Bone and soft tissue tumours Flashcards
What is a saroma?
Malignant tumour that arises from connective tissues
Spread along fascial planes
Haematogenous spread to lungs
Rarely to regional lymph nodes
What is a bone tumour
Benign tumour of skeleton common
malignant tumours are rare although mets are very common especially in those over 50
What is are bone forming tumours called?
benign: osteoid osteoma, osteobalstoma
malignant: osteosarcoma
What is are cartilage forming tumours called?
Benign: enchonfroma, osteochondroma
Malignant: chondrosarcoma
What is are fibrous tissue tumours called?
Benign: fibroma
Malignant: fibrosarcoma, malignant fibrous, histiocytoma
What is are vascular tissue tumours called?
benign: heamangioma, aneurysmal bone cyst
Malignant: angiosarcoma
What is are adipose tumours called?
Benign: lipoma
Malignant: liposarcoma
What is are marrow tissue tumours called?
malignant: ewing’s sarcoma, lymphoma, myeloma
What is are tumour like lesions called?
benign: simple bone cycst, fibrous cortical defect
Describe how other tumours present
are locally destructive and rarely mestastasise, giant cell tumours
How do bone tumours typically present?
Pain Mass Abnormal x-rays incidental bone tumours- PAIN
How do bone tumours present
Actively related if large enough to weaken bone
Progressive and pain at rest and night
What examinations can be used to look at bone tumours
general health Measurements of mass location shape consistency mobility tenderness local temerature neuro-vascular deficits
What do x-rays show when looking at bone tumours
Clear margins, surroundign rim of bone
cortical expansion can occur with benign lesions
less well defined zones of transition between lesions adn normal bone
cortical destruction
Periosteal reactive new bone growth occurs when the lesion destroys the cortex
Codman’s triangle, onion skinning or sunburst pattern
How can CT’s be used in bone tumours?
Assess ossification and calcification
Integrity of the cortex
best for assessing nidus in osteoid ostemoa
Staging- primarily of lungs
How can isotope bone scan be used for bone tumours
Staging for skeltal metastasis
Multiple lesions- osteochondroma, enchondrome, fibrous dysplasia and histiocytosis
Frequently negative in myeloma
Benign also demonstrate increased uptake
How can MRI be used for looking at bone tumours
Study of choice
Size, extend, anatomical relationships, accurate for limits of disease both within adn outside bone
Specific for lipomas, heamangiomas,heamatomas or OVNS, non specific for benign vs malignant
What other investigations can be carried out to look at bone tumours
Angiogrpahy- superseeded by MRI
Pseudoaneurysms, A-V malformations
PET- may be useful ofr investigating response to chemo
What must be done before a biopsy
The ful lowrks bloods, x ray of affected limb and chest MRI of lesion Bone scan CT chest, abdo, pelvis
What are the cardinal features of malignant bone tumours
Increasing pain Unexplained pain Deep seated bori g antue Night pain Difficulty weight brearing Deep swelling
What are the clinical features of bone tumours
Pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasm
How does pain sepcifically present in bone tumours?
cardinal feature increasing pain- impending fracture analgesics eventually ineffective not related to exercise deep boring ache, worse at night
How does loss of function specifically present in bone tumours?
limp
reduced joint movement
stiff back
How does swelling specifically present in bone tumours?
Generally diffuse in malignancy
Generally near end of long bone
Once reaching noticeable size, enlargement mat be rapid
Warmth over swelling and venous congestion
Pressure effects e.g. intrapelvic
How does a patholgical fracture sepcifically present in bone tumours?
minimal truama
pain prior to fracture
How does MR scan sepcifically present in bone tumours?
very good for showing intraosseous extent of tumour
Extraosseous soft tissue extent of tumour
Joint involvement
Skip metastases
Epiphyseal extension
Determines resection margins
How is treatment of bone tumours carries out
Aim is to be free of disease Chemo Surgery Radiotherapy Team effort
What is involved in surgery
Limb salvage possible for most cases
Consider involvement of neurovascular structures
Pathological fractures
Why are cartilage tumours difficult?
Benign but aggressive
What is suspicious signs of a soft tissue tumour?
deep tumours of any size
Subcutaneous growth>5cm
Rapid growthm hard, craggy, non-tender
anyone with these signs should be referred
What is suspicious swelling?
Rapidly growing
Hard, fixed craggy surface, indistinct margins
Non-tender to palpation but associated with deep ache, worse at night
May be painless
recurs after excision
What is metastatic bone disease?
Secondary bone tumours are 25 times more common than primary ones
Most common site fo secondary after lung and liver
What are the 7 most common cancers that metastasise to bone
LUNG-smokers, CXR, sputum cytology BREAST- examine PROSTATE- PSA KIDNEY- US THYROID- examine GI TRACT-FOB, barium studies, endocscopy MELANOMA- examine
How do you prevent a pathological fracture
What is survival like after a pathological fracture
Early chemotherapy
Pophylactic internal fixation- lytic lesion and increasing pain and/or 2.5cm diameter or 50% destruction. Better with Mirel’s scoring system
depends on the tumour
What surgical prevention of fractures can be carried out
Embolisation especially renal,thyroid, wait 48hours before surgery.
Only one long bone at a time
Aim for early painless weight bearing and mobilisation
Fracture of non weight bone can be treated conservatiely but re fracture frequently
What are some key points regarding metastatic bone disease?
Prognosis is steadily improving
Never assume a solid lytic lesion is a metastasis
Fractures rarely unite even if stabilised
prophylactic fixation is less traumatic for patient
Never rush to fix a pathological fracture
Decompress and stabilise spinal metastases
Constructs should allow for immediate weightbearing and aim to last the patients lifetime
Describe a soft tissue tumour
Painless Mass deep to fascia Any mass >5cm Any fixed hard or indurated mass Any recurring mass Imaging studies conducted with an MRI
