Bone and soft tissue tumours

Question 1

What are sarcomas?

Answer 1

Malignant tumours arising from connective tissues

Question 2

How does a sarcoma spread to the lungs?

Answer 2

Via haematogenous spread

Question 3

Are benign tumours of the skeleton rare or common?

Answer 3

Common

Question 4

Are malignant tumours of the skeleton rare or common?

Answer 4

RARE

Question 5

What is very common related to tumours of the skeleton?

Answer 5

Bony secondaries

Question 6

In a bone tumour in a patient > 50 y/o, is it likely to be benign or metastatic?

Answer 6

Metastatic

Question 7

What is the commonest primary malignant bone tumour in the younger patient?

Answer 7

Osteosarcoma

Question 8

What is the commonest primary malignant bone tumour in the older patient?

Answer 8

Myeloma

Question 9

3 examples of malignant primary bone tumours

Answer 9

Osteosarcoma
Ewings sarcoma
Chondrosarcoma

Question 10

Presentation of malignant primary bone tumour

Answer 10

Increasing pain 
Unexplained pain
Deep-seated boring nature
Night pain 
Difficulty in weight bearing 
Deep swelling
Loss of function (limp, ROM)
Deformity
Impending fracture (especially lower limb)
Neurovascular effects 
Deep seated mass
Systemic effects of neoplasia

Question 11

Pain features of bone tumours

Answer 11

Increasing pain 
Persisting 
Analgesics eventually ineffective
Not related to exercise, present at rest
Nocturnal 
Deep boring ache, worse at night

Question 12

Cardinal feature of bone tumours

Answer 12

Pain

Question 13

Suspicious signs of soft tissue tumours

Answer 13

Deep (i.e. deep to deep fascia) of any size
Subcutaneous tumours > 5cm 
Rapid growth 
Hard, craggy 
Non-tender

Question 14

Presentation of soft tissue tumours

Answer 14

Painless
Mass deep to deep fascia
Any mass > 5cm 
only fixed, hard or undurated mass 
Any recurrent mass

Question 15

Commonest soft tissue tumour

Answer 15

Lipoma

Question 16

Beware of swelling which is…..

Answer 16

Rapid growing
Hard, fixed, craggy surface with indistinct margins
Non tender to palpation, but associated with deep ache, especially at night
beware - MAY BE PAINLESS
recurred after previous excision

Question 17

Investigation for bone tumours

Answer 17

X ray

Question 18

Investigation for soft tissue tumours

Answer 18

MRI

Question 19

Examination of bone and soft tissue tumours looks at….

Answer 19

General health 
Measurements of mass
location 
shape
consistency 
mobility
tenderness
local temperature
neuro-vascular deficits

Question 20

Signs on an X-ray of an inactive bone lesion

Answer 20

Clear margins
Surrounding rim of reactive bone
Cortical expansion can occur with aggressive benign lesions

Question 21

Signs of an X-ray of an aggressive bone lesion

Answer 21

Less well defined zone of transition between lesion and normal bone (permeative growth)
Cortical destruction = malignancy
Periosteal reactive new bone growth occurs when the lesion destroys the cortex (onion skinning or sunburst pattern)

Question 22

What are isotope bone scans used for?

Answer 22

Staging for skeletal metastases

Question 23

Treatment of bone tumours

Answer 23

Chemo
Surgery
Radiotherapy

Question 24

How much more common is a 2ndry bone tumour vs a 1ry bone tumour?

Answer 24

Secondary 25x more common than primary

Question 25

Bone is the most common site for secondary after what cancers?

Answer 25

Lung

Liver

Question 26

Order of frequency of sites of secondary bone tumours

Answer 26

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

Question 27

7 commonest primary cancers which metastases to bone

Answer 27

Lung
breast
prostate
kidney 
thyroid
GI tract 
melanoma
(neuroblastoma of adrenal medulla)

Question 28

When surgery is indicated for spinal metastases, what is generally required?

Answer 28

Decompression

Stabilisation