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Bone and Soft Tissue tumours > Bone and soft tissue tumours > Flashcards

Bone and soft tissue tumours Flashcards

1
Q

What is sarcoma?

A

Malignant bone tumour

Malignant soft tissue tumour

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2
Q

Bone tumour

A

Benign (very common)
Malignant
-Primary (<30yo) : Osteosarcoma ( around knees)
:Ewing’s sarcoma
-Secondary (>50yo) : from Breast CA ( to vertebrae)

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3
Q

Commonest primary bone malignancy in younger pts

A

Osteosarcoma

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4
Q

Commonest primary bone malignancy in older pt

A

Myeloma

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5
Q

What is myeloma

A

Cancer of plasma cells
Plasma cells make antibodies
Abnormal plasma cells making abnormal antibodies

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6
Q

Most common soft tissue tumour you would see?

A

Lipoma ( benign adipose tissue tumour)

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7
Q

Hx: Presenting history of any tumour

A 
Pain in limbs ( weakened by benign/malignant tumour->under strees-->risk of fracture-->feel as pain)
   -Pain at night in limb/back + rest
   -ALWAYS Think of Bone tumours
Mass (if advanced stage)
Incidental abnormal XRay
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8
Q

Bone tumour always think of this sign

A

PAIN-not activity related

-getting worse at rest and night

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9
Q

Do benign bone tumours have pain?

A

Yes,if large enough to weaken the bone

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10
Q

Which benign bone tumour can cause pain?

A

Osteoid osteoma

  • is a very small tumour in end of femur/tibia
  • tense pain at night
  • Classically relieved by NSAIDs
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11
Q

PE: Physical Examination of tumour?

A

Gen health ( weight loss if cancer progresses)
Measure the mass
Location
Shape
Consistency
Mobility of mass-stuck to skin/deeper tissue?
Tenderness (not tender is malignant)
Local Temp
Neurovascular deficits( tumour can invade BV and n. –>change in power,sensation,circ.)

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12
Q

***Signs of malignant tumour (soft tissue and bone) from a swelling-IMPORTANT

A
  • Rapidly growing
  • Hard, fixed, craggy ( irregular) surface, indistinct margins (malignant!)
  • Non-tender on palpation, but assoc with deep ache, esp worse at night ( if tender is inflammatory,non-tender is malignant)
  • Beware: may be painless ( beware! esp in soft tissue sarcoma painless usually, bone sarcoma is PAINFUL)
  • Recurred after previous excision ( soft tissue sarcoma)

Be suspicious of malignant tumour until proven otherwise

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13
Q

Why do a biopsy?

A

To define what the tumour is (histology) and then decide Tx

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14
Q

What should you do before a biopsy?

A
  1. Bloods (UnE, LFT)
  2. Xray of affected limb
  3. CXR ( for metatstatic bone cancer to lungs;lung secondary cancer)
  4. MRI ( check extent)
  5. Bone scan
  6. CT chest,abdo,pelvis ( for LN metastases)
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15
Q

Types of investigation for bone tumour

A

*Plain Xray
*MRI
- can see extent of invasion, anatomical relationships eg BV ,LN,nerves,fascia
-specifically for lipoma ( no need to do other investigations
CT
-for osteoid osteoma,
-check lungs for metastases ( majority sarcoma metatstasise to lungs)
Bone scan
-Technetium 99m

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16
Q

What is myositis ossificans?

A

Ectopic bone forming within muscles
-due to head injury, blast injury
Is not a tumour

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17
Q

What can you see on Xray

A

Got fracture (pathological) due to tumour
Cortical destruction ( malognancy)
Periosteal reaction occurs when lesion destroys cortex
-new bone forms in response to injury to periosteum, is a healing process
- Sunburst pattern ( tumour bursting out of bone)
-Codman’s triangle

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18
Q

Purpose of CT

A

-assess ossification and calcification
-*check lungs for staging ( bone sarcoma often
metastasise to lungs)
-best for assessing osteoid osteoma

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19
Q

Purpose of bone scan

A
  • Staging for skeletal metastasis ( often from breast cancer)
  • benign bone tumour can show up too if got high cell turnover–>high isotope uptake
  • negative in myeloma
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20
Q

Purpose of MRI

A

The Golden Choice

  • size, extent,anatomical relationships of tumour
  • to determine resection margin

Downside: non-specific for benign or malignant

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21
Q

**Malignant primary bone tumours (Osteosarcoma, Ewing’s sarcoma) cardinal features?

A
  • ** PAIN
    - Increasing pain
    - Unexplained pain
    - Deep-seated boring nature pain ( v diff from osteoarthritis pain)
    - Night pain (diff from osteoarthritis)
  • Difficulty weight-bearing
  • Deep swelling—>always think MPBT
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22
Q

***Any bone tumour SnS

A

Pain

  • persistent
  • increasing pain
  • at rest
  • at night

Vague deep seated mass

Do Xray

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23
Q

Difference between osteosarcoma and Ewing’s sarcoma

A
  • Osteosarcoma more common than Ewing’s
  • Ewing’s responds to radiotherapy, osteosarcoma no
  • osteosarcoma is a bone-forming tumour
  • Ewing’s sarcoma is a bone marrow tumour
24
Q

Age range of osteosarcoma

A

10-30yo and predominantly Male

25
Q

Site of osteosarcoma

A

Around the knee

  • Distal femur
  • Proximal tibia
26
Q

***Clinical features of any bone tumour (benign/malignant)

A
  • PAIN ***
    - DEEP BORING ACHE WHICH GETS WORSE AT NIGHT (MALIGNANCY)
    - increasing pain–>impending fracture ( esp lower limb)
    - not related to physical activity( persistent, not mechanical pain, is boring pain)
    - beware of pt that keep coming back due to pain
  • loss of function
    - due to pain
    - reduced joint movement
    - *stiff back (esp children)
  • swelling
    - gen near end of long bones
    - once reached noticeable size, enlarges rapidly (wk on wk)
    - a lot of bloodflow so is warm
    - pressure on nearby structures
  • pathological fracture (benign / malignant)
    - minimal trauma + history weeks of pain before the fracture
    - osteoporosis most common cause rather than bone tumour

-joint effusion
if tumour is next to joint

  • deformity
  • neurovascular effects
  • systemic effects of neoplasia
    • low fever,loss of appetite,weight loss
27
Q

What treatment for bone tumours?

A

Chemotherapy ( to shrink tumour)
Surgery (to resect)
Radiotherapy ( Ewing’s can, Osteosarcoma cannot, is the distinguishing factor between the two)

28
Q

What is the goal of treatment for bone tumours

A

Make free of disease

29
Q

The commonest primary CA to metastasise to bone?

A

Breast CA

30
Q

Primary CA which metastasise to bones?

A 
Paired midline organs primary CA
     - Breast (commonest)
     - Lung
     - Prostate
     - Kidney
     - Thyroid
GI tract
Melanoma
31
Q

Most common site of metastasis

A
  1. Lung
  2. Liver
  3. Bone
32
Q

Common sites of secondary metastasis on bone

A

Vertebrae** > Prox femur>pelvis>ribs>sternum>skull

33
Q

The commonest primary CA metastasises to lungs

A

melanoma

34
Q

Secondary bone CA is more common than primary bone CA?

A

YES

35
Q

Term for :
-A fracture that happens due to diseased/weakened bone ( not injury)

-the bone breaks under very light force that normally doesn’t fracture a healthy bone?

A

Pathological fracture

36
Q

Extra: Types of pathological fracture?

A
  • Vertebral fracture
  • Fracture of neck of femur
  • Distal radius fracture(Colles’ wrist fracture/dinner fork deformity)
37
Q

Prevention of pathological fracture?

A
  • Early chemotherapy
  • Deep X ray therapy
  • Surgery:
    - Prophylactic internal fixation using Mirel’s scoring system ( score 8 or more)
    - done one long bone at a time ( risk of showering emboli during surgery)
38
Q

Aim of prophylaxis of pathological fracture ?

A

Early painless weight-bearing and mobilisation

39
Q

What is Mirel’s scoring system?

A
  • Tool useful for management of bone tumours
    - identifies patients who would benefit from prophylactic fixation if they have high enough risk (Mirel score 8 or more) of pathological fracture
    - if get score of 8 or more, prophylactic fixation is suggested prior to radiotherapy ( don’t do radiotherapy as 1st step as will fracture the bone before you can fix it)
40
Q

What is prophylactic fixation?

A

Fixation - Putting screws/wires into bone for bone surgery/ bone repair
-Prevent the (high risk of fracture ) bone from fracturing

41
Q

Survival rate of breast CA with bone metastases?

A

many years

42
Q

Survival rate of breast CA with soft tissue metastases?

A

1-2 years only

43
Q

Another criteria for prophylactic internal fixation besides Mirel’s scoring system?

A

Lytic lesion (spots of bone tissue destroyed)+ increasing pain+/- >2.5cm diameter+/- >50% cortical destruction

44
Q

Bone metastases

What is a lytic lesion?

A

Spots of bone tissue destroyed

45
Q

Bone metastases

What is a blastic lesion?

A

Filled with extra bone cells

46
Q

Treatment for pathological fracture of hip/ proximal femur?

A

Cemented hip prostheses

( not internal fixation)

47
Q

Should you rush to fix a pathological fracture?

A

No, use traction and splintage while waiting for other investigations/discussing surgical intervention

48
Q

What is required when surgery for spinal metastases?

A

Decompression of spinal cord and stabilisation–>make pt mobile

49
Q

Soft tissue tumour

If lesion<5cm, what is it?

A

Very likely to be lipoma rather than sarcoma

50
Q

Soft tissue tumour

If lesion is deep seated (below fascia) , what is it?

A

Think sarcomas

51
Q

The larger the tumour gets (>5cm), the more likely you should suspect sarcoma rather than lipoma?

A

YES man

52
Q

***Top 3 Suspicious signs of malignant soft tissue tumour?

A
  • Deep tumours of any size (deep to deep fascia)
  • Subcutaneous tumour>5cm
  • Any mass with rapid growth,hard, craggy ( irregular surface),non-tender
53
Q

What should you do if pt suspected of malignant soft tissue tumour?

A

Refer to specialist tumour centre

54
Q

***Malignant soft tissue tumour (soft tissue sarcoma) features incl the top 3 signs

A
  • painless—hence get bigger pt not worried (benign/malignant), malignant (soft tissue sarcoma) can get pain if it is large enough to impinge on nerves
  • mass deep to deep fascia (malignant)
  • any mass >5cm (malignant)
  • any fixed, hard, irregular surface mass (malignant)
  • any recurrent mass after excision (malignant)
55
Q

Imaging study of choice for soft tissue tumour

A

MRI

56
Q

Is soft tissue sarcoma or bone sarcoma or both painful?

A

Only bone sarcoma is painful

Soft tissue sarcoma usually painless , it can be painful if it is large enough to impinge on nerves

57
Q

Difference between benign soft tissue tumour (lipoma) and malignant/sarcoma soft tissue tumour (liposarcoma)?

A

Lipoma (benign soft tissue tumour) vs Liposarcoma ( malignant soft tissue tumour)

Site: everywhere thigh, retroperitoneum

Physical feature: Smooth Irregular and hard
Moveable with fingers Fixed, stuck to other tissues

Growth rate : Slow growth Rapid growth

Recurrence: Rare Common ( even after excision)

BOTH ARE usually PAINLESS (unless they get so big they impinge on nearby nerves)

Bone and Soft Tissue tumours (2 decks)

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