Bone and Soft Tissue Tumours Flashcards
What is sarcoma and how does it spread?
- Malignant tumour arising from the connective tissue
- Spreads along the fascial planes and haematogenous spread to the lungs
Which tumours form bone?
- Benign: osteoid osteoma and osteoblastoma
- Malignant: osteosarcoma
Which tumours form cartilage?
- Benign: enchondroma and osteochondroma
- Malignant: chondrosarcoma
Which tumours are fibrous tissue tumours?
- Benign: fibroma
- Malignant: fibrosarcoma an malignant histiocytoma
Name the vascular tissue tumours
- Benign: haemangioma and aneurysmal bone cyst
- Malignant: angiosarcoma
Name the adipose tissue tumours
- Benign: lipoma
- Malignant: liposarcoma
Name the marrow tissue tumours
Ewing’s sarcoma, lymphoma and myeloma (all malignant)
What are the suspicious signs of a soft tissue tumour?
- Deep tumours of any size
- Subcutaneous tumours > 5cm
- Rapid growth, hard, craggy and tender
What is the most common bony tumour in patients over 50?
Metastasis
What is the commonest primary malignant tumour in younger patients?
Osteosarcoma
What is the commonest primary malignant tumour in older patients?
Myeloma
How do bone and soft tissue tumours present?
- Pain (bony pain if bone tumour)
- Mass
- Incidental finding on XR
What is the pain like in bony tumours?
- Activity related
- Progressive pain at night and at rest
What investigations can be done?
- X-rays
- CT
- Isotope bone scan
- MRI
- Angiography
- PET
- Biopsy
- Bloods
What will an inactive tumour look like on x-ray?
- Clear margins
- Surrounding rim of reactive bone
- Corticol expansion can occur with aggressive benign lesions
What will an aggressive tumour look like on x-ray?
- Less well defined transition zone between lesion and normal bone
- Cortical destruction
- Periosteal reactive new bone growth
- Codman’s triangle, onion skinning or sunburst pattern
What are the cardinal features of malignant primary bone tumours?
- Increasing and unexplained pain
- Deep seated boring nature
- Night pain
- Difficulty weight bearing
- Deep swelling
Give three examples of malignant primary bone tumours
- Osteosarcoma
- Ewings sarcoma
- Chondrosarcoma
What are the clinical features of bone tumours?
- Pain (worse at night and unrelated to exercise)
- Loss of function (limp, reduced joint movement and stiff back)
- Swelling
- Pathological fracture
- Joint effusion
- Deformity
- Neurovascular effects
- Systemic effects of neoplasia
What investigation should be done for bone tumours?
MRI
What are the treatment options for malignant bone cancers?
- Chemo
- Surgery
- Radiotherapy
What are the common sites for metastases to go in the bone?
Vertebrae > proximal femur > pelvis > ribs > sternum > skull
Which tumours commonly metastasise to the bone?
- Lung
- Breast
- Prostate
- Kidney
- Thyroid
- GI
- Melanoma
How can pathological fractures be prevented?
- Early chemo
- Prophylactic internal fixation
- +/- use of bone cement
Which scoring system is used to assess fracture risk?
Mirel’s Scoring system
How do soft tissue tumours present?
- Painless
- Mass deep to the deep fascia
- Mass > 5cm
- Fixed, hard or indurated mass
- Any recurrent mass
How should soft tissue tumours be investigated?
MRI
