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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
Where are chondrosarcomas usually located?
Pelvis | Proximal and distal femur
26
Describe chondrosarcomas
Lytic or plastic lesion with reactive cortical thickening
27
What are the most common malignant primary bone cancers?
Osteosarcoma Chondrosarcoma Ewing's sarcoma
28
What are the most common benign bone tumours, and which is the commonest?
Osteoid osteoma Osteochondroma (most common) Enchondroma
29
Who are usually affected by osteoid osteomas?
Young people aged 5-25
30
How do osteoid osteomas present?
Pain worse at night, relieved by aspirin
31
What is an osteoid osteoma?
Central nodule of woven bone with osteoblastic rim
32
What is the appearance of osteoid osteomas on x-ray?
'Little o' on x-ray
33
Which benign bone tumour can spontaneously resolve?
Osteoid osteoma
34
What is the treatment for osteoid osteoma?
Radiofrequency ablation
35
What is an osteochondroma?
Benign lesion formed from abnormal cartilage
36
What is Hereditary Multiple Exostoses (HME)?
A genetic condition where patients have hundreds of osteochondromas Lesions can progress to chondrosarcoma
37
Who are usually affected by osteochondromas?
Adolescents, young adults
38
What can cause osteochondroma?
Idiopathic Genetic conditions (HME) Trauma
39
What is an enchondroma?
Benign intramedullary cartilage lesion
40
How do enchondromas usually present?
Asymptomatic, incidental finding
41
How are enchondromas treated if symptomatic?
Curattage and bone grafting
42
What are the most common bones to get secondary metastases?
``` Vertebra Pelvis Ribs Femurs Skull ```
43
Is surgery usually done for metastases TO bone?
Yes - as a palliative procedure
44
What is the process of analysing a bone radiograph?
``` Location/nature Neocortex Cortical involvement Zone of transition Matrix ```
45
What is a diaphysis?
The main shaft of a bone
46
What is a metaphysis?
The neck portion of a bone between the shaft (diaphysis) and the end (epiphysis)
47
What is an epiphysis?
The rounded end of a long bone
48
What is a 'sun-burst' appearance on a bone radiograph?
Looks like fine lines coming out of a bone | Feature of aggressive pathology
49
What is a Codman triangle?
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
If there is clear distinction from normal to abnormal bone, is the lesion likely to be benign or malignant?
Benign
51
What is the zone of transition?
How wide or narrow the distinction is from normal to abnormal bone
52
If it is difficult to tell where normal bone ends and abnormal bone begins, is the lesion likely to be benign or malignant?
Malignant
53
What does a 'cloud-like fluffy' appearance suggest?
Osteoblast activity | Formation of new abnormal bone
54
In what age group would you expect to find a neuroblastoma?
Around age 1
55
In what age group would you expect to find Ewing's sarcoma?
Age 1-30
56
In what age group would you expect to find an osteosarcoma?
Age 10-30
57
In what age group would you expect to find fibrosarcomas, osteosarcomas and lymphomas?
Age 30-40
58
In what age group would you expect to find metastatic carcinoma or multiple myeloma?
Age 40+
59
What are examples of lesions that are well defined?
Enchondroma Chondrosarcoma (low grade) Osteoblastoma Myeloma
60
What are examples of lesions that are ill-defined?
Ewing's sarcoma Osteosarcoma Myeloma Chondrosarcoma (high grade)
61
What are examples of lesions that are sclerotic?
``` Osteosarcoma Osteoid osteoma Osteoblastoma Enchondroma Osteoma ```
62
What are the red flags for bone tumours?
Increasing pain Persistent pain Pain worse at night Atruamatic symptoms
63
What are the radiological features of malignant lesions?
Broad zone of transition Periosteal reaction Cortical destruction

Y2 - MSK (9 decks)

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