Bone and soft tissue tumours Flashcards
What are sarcomas?
Malignant tumours arising from connective tissues
How does a sarcoma spread to the lungs?
Via haematogenous spread
Are benign tumours of the skeleton rare or common?
Common
Are malignant tumours of the skeleton rare or common?
RARE
What is very common related to tumours of the skeleton?
Bony secondaries
In a bone tumour in a patient > 50 y/o, is it likely to be benign or metastatic?
Metastatic
What is the commonest primary malignant bone tumour in the younger patient?
Osteosarcoma
What is the commonest primary malignant bone tumour in the older patient?
Myeloma
3 examples of malignant primary bone tumours
Osteosarcoma
Ewings sarcoma
Chondrosarcoma
Presentation of malignant primary bone tumour
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
Pain features of bone tumours
Increasing pain Persisting Analgesics eventually ineffective Not related to exercise, present at rest Nocturnal Deep boring ache, worse at night
Cardinal feature of bone tumours
Pain
Suspicious signs of soft tissue tumours
Deep (i.e. deep to deep fascia) of any size Subcutaneous tumours > 5cm Rapid growth Hard, craggy Non-tender
Presentation of soft tissue tumours
Painless Mass deep to deep fascia Any mass > 5cm only fixed, hard or undurated mass Any recurrent mass
Commonest soft tissue tumour
Lipoma
Beware of swelling which is…..
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
Investigation for bone tumours
X ray
Investigation for soft tissue tumours
MRI
Examination of bone and soft tissue tumours looks at….
General health Measurements of mass location shape consistency mobility tenderness local temperature neuro-vascular deficits
Signs on an X-ray of an inactive bone lesion
Clear margins
Surrounding rim of reactive bone
Cortical expansion can occur with aggressive benign lesions
Signs of an X-ray of an aggressive bone lesion
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)
What are isotope bone scans used for?
Staging for skeletal metastases
Treatment of bone tumours
Chemo
Surgery
Radiotherapy
How much more common is a 2ndry bone tumour vs a 1ry bone tumour?
Secondary 25x more common than primary
Bone is the most common site for secondary after what cancers?
Lung
Liver
Order of frequency of sites of secondary bone tumours
Vertebrae > proximal femur > pelvis > ribs > sternum > skull
7 commonest primary cancers which metastases to bone
Lung breast prostate kidney thyroid GI tract melanoma (neuroblastoma of adrenal medulla)
When surgery is indicated for spinal metastases, what is generally required?
Decompression
Stabilisation
