Bone and Soft Tissue Tumours Flashcards
What are the two different categories of tumours?
- Benign
- Malignant
- Primary
- Secondary
What is a sarcoma?
Is malignant tumour arising from connective tissues
How do sarcomas spread?
- Spreads along fascial planes
- Haematogenous spread to lungs
- Rarely to regional lymph nodes
For bone tumours, which of benign and malignant is more common?
Benign are common, malignant are rare
Are bone secondaries common or rare?
Bony secondary’s are very common, if bony tumour patient is >50 years likely to be metastatic
What are benign and malignant bone forming tumours?
- Benign
- Osteoid osteoma, osteoblastoma
- Malignant
- Osteosarcoma
What are benign and malignant cartilage forming tumours?
benign: enchondroma, osteochondroma
malignant: chondrosarcoma
What are benign and malignant fibrous tissue tumours?
benign: fibroma
malignant: fibrosarcoma, malignant fibrous histiocytoma
What are benign and malignant vascular tissue tumours?
- Benign
- Haemangioma, aneurysmal bone cyst
- Malignant
- Angiosarcoma
What are benign and malignant adipose tissue tumours?
benign: lipoma
malignant: liposarcoma
What are bone marrow tumours?
- Malignant
- Ewing’s sarcoma, lymphoma, myeloma
What does GCT stand for?
Giant cell tumours
Are giant cell tumours (GCT) benign or malignant?
- benign
- locally destructive and can rarely metastasis
What are some examples of tumour like lesions?
- Benign
- Simple bone cyst
- Fibrous cortical defect
What are the most common malignant bone tumours in younger and older patients?
- Osteosarcoma in younger patient
- Myeloma in older patient
What is a common history of tumours?
- Pain
- Mass
- Abnormal x-rays (usually incidental)
Describe the pain due to bone tumours?
- activity related
- progressive pain at rest and night
How do benign bone tumours often present?
- May present with activity related pain if large enough to weaken bone
- Example is osteoid osteoma
What parts of examination are important for bone tumours?
- General health
- measurements of mass
- location
- shape
- consistency
- mobility
- tenderness
- local temperature
- neuro-vascular deficits
What investigations are done for tumours?
- plain x-rays (most useful for bone lesions)
- CT
- isotope bone scan
- MRI
- angiography
- PET
- biopsy
What kind of tumours are plain x-rays most useful for?
Bone tumours
How do inactive and aggresive tumours differ on plain x-rays?
inactive
- clear margins
- surrounding rim of reactive bone
- cortical expansion can occur with aggressive benign lesions
aggressive
- less well defined zone of transition between lesion and normal bone
- cortical destruction is an indicator of malignancy
What is CT useful for for bone tumours?
- Assessing ossification and calcification
- Integrity of cortex
- Staging
What imaging technique is used to stage skeletal metastasis?
Isotope bone scan
What are MRIs useful for?
Size, extent, anatomical relationship
Isotope bone scans are specific for what tumours?
- Specific for osteochondroma, enchondroma, fibrous dysplasia and histiocytosis
MRI are specific for what tumours?
Specific for lipoma, haemangioma, haematoma or PVNS
What is angiography useful for?
Embolism of vascular tumours
What are PET scans useful for?
investigating response to chemotherapy
What is done to define a tumour (as benign or malignant)?
- Biopsy
- Is how tumour is defined (what kind of tumour)
- Before biopsy, bloods and x-ray, maybe MRI of lesion, bone scan and CT of chest
What is the presentation of malignant primary bone tumours?
- Cardinal features
- Increasing pain
- unexplained pain
- Deep-seated boring nature
- Night pain
- Difficulty weight-bearing
- Deep swelling
What are some examples of malignant primary bone tumours?
- Osteosarcoma
- Ewings sarcoma
- Chondrosarcoma
Does osteosarcoma affect more males or females?
Males
What are the clinical features of osteosarcoma?
- Pain
- Cardinal feature
- Analgesics eventually ineffective
- Not related to exercise
- Character – deep boring ache, worse at night
- loss of function
- Limp
- Reduced joint movement
- Stiff back
- Swelling
- pathological fracture
- joint effusion
- deformity
- neurovascular effects
- systemic effects of neoplasia
What investigation should be done for osteosarcoma?
- MR scan
- Investigation of choice
- Very good for showing
- intraosseous (intramedullary) extent of tumour
- extraosseous soft tissue extent of tumour
- joint involvement
- skip metastases
- epiphyseal extension
- Determines resection margins
What is the treatment of osteosarcoma?
- Chemotherapy
- Surgery
- Limb salvage usually possible
- Consider involvement of neurovascular structures
- Radiotherapy
Is primary or metastatic bone disease more common?
Metastatic bone tumours 25x more common than primary:
- Most common site for secondary’s after lung and liver
What area of the body most commonly metastasises to bone?
Breast
What site of the skeleton is most common for secondary tumours in order of 1 to 6?
- Vertebrae
- Proximal femur
- Pelvis
- Ribs
- Sternum
- Skull
What are the 7 most common primary timours that metastasis to bone in order?
- LUNG - smoker; CXR, sputum cytology
- BREAST - commonest; examine!
- PROSTATE - osteosclerotic 2°; PR, PSA
- KIDNEY - solitary, vascular; IVP + US, angiography & embolise
- THYROID - esp. follicular Ca; examine
- GI TRACT - FOB, endoscopy, Ba studies, markers
- MELANOMA - examine!
What is a pathological fracture?
Bone fracture that is caused by disease
How are pathological fractures prevented?
- Early chemotherapy
- Prophylactic internal fixation
What scoring system is used to assess risk of pathological fractures?
Mirel’s scoring system
Describe Mirel’s scoring system?
Max score is 12, lesion score of 8 or above then prophylactic action is recommended
Assesses: site, pain, lesion, size
Describe the character of pain due to bone cancer?
- Persistent
- Increasing
- Non-mechanical/rest
- Nocturnal
What is the most common soft tissue tumour?
Lipoma is most common soft tissue tumour
As the size of tumour increases, is it more likely to be sarcoma or liposarcoma?
Sarcoma
Describe the clinical features of soft tissue tumours?
Painless
When should you be suspicious of malignancy for soft tissue tumours?
- Deep to deep fascia
- More than 5cm
- Fixed, hard or indurated mass
- Any recurrent mass
What is the imaging study of choice for soft tissue tumours?
MRI
