Bone Cancer Flashcards
Describe the epidemiology of bone cancer
- Bi-modal age distribution
- Main peak 70-74 Yrs
- Second peak 19 Yrs
What aetiological factors are associated with bone cancer?
- Age
- RT as a child
- Paget’s disease
- Ollier’s disease
- Genetics (Li Fraumeni syndrome,…)
- Exposure to radiation
What signs and symptoms are associated with bone cancer?
- Pain & swelling in/around affected bone
- Weakened bone - potential for pathological fracture
- Noticeable lump over a bone
- Area hot and red
- Associated fever
- Weight loss
- Persistent bone pain/night pain
- Metastatic symptoms according to area
What investigations are used to diagnose bone cancer?
- X-ray [show areas of bone destruction/new bone development]
- MRI [method of choice]
- CT
- Istope bone scan [metastases]
- Biopsy
What are the main types of bone cancer?
- Osteosarcoma
- Ewing’s sarcoma
- Chondrosarcoma
- Spindle cell sarcoma
- Chordoma
- Giant-cell tumour osteoclastoma
Describe the route of spread of bone cancer
- Local spread within bone of origin
- Soft tissues surrounding bone
- Blood bourne mets to lungs or other bones
- [Lymph node involvement uncommon]
How are bone cancers staged?
TNM system
T part is divided into smaller subgroups
* appendicular
* spine
* pelvis
What are the main characteristics of osteosarcoma?
- Most common primary bone tumour
- Osteoid matrix
- Most common type for teenagers & YAs
What are the main characteristics of Ewing’s Sarcoma?
- Most common in children & YAs
- Arises from medullary cavity
- Extraossous presentation
- On X-rays ‘moth-eaten’ appearance
- Lucent legions in shaft of long bones
What are the main treatment options for bone cancer?
- Chemo
- Surgery
- RT
- Immunotherapy
Surgery is option of choice
Dicuss the types of surgery for bone cancer
- All patients should undergo definitive resection of their sarcoma
- Limb sparing surgery treatment of choice over amputation - tumour resected with large margin of normal tissue. Metal framwork pins segments together
Discuss the indications for RT for primary bone tumours
- Patients with primary bone lymphoma
- Paients with inoperable tumours
- Poor performance status/decline surgery
- Metastatic disease
- Residual disease/postive margins post surgery
- Considered for Ewing’s patients who have poor response to chemo
How many phases is RT usually delivered in for primary bone cancer?
2
What dose and fractionation are standard for osteosarcoma, fibrosarcoma, and chondrosarcoma?
Energy: 6-10 MV photons
VMAT technique
Phase 1:
* 50 Gy 25# 5 weeks
Phase 2:
* 10 Gy 5# 1 week
Describe the indications of RT of Ewing’s Sarcoma
Wide surgical margins & good response to chemo
* no RT
Wide margins & poor response
* 45 Gy 5 weeks [phase 1]
* 54 Gy 6 weeks [phase 2]
Surgery not possible
* 54-60 Gy 6 weeks
