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Y2 - MSK > Bone Cancer > Flashcards

Bone Cancer Flashcards

1
Q

What does the prefix ‘sarco’ mean?

A

Soft tissue

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2
Q

What are the 3 types of bone tumour?

A

Bone-forming
Cartilage-forming
Others

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3
Q

Describe bone-forming tumours?

A

Ones that create additional structures or lucency within the medulla

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4
Q

What are examples of bone-forming tumours?

A

Osteoma
Osteoid osteoma and osteoblastoma
Osteosarcoma

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5
Q

What are examples of cartilage-forming bone tumours?

A

Chondroma (enchondroma)
Osteochondroma
Chondrosarcoma

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6
Q

What are example of other (not bone or cartilage forming) bone tumours?

A

Ewing’s sarcoma

Giant cell tumour

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7
Q

What is the commonest cancer affecting bone?

A

Metastatic bone cancer

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8
Q

What are the commonest sites that metastasise to bone?

A 
Breast
Lungs
Thyroid
Kidney
Prostate
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9
Q

What is the commonest primary cancer affecting the bones?

A

Multiple myeloma (doesn’t affect just bone)

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10
Q

What is the commonest primary bone cancer?

A

Osteosarcoma

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11
Q

What are risk factors for primary bone cancer?

A 
Previous radiotherapy
Predisposing conditions (Paget's, fibrous dysplasia, multiple enchondroma)
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12
Q

How does bone cancer present?

A 
Persistent, increasing pain
Pain is well localised
Pain is not usually associated with movement
Pain is worse at night
Atraumatic
Swelling and erythema over joint
Palpable mass
Pathological fracture
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13
Q

What investigations are done in suspected bone cancer?

A

Plain radiographs (AP and lateral)
CT
MRI
Bone scan

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14
Q

What is the problem with x-rays in bone cancer?

A

May not show up in radiograph until >50% loss of cortical bone so no signs on x-ray doesn’t rule it out

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15
Q

What are the treatment options in bone cancer?

A

Neoadjuvant chemotherapy, radiotherapy, hormone therapy
Surgery (reconstruction/amputation)
Adjuvant (chemo/radiotherapy)

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16
Q

Who are often affected by osteosarcomas?

A

Children and young adults

2nd peak in elderly patients with Paget’s

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17
Q

Where are osteosarcomas usually located?

A

Around distal femur, proximal tibia

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18
Q

How common are metastases in osteosarcoma?

A

10-20% present with metastases

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19
Q

What is the treatment for osteosarcoma?

A

Chemotherapy and limb salvage

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20
Q

Who are usually affected by Ewing’s sarcomas?

A

Young people 5-25 years of age

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21
Q

Where are Ewing’s sarcomas usually located?

A

Diaphysis (shaft) of long bones, usually around distal femur, proximal tibia

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22
Q

What is the treatment for Ewing’s sarcoma?

A

Chemotherapy with limb salvage

Can have adjuvant radiation

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23
Q

What benign tumours can (rarely) give rise to chondrosarcoma?

A

Enchondroma

Osteochondroma

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24
Q

Who are usually affected by chondrosarcomas?

A

Older patients 40-75 years

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25
Q

Where are chondrosarcomas usually located?

A

Pelvis

Proximal and distal femur

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26
Q

Describe chondrosarcomas

A

Lytic or plastic lesion with reactive cortical thickening

27
Q

What are the most common malignant primary bone cancers?

A

Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma

28
Q

What are the most common benign bone tumours, and which is the commonest?

A

Osteoid osteoma
Osteochondroma (most common)
Enchondroma

29
Q

Who are usually affected by osteoid osteomas?

A

Young people aged 5-25

30
Q

How do osteoid osteomas present?

A

Pain worse at night, relieved by aspirin

31
Q

What is an osteoid osteoma?

A

Central nodule of woven bone with osteoblastic rim

32
Q

What is the appearance of osteoid osteomas on x-ray?

A

‘Little o’ on x-ray

33
Q

Which benign bone tumour can spontaneously resolve?

A

Osteoid osteoma

34
Q

What is the treatment for osteoid osteoma?

A

Radiofrequency ablation

35
Q

What is an osteochondroma?

A

Benign lesion formed from abnormal cartilage

36
Q

What is Hereditary Multiple Exostoses (HME)?

A

A genetic condition where patients have hundreds of osteochondromas
Lesions can progress to chondrosarcoma

37
Q

Who are usually affected by osteochondromas?

A

Adolescents, young adults

38
Q

What can cause osteochondroma?

A

Idiopathic
Genetic conditions (HME)
Trauma

39
Q

What is an enchondroma?

A

Benign intramedullary cartilage lesion

40
Q

How do enchondromas usually present?

A

Asymptomatic, incidental finding

41
Q

How are enchondromas treated if symptomatic?

A

Curattage and bone grafting

42
Q

What are the most common bones to get secondary metastases?

A 
Vertebra
Pelvis
Ribs
Femurs
Skull
43
Q

Is surgery usually done for metastases TO bone?

A

Yes - as a palliative procedure

44
Q

What is the process of analysing a bone radiograph?

A 
Location/nature
Neocortex
Cortical involvement
Zone of transition
Matrix
45
Q

What is a diaphysis?

A

The main shaft of a bone

46
Q

What is a metaphysis?

A

The neck portion of a bone between the shaft (diaphysis) and the end (epiphysis)

47
Q

What is an epiphysis?

A

The rounded end of a long bone

48
Q

What is a ‘sun-burst’ appearance on a bone radiograph?

A

Looks like fine lines coming out of a bone

Feature of aggressive pathology

49
Q

What is a Codman triangle?

A

A lesion has causes the periosteum to lift off the bone, which has then been filled in with new bone formation
Aggressive feature but takes longer to form - slower growing

50
Q

If there is clear distinction from normal to abnormal bone, is the lesion likely to be benign or malignant?

A

Benign

51
Q

What is the zone of transition?

A

How wide or narrow the distinction is from normal to abnormal bone

52
Q

If it is difficult to tell where normal bone ends and abnormal bone begins, is the lesion likely to be benign or malignant?

A

Malignant

53
Q

What does a ‘cloud-like fluffy’ appearance suggest?

A

Osteoblast activity

Formation of new abnormal bone

54
Q

In what age group would you expect to find a neuroblastoma?

A

Around age 1

55
Q

In what age group would you expect to find Ewing’s sarcoma?

A

Age 1-30

56
Q

In what age group would you expect to find an osteosarcoma?

A

Age 10-30

57
Q

In what age group would you expect to find fibrosarcomas, osteosarcomas and lymphomas?

A

Age 30-40

58
Q

In what age group would you expect to find metastatic carcinoma or multiple myeloma?

A

Age 40+

59
Q

What are examples of lesions that are well defined?

A

Enchondroma
Chondrosarcoma (low grade)
Osteoblastoma
Myeloma

60
Q

What are examples of lesions that are ill-defined?

A

Ewing’s sarcoma
Osteosarcoma
Myeloma
Chondrosarcoma (high grade)

61
Q

What are examples of lesions that are sclerotic?

A 
Osteosarcoma
Osteoid osteoma
Osteoblastoma
Enchondroma
Osteoma
62
Q

What are the red flags for bone tumours?

A

Increasing pain
Persistent pain
Pain worse at night
Atruamatic symptoms

63
Q

What are the radiological features of malignant lesions?

A

Broad zone of transition
Periosteal reaction
Cortical destruction

Y2 - MSK (9 decks)

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