Bone and Soft Tissue Tumours

Question 1

What is a sarcoma?

Answer 1

A malignant tumour of connective tissue

Question 2

How can sarcoma spread?

Answer 2

Fascial planes
Haematogeous spread to lungs
Rarely to regional lymph nodes

Question 3

Is it more common for a bone primary tumour to be benign or malignant?

Answer 3

Benign

Question 4

How are malignancies of bone likely to come about in over 50s?

Answer 4

Metastatic spread

Question 5

What are examples of benign bone tumours?

Answer 5

Osteoid osteoma, osteoblastoma

Question 6

What are examples of benign cartilage tumours?

Answer 6

Enchondroma

Osteochondroma

Question 7

What is a malignant bone tumour called?

Answer 7

Osteosarcoma

Question 8

What a malignant cartilage tumour called?

Answer 8

Chondrosarcoma

Question 9

What is a benign fibrous tissue tumour called?

Answer 9

Fibroma

Question 10

What are examples of malignant fibrous tissue tumours?

Answer 10

Fibrosarcoma

Malignant fibrous histiocytoma

Question 11

What are examples of benign vascular tissue tumours?

Answer 11

Haemangioma

Aneurysmal bone cyst

Question 12

What is a malignant vascular tissue tumour called?

Answer 12

Angiosarcoma

Question 13

What is a benign adipose tissue tumour called?

Answer 13

Lipoma

Question 14

What is a malignant adipose tissue tumour called?

Answer 14

Liposarcoma

Question 15

What are examples of malignant marrow tissue tumours?

Answer 15

Ewing’s sarcoma
Lymphoma
Myeloma

Question 16

What is the main symptom of a primary bone symptom?

Answer 16

PAIN

Question 17

What are features of pain in bone tumours?

Answer 17

Activity related

Progressive pain at rest and at night

Question 18

What should be done when examining a tumour?

Answer 18

General health of patient
Measurement of mass
Location of tumour
Shape of tumour
Consistency
Mobility
Tenderness
Local temperature
Neuro-vascular deficits

Question 19

What investigations can be done for tumours?

Answer 19

X-rays
Calcifications
Myositis ossificans
Phleboliths in haemangioma

Question 20

What is isotope bone scan used for?

Answer 20

Staging for skeletal metastasis

Question 21

What are multiple lesions on an isotope bone scan a sign of?

Answer 21

Osteochondroma
Enchondroma
Fibrous dysplasia
Histiocytosis

Question 22

What is MRI specific for?

Answer 22

Lipoma
Haemangioma
Haematoma
Pigmented VilloNodular Synovitis

Question 23

What are cardinal features of malignant primary bone tumours?

Answer 23

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

Question 24

What are clinical features of osteosarcoma?

Answer 24

Pain
Loss of function
Swelling
Pathological fracture
Joint effusion
Deformity
Neurovascular effects
Systemic effects of neoplasia

Question 25

What loss of function is a result of osteosarcoma?

Answer 25

Limp Reduced joint movement Stiff back

Question 26

How is Ewing's sarcoma treated?

Answer 26

Chemotherapy Surgery Radiotherapy

Question 27

What should you do with patient's with a suspected malignant soft tissue tumour?

Answer 27

Refer to specialist tumour centre

Question 28

What are signs that would make you suspicious of a soft tissue tumour being malignant?

Answer 28

``` Deep to fascia Subctuaneous tumours >5cm Rapid growth Hard Craggy Non-tender ```

Question 29

7 commonest primary cancers metastasising to bone?

Answer 29

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

Question 30

What scoring system is used to assess fracture risk assessment?

Answer 30

Mirel's scoring system

Question 31

How is the site scored in Mirel's scoring system?

Answer 31

Upper limb - 1 Lower limb - 2 Peritrochanter - 3

Question 32

How is pain scored in Mirel's scoring system?

Answer 32

Mild - 1 Moderate - 2 Functional - 3

Question 33

How is lesion scored in Mirel's scoring system?

Answer 33

Blastic - 1 Mixed - 2 Lytic - 3

Question 34

What is scored in Mirel's scoring system?

Answer 34

Site Pain Lesion Size

Question 35

What score in Mirel's scoring system is indicative of prophylactic fixation before radiotherapy?

Answer 35

8 or more