Bone and Soft Tissue Tumours

Question 1

What is a sarcoma?

Answer 1

A malignant tumour arising from connective tissue

Question 2

How do sarcomas spread?

Answer 2

Spread along fascial planes is common
Haematogenous spread to lungs most common metastasis
Some subtypes also spread to regional lymph nodes

Question 3

What is the most common type of soft tissue tumour?

Answer 3

Lipoma

Question 4

What signs should make you suspicious of a malignant tumour?

Answer 4

• Deep tumours of any size
• Subcutaneous tumours >5cm
• Rapid growth, hard/craggy mass

Question 5

When is a swelling concerning?

Answer 5

• Rapidly growing
• Hard, fixed, craggy mass
• Non-tender to palpation
• May be painless
• Recurred after previous excision

Question 6

What features of a tumour increase the likelihood of it being metastatic?

Answer 6

Risk increases:

• When the tumour is deeper
• When the tumour grade is higher
• The longer the tumour has been present

Question 7

When is radiotherapy effective?

Answer 7

Up to six months after surgery but should be started as soon as wound has healed

Question 8

What are the characteristics of giant cell tumours?

Answer 8

Histologically benign
Can metastasise
Can be highly locally destructive

Question 9

What are the different tumour-like lesions?

Answer 9

Simple bone cysts

Fibrous cortical defects

Question 10

What are the most common primary malignant bone tumours in young and old populations?

Answer 10

Most common in young patients is osteosarcoma

Most common in older patients is myeloma

Question 11

How does a bone tumour usually present?

Answer 11

Progressive pain with no abnormality on examination

Night pain will eventually develop, at which point the tumour may be palpable

Question 12

What is the first line investigation in suspected bone tumour?

Answer 12

X-ray

Question 13

What features on an x-ray indicate benign disease?

Answer 13

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

Question 14

What features on x-ray indicate malignant disease?

Answer 14

• Less well defined zone of transition between lesion and normal bone (permeative growth)
• Cortical destruction (should make you suspicious of malignancy)
• Periosteal reactive new bone growth occurs when the lesion destroys the cortex.
• Codman’s triangle, onion-skinning or sunburst pattern

Question 15

When can CT scans be helpful in bone tumours?

Answer 15

When assessing ossification and calcification
Can also give information on the integrity of the cortex
Helpful in staging of disease

Question 16

When are isotope bone scans helpful?

Answer 16

• Staging for skeletal metastasis

- Multiple lesions

Question 17

What are the disadvantages of isotope bone scans?

Answer 17

• Frequently negative in Myeloma

- Benign also demonstrate increased uptake

Question 18

What are the advantages and disadvantages of MRI?

Answer 18

Advantages:
- Size, extent, anatomical relationships
- Accurate for limits of disease both within and outside bone
- Specific for Lipoma, haemangioma, haematoma or PVNS.
Disadvantages:
- Non-specific for benign vs. malignant

Question 19

What should be done before biopsy?

Answer 19

• Bloods
• X-rays of affected limb and chest
• MRI of lesion
• Bone Scan
• CT Chest, abdo & pelvis

Question 20

What is the diagnostic investigation in both bone and soft tissue tumours?

Answer 20

Needle core biopsy

Question 21

What are the cardinal features of a malignant primary bone tumour?

Answer 21

• Increasing pain
• Unexplained pain
• Deep-seated boring nature
• Night pain
• Difficulty weight-bearing
• Deep swelling

Question 22

What are the clinical features of osteosarcoma?

Answer 22

• pain
• loss of function
• swelling
• pathological fracture
• joint effusion
• deformity
• neurovascular effects
• systemic effects of neoplasia

Question 23

What are the most common tumours that spread to the bone?

Answer 23

• Lung
• Breast
• Prostate
• Kidney
• Thyroid
• GI tract
• Melanoma

Question 24

What parts of the skeleton are most commonly affected by secondary bone metastases?

Answer 24

Vertebra
Proximal femur
Pelvis
Ribs
Sternum 
SKull

Question 25

What scoring system is used to assess risk of pathological fracture in someone with bone cancer?

Answer 25

Mirels scoring system