bone and soft tissues

Question 1

what is a sarcoma

Answer 1

tumour of connective tissue
MSK tumour
malignant
spread along fascial planes and haematogenous spread to lungs
word ending eg osteosarcoma, chondrosarcoma, fibrosarcoma

Question 2

how common are bone tumours

Answer 2

benign- common
malignant-rare
secondary- very common

Question 3

benign tumours of bone

Answer 3

osteoid, osteoma, osteoblastoma (night pain and needs to be removed)

Question 4

commonest primary malignant bone tumour in older patients

Answer 4

myeloma (marrow)

Question 5

commonest primary malignant bone tumour in younger patients

Answer 5

osteosarcoma

Question 6

signs and symptoms of bone tumours

Answer 6

pain- activity related if bone weakened, progressive pain at rest and night
abnormal x rays incidental
knee more common
difficulty weight bearing
deep
pathological fracture rare

swelling-
hard, fixed, craggy
non tender to palpation
deep ache
may be painless
recurred after previous excision
rapidly growing
warmth over it
MALIGNANT

extreme pain in small osteoid osteomas

Question 7

investigations

Answer 7

x ray for bone lesions . clear margins, surrounding rim of reactive bone
MRI- study of choice
US for soft tissue
biopsy
CT- best for osteoid osteoma, staging
isotope bone scan for mestastasis

Question 8

Ewing sarcoma

Answer 8

– a form of bone and soft tissue cancer most often affecting children and young adults

Question 9

what must be done before biopsy

Answer 9

bloods
xrays of affected limb and chest
mri
bone scan
ct chest, abdo, pelvis

Question 10

treatments

Answer 10

chemo
surgery- limb salvage possible for most cases. consider involvement of neurovascular structures. if badly done biopsy then can spread tumour and make impossible to salvage
radio
MDT!

Question 11

suspicious signs in soft tissue tumour that require referral

Answer 11

deep tumours of any size
subcutaneous tumours >5cm
rapid growth, hard, craggy, non tender

Question 12

sites in order of frequency for all secondary

Answer 12

vertebrae, proximal femur, pelvis, ribs, sternum, skull

Question 13

7 most common primary cancers that metastasise to bone

Answer 13

lungs, breast, prostate, kidney, thyroid, GI tract, melanoma

Question 14

prognosis of pathological fracture

Answer 14

approx 50% of patients with pathological fractures will survive >6months and 30% >= 1year
use splintage instead of surgery if unsure

Question 15

pathological fracture prevention

Answer 15

early chemo
prophylactic internal fixation
use of bone cement
depends on mirels scoring system out of 12. based on pain, site of lesion, lesion type, size

Question 16

most common soft tissue tumour

Answer 16

lipoma

Question 17

signs of soft tissue tumours

Answer 17

painless
mass deep to deep fascia
any fixed, hard or indurated mass
any recurrent mass