancer
Investigating response to chemo
8 clinical features of bone tumours
- Pain
- Loss of function
- Swelling
- Pathological fracture
- Joint effusion
- Deformity
- Neurovascular deficits
- Systemic effects of neoplasia
Describe the pain in patients with bone tumours
- Increasing pain
- Analgesics eventually ineffective
- Not exercise related
- DEEP BORING ACHE, WORSE AT NIGHT = !!!
Describe the loss of function in patients with bone tumours
- Limp
- Reduced ROM
- Stiff back (esp. child)
Describe the swelling seen in patients with bone tumours
- Generally diffuse in malignancy
- Generally near the end of long bones
- Warmth over swelling + venous congestion = ACTIVE!
- Once reaching a notable size, enlargement may be rapid
Red flag for a pathological fracture
Minimal trauma + Hx of pain prior to # = !!!
3 types of treatments for bone tumours
- Chemotherapy
- Radiotherapy
- Surgery
Suspicious signs for soft tissue tumours
- Deep tumour of any size (i.e. deep to deep fascia)
- Subcutaneous tumours >5cm
- Rapid growth, hard, craggy and non-tender
What a red flags for swellings
- Rapidly growing
- Hard, fixed, craggy surface with indistinct margins
- Non-tender to palpation but assoc. with deep ache, esp. worse at night
- Recurred after previous excision
Primary or secondary bone tumour more common
Secondary (25x)
Most common site of primary tumour in secondary bone disease
Breast
6 common sites of primary tumour in secondary bone disease
- Breast
- Lung
- Prostate
- Kidney
- GI tract
- Thyroid
Prevention of pathological fractures
- Early chemo
- Bone cement
- Prophylactic internal fixation
Indications for prophylactic internal fixation
-Lytic lesion + increasing pain &/or -=/> 2.5cm tumour &/or -=/> 50% cortical destruction
How is fracture risk assessed
Mirel’s Scoring system
- Site
- Pain
- Lesion
- Size
What Mirel score indicates prophylactic internal fixation
8 or above (prior to radiotherapy)
12 is maximum
Most common soft tissue tumour
Lipoma
Red flags for deep soft tissue tumours
- Deep seated
- > 5cm
- Painless
- Fixed, hard or indurated mass
- Recurrent
