Bone And Soft Tissue Tumours

Question 1

What are the important clinical features of bone and soft tissue tumours?

Answer 1

Pain
- activity related 
- progressive pain at rest and at night 
Loss of function YN
Swelling
Fracture (pathological)
Joint effusion
Deformity 
Mass
Abnormal x rays

Question 2

What are the differences between features of benign and malignant bone and soft tissue tumours?

Answer 2

Benign tumours:
- may present with activity related pain if large enough to weaken bone

Malignant primary bone tumours red flags

• increasing / unexplained / deep seated / night pain
• difficulty weight bearing
• deep swelling

Soft tissue malignant tumours red flags

• deep to deep fascia
• > 5cm subcutaneous tumour
• rapid growth, hard, craggy, non tender
• worse at might

Question 3

What investigations are used in bone and soft tissue tumours and how are they interpretations?

Answer 3

Plain x rays - used for bone lesions. Can see calcification, Myositis ossificans, phleboliths in haemangioma
Inactive lesions - clear margins, surrounding rim of reactive bone
Aggressive - less well defined zone of transition, cortical destruction

CT - assess ossification and calcification

Isotope bone scan - staging skeletal metastasis

MRI - study of choice, determines six, extent, anatomical relationships

Others include angiography, PET

Biopsy lastly

Question 4

What is the natural progression of bone and soft tissue tumours?

Answer 4

X

Question 5

What is metastatic bone disease?

Answer 5

25x more common than primary bone disease
Most common site for mets after lung and liver
Most common cancers which metastasise follows bone: lung, breast, prostate, kidney, thyroid, gi, melanoma