Bone and Soft Tissue tumours Flashcards
What is sarcoma?
Malignant tumours arising from connective tissues.
They spread along fascial planes and if haematogenous then spread to lungs or lymph nodes.
What are some examples of benign bone forming tumours ?
Osteoid osteoma
Osteoblastoma
What are some examples of malignant bone forming tumours?
Osteosarcoma
What are some examples of benign cartilage forming tumours?
Enchondroma
Osteochondroma
What are some examples of malignant cartilage forming tumours?
Chondrosarcoma
What are some examples of benign fibrous tissue tumours?
Fibroma
What are some examples of malignant fibrous tissue tumours?
Fibrosarcoma, malignant fibrous histiocytoma.
What are some examples of vascular tissue tumours?
Benign - haemangioma, aneurysmal bone cyst
Malignant - angiosarcoma
What are some examples of adipose tissue tumours?
Benign - lipoma
Malignant - liposarcoma
What are some examples of marrow tissue tumours?
Ewing’s sarcoma, lymphoma and myeloma.
What are some suspicious signs of soft tissue tumours?
Deep tumours of any size Subcutaneous tumours >5cm Rapid growth Hard, craggy or non-tender tumours. Indistinct margins Recurred after previous excision.
What sort of pain is experienced in Bone tumours?
Activity related pain
Progressive pain at rest and nighttime.
What investigations would you carry out for bone lesions?
Plain X-ray (most useful)
CT
Isotope bone scan
MRI
What may you see on an x-ray of an inactive bone lesion?
Clear margins
Surrounding rim of reactive bone
Cortical expansion can occur with aggressive benign lesions.
What may you see on an x-ray of an aggressive bone lesion?
Less well defined zone of transition between lesions and normal bone.
Cortical destruction
Periosteal reactive new bone growth occurs when lesion destroys cortex.
Codma’s triangle, onion-skinning or sunburst pattern.
What is needed before a biopsy is taken?
Bloods X-rays of affected limb and Chest MRI of lesion Bone scan CT chest, abdo and pelvis.
What are the cardinal features of malignant primary bone tumours?
Increasing pain Unexplained pain Deep-seated boring nature Night pain Difficulty weight bearing Deep swelling
What are the clinical features of Osteosarcoma?
Pain Loss of function Swelling Pathological fracture Joint effusion Deformity Neurovascular effects Systemic effects of neoplasia
What features of swelling would you notice in someone with osteosarcoma?
Generally diffuse in malignancy
Near end of long bone
Enlargement may be rapid if tumour is reaching a noteable size.
Warmth over swelling and venous congestion.
Pressure affects.
What sites within bone are common for secondary metastatic bone disease?
Vertebrae Proximal femur Pelvis Ribs Sternum Skull
What are some common primary cancer that’s metastasise to bone?
Lung Breast Prostate Kidney Thyroid GI tract Melanoma
How are pathological fractures prevented?
Early chemo/DXT
Prophylactic internal fixation with potential use of bone cement.
Embolisation
What is used to assess fracture risk?
Mirel’s scoring system
Score 1 = upper limb, mild pain, plastic lesion, <1/3 in size.
Score 2 = lower limb, moderate pain, mixed lesion, 1/3-2/3 in size.
Score 3 = peritrochanter, functional pain, lytic lesion, >2/3 size.
Maximum score is 12. If >8 then prophylactic fixation is recommended prior to radiotherapy.
What is required if surgery is indicated for spinal metastases?
Decompression and stabilisation.
