Bone and Soft Tissue Tumours Flashcards
Sarcoma
- Malignant tumours arising from connective tissues
- Spread along fascial planes
- Haematogenous spread to lungs
- Rarely to regional lymph nodes (rhabdomyosarcomas, epithelioid sarcomas & synovial sarcomas)
Soft tissue tumours suspicious signs
-deep (i.e. deep to deep fascia) tumours of any size
–subcutaneous tumours > 5 cm
–rapid growth, hard, craggy, non-tender
-may associated with deep ache, especially worse at night
Soft tissue tumours investigations
- CT of primary tumour
- MRI of primary tumour
- CT scan of chest
- PET scan
Soft tissue tumour treatment
- excision
- chemotherapy
- radiotherapy
Bone tumour history
- pain
- activity related
- progressive pain at rest and at night - mass
- abnormal x-rays - incidental
Bone tumour investigations
- plain x-rays
- CT
- isotope bone scan
- MRI
- angiography
- PET
- bone biopsy
Complete work up prior to biopsy:
- Bloods
- X-rays of affected Limb and Chest
- MRI of lesion
- Bone Scan
- CT Chest, abdo & pelvis
Clinical features of bone tumours
- pain
- increasing pain - impending # (esp. lower limb)
- analgesics eventually ineffective
- not related to exercise
- deep boring ache, worse at night
- difficulty weight bearing - loss of function
- limp
- reduced joint movement
- stiff back (esp. child) - swelling
- generally diffuse in malignancy
- generally near end of long bone
- warmth over swelling and venous congestion - pathological fracture
- minimal trauma and h/o pain prior to # - joint effusion
- deformity
- neurovascular effects
- systemic effects of neoplasia
7 commonest primary cancers which metastasise to bone
1-LUNG - smoker; CXR, sputum cytology
2-BREAST - examine
3-PROSTATE - PR, PSA
4-KIDNEY - solitary, vascular; IVP + US, angiography & embolise
5-THYROID - esp. follicular Ca; examine
6-GI TRACT - FOB, endoscopy, Ba studies, markers
7-MELANOMA - examine
Pathological fracture/ long bone mets
- Metastatic pathological fractures rarely unite, even if stabilized
- Prophylactic fixation of long bone mets is generally easier for the surgeon and less traumatic for the patient
- Use the Mirels scoring system
Treatment of bone tumours
Low grade disease: -wide surgical resection and reconstruction High grade non-metastatic disease add: -neoadjuvant chemotherapy -adjuvant chemotherapy High grade metastatic disease add: -radiotherapy
-radiotherapy
Metastatic bone disease
- secondary bone tumour 25 times commoner than primary
- bone most common site for metastasis after lung and liver
- sites - order of frequency
- vertebrae > proximal femur > pelvis > ribs > sternum > skull
