Bone Cancer Flashcards
What are types of primary bone malignancies?
- Osteosarcoma- most common
- Ewing’s sarcoma
- Chondrosarcoma
Who gets osteosarcoma?
- Mainly children and adolescents
Where does osteosarcoma occur?
- Metaphyseal region of long bones prior to epiphyseal closure
- 40% occuring in femur
- 20% in tibia
- 10% in humerus
Xray findings in osteosarcoma?
- Codman triangle (from periosteal elevation)
- Sunburst pattern
What genes are associated with osteosarcoma?
- Mutation of Rb gene significantly increases the risk of osteosarcoma
- Hence association with retinoblastoma
What other predisposing factors are there for osteosarcoma?
- Paget’s disease of the bone
- radiotherapy
Presentation of osteosarcoma?
- Bone pain- particularly at night
- mass or swelling
- restricted movement in joint
may be mistaken for growing pains in kids
Presentation of osteosarcoma?
- Bone pain- particularly at night
- mass or swelling
- restricted movement in joint
may be mistaken for growing pains in kids
Ddx for osteosarcoma?
- Growing pains
- Septic arthritis
- Gout
- Ewings sarcoma
Where do sarcomas metastise to?
- lungs
Investigations of osteosarcoma?
- X-ray of the bone/ joint
- CT thorax as it most likely metastises to the lungs
- Biopsy
Management of osteosarcoma?
- Surgery-removing tumour or limb sparing or partial or full amputation
- Chemotherapy- neoadjuvant in the pelvis, may have adjuvant after
- Immunotherapy e.g. mifamurtide (MEPACT) in children and adolescents and help reduce chance of tumour coming back
- Radiotherapy- not often used
What is the histology of Ewing’s sarcoma?
- Small round blue cell tumour
Who gets Ewing’s sarcoma?
- children and adolescents
Where does Ewing’s sarcoma affect?
- pelvis and long bones
- tends to cause severe pain
What gene mutation is Ewings sarcoma associated with?
- t(11;22) translocation which results in EWS- FLI1 gene product
What does the xray show in ewing’s sarcoma?
- onion skin appearance
What is chondrosarcoma?
- Malignant tumour of cartilage
Where does chondrosarcoma affect?
axial skeleton
Symptoms of Ewings sarcoma?
- pain in affected bones that gets progressively worse
- swelling and tenderness
- may have a fever
- severe tiredness adn weight loss
Investigations of Ewings sarcoma?
- Bloods- FBC: anaemia and raised WCC and ESR: raised
- xray
- MRI/CT or PET
- Bone scan
- Bone biopsy
Who gets chondrosarcoma?
Older pts
>40
How does chondrosarcoma present?
- large mass on the affected bone
- feeling of pressure around the mass
- pain that increases over time
- pain that is worse at night + relieved by NSAIDS
- Local swelling
How does chondrosarcoma present?
- large mass on the affected bone
- feeling of pressure around the mass
- pain that increases over time
- pain that is worse at night + relieved by NSAIDS
- Local swelling
Treatment of Ewings sarcoma?
- Surgery
- Chem
- Radiotherapy
- Amputation + prosthetic
- Resection of mets
- Rehab
RF for chondrosarcoma?
- Enchondromas. A type of benign bone tumor that begins from cartilage and usually affects the hands (can also affect other areas).
- Multiple exostoses (osteochondromas). The presence of multiple osteochondromas (an overgrowth of cartilage and bone near the end of the growth plate).
- Ollier disease. A cluster of enchondromas (benign cartilage tumors that usually affect the hands).
- Maffucci syndrome. A combination of multiple enchondromas (benign cartilage tumors that usually affect the hands) angiomas (benign tumors made up of blood vessels).
