bone and soft tissue tumours Flashcards
what are sarcomas ?
malignant tumours arising from connective tissues
spread along fascial planes
haematogenous spread to lungs
rarely to regional lymph nodes
what are benign bone-forming tumours ?
osteoid osteoma
osteoblastoma
what are malignant bone-forming tumours ?
osteosarcoma
what are benign cartilage-forming tumours ?
enchondroma
osteochondroma
what are malignant cartilage-forming tumours ?
chondrosarcoma
what are benign fibrous tissue tumours ?
fibroma
what are malignant fibrous tissue tumours ?
fibrosarcoma
malignant fibrous histiocytoma
what are benign vascular tissue tumours ?
haemangioma
aneurysmal bone cyst
what are malignant vascular tissue tumours ?
angiosarcoma
what are benign adipose tumours ?
lipoma
what are malignant adipose tissue tumours ?
liposarcoma
what are malignant marrow tissue tumours ?
Ewing’s sarcoma
lymphoma
myeloma
what are suspicious signs of a soft tissue tumour ?
deep - deep to fascia of any size
subcutaneous tumours >5cm
rapid growth, hard, craggy, non-tender
what features of swelling should you beware of ?
rapidly growing
hard, fixed, craggy, indistinct margin
non-tender, but deep ache at night
recurred after excision
what is the most common primary malignant bone tumour in young people ?
osteosarcoma
what is the most common primary malignant ‘bone’ tumour in old people ?
myeloma
what is the clinical presentation of a bone tumour ?
pain - activity related, progressive at rest and night
mass
abnormal xray
what xray findings are suggestive of specific diseases ?
calcification - synovial sarcoma
myositis ossificans
phleboliths in haemangioma
what xray signs suggest inactive tumour ?
clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive lesions
what xray features suggest aggressive tumour ?
less well defined margins
cortical destruction
periosteal reactive new bone growth occurs when the lesion destroys the cortex
onion skinning
what conditions can you see multiple lesions on an isotope bone scan ?
osteochondroma
enchondroma
fibrous dysplasia
histiocytosis
what are cardinal features of malignant primary bones tumours ?
increasing pain unexplained pain deep-seating boring nature night pain difficulty weight bearing deep swelling
what are clinical features of an osteosarcoma ?
pain - cardinal, worse at night loss of function- limp, reduced ROM, stiff back swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia
what is the investigation for osteosarcoma ?
MRI
bone scan
xray
how do you treat Ewing’s sarcoma ?
chemo
surgery
radiotherapy
what are the 7 most common cancers which metastasise to bone ?
lung breast - commonest prostate kidney thyroid GI melanoma
what is the survival rate for patients with pathological fractures ?
50% survive >6months
30% survive >1year
how do you prevent pathological fracture ?
early chemo
prophylactic internal fixation
bone cement
what is the scoring system for fracture risk and what are the variables ?
Mirel’s scoring
site
pain
lesion
size
what are score 1 options on fracture risk assessment ?
upper limb
mild pain
blastic lesion
<1/3rd
what are score 2 options on fracture risk assessment ?
lower limb
moderate pain
mixed lesion
1/3-2/3rd
what are score 3 options on fracture risk assessment ?
peritrochanter
functional pain
lytic lesion
>2/3rd
