Bone, Cartilage and Soft Tissue Carcinoma Flashcards
Skeletal system consists of?
Bone and Cartilage
What function does bone and cartilage provide for the body?
Shape, Form and Ability to move
What structure is protected by the skeletal system?
Softer tissue
Bones are reservoirs for what?
Fats, minerals and blood cell production
What does extra-skeletal tissues provide?
Connection, Support and Locomotion
What is the most common pediatric skeletal malignancies and 2nd most common adult bone tumor?
Osteosarcomas
What is the most common adult bone tumor?
Chondrosarcoma
What is the most commonly seen bone tumor in teenagers and young adults?
Ewings Sarcoma
What are some suspected causes of bone and cartilage carcinomas?
Genetics (Suppressor genes linked to sarcomas), Higher birth weight/greater height (Correlates with osteosarcoma), Areas of prolonged growth and overstimulated metabolism
What are some conditions that cause an overstimulation of metabolic activity?
Paget’s Disease, Hyperparathyroidism and Osteomyelitis
How does paget’s disease contribute to bone and cartilage malignancies?
Disrupt old bone breakdown, which interferes with new bone formation
How does hyperparathyroidism contribute to bone and cartilage malignancies?
loss of calcium in the bone (Parathyroid regulates calcium in the blood)
How does osteomyelitis contribute to bone and cartilage malignancies?
infection of the bone or bone marrow
What are some other etiologic factors contributing to bone and cartilage malignancies?
Radiation, Exposure to occupational isotopes, Chromosome defect in Ewing’s Sarcoma
Radiation as an etiological factor can contribute to which malignancies?
Osteosarcomas, Chondrosarcomas, and Fibrosarcomas
With higher incidence occurring in children, the indicates what about these cancers?
greater occurrence in areas of rapid growth
Where are the most common sites for bone and cartilage malignancies?
Near growth plates
What is a growth plate?
Area of rapid cellular proliferation in long bones
What two structure contain the largest growth plates?
Distal Femur and Proximal Tibia
Distal Femur and Proximal Tibia are the two most common sites of _______ bone tumors.
Primary
What is the diaphysis?
Main shaft of the bone
What is the epiphysis?
knoblike portions at either ends of the bones
What is the periosteum?
hard dense covering of the bone
What are the 3 most common sites of osteosarcomas?
Distal Femur, Proximal Tibia and Proximal Humerus
What are the 3 most common sites of chondrosarcomas?
Femur, Shoulder and Proximal Humerus
What are the most common sites of fibrosarcomas?
Tubular bones (Femur and Tibia)
What are the most common sites of Ewing’s Sarcoma?
Lower half of the body, most commonly in the diaphysis
What are the most common sites of Multiple Myeloma?
Plasma Cells
What are the most common sites of Giant Cell tumor?
Metaphysis or Epiphysis
What are the most common sites of metastatic disease?
Vertebral Bodies, Pelvic Bones, Ribs, and sometimes widespread
What is the most common symptoms of bone and cartilage carcinomas?
Pain, Swelling, Neurologic (if spine is involved), Palpable mass, Fever, Weight loss and Fatigue
Pain in bone cancers usually correlates with what characteristic of the tumor?
Tumor Size
What is radiograph able to detect about bone cancers?
Osteolytic vs Osteoblastic lesions
What modality is replacing CT and what does this examination display about the malignancy?
MRI and shows disease growth and neurovascular structure relationship
What are two other examinations/test that can be done on bone cancers?
Bone scan and Technetium-99m
What is the importance of surgical biopsy in bone and cartilage malignancies?
able to determine the radiosensitivity of the cancer
What grading system is used for bone and cartilage malignancies?
AJCC system
In terms of grade, what does a G1 bone cancer mean?
Low grade cancer
In terms of grade, what does a G2 bone cancer mean?
High grade cancer
Where do high grade sarcomas typically spread too and by what way?
Peripheral lung and hematougenously
Osteosarcomas spread to which structure and at what rate?
Lungs about 80% chance
What are the upsides to low grade sarcomas?
slow growing and easier to control
What are the downsides to low grade sarcomas?
can reoccur and become high grade
Skip mets can occur in the spread on bone cancers. True or False?
True
What percentage of primary skeletal malignancies are osteosarcomas?
35%
Osteosarcomas are sensitive and resistant to which type of treatments?
Chemosensitive and Radioresistant
What are the preferred methods of treatment for osteosarcomas?
Chemotherapy and surgery
What percentage of patients receive amputations in the case of osteosarcomas?
20%
What is the 5 year survival rate of osteosarcoma?
60-70%
Why is XRT an uncommon treatment method for Osteosarcomas?
Not effective cause they are radioresistant
When is XRT used for osteosarcomas?
adjuvant for chemo for cancers that are unresectable, partial resected or positive margins
What is the dosage given for osteosarcoma?
Post-op 55 Gy, but boost to 64-68 Gy
What is the dosage given for unresectable osteosarcoma?
60-70 Gy
What should be included in the treatment field for osteosarcomas?
include scar in the treatment and leave 1-3 cm of skin margin
What is the purpose of the 1-3 cm margin on the skin?
To prevent edema and constrictive fibrosis
Osteosarcomas are most commonly prevalent in what demographic?
<35 YO, tall people, 1:1 in children, 2:1 more common in males than female older than 15
XRT is used in the treatment of osteosarcomas to contain the tumor and prevent lung mets. True or false?
True
Chondrosarcomas arise from what element of the bones?
Mesenchymal
Chondrosarcomas can occur in any cartilage forming bone. True or False?
True
What are important prognostic factors for Chondrosarcomas?
Location and Grade
Chondrosarcomas are radiosensitive and less aggressive. True or false?
False. Chondrosarcomas are radioresistant and also aggressive malignancies
What is the treatment of choice for chondrosarcomas?
Surgery
What are the dosages for chondrosarcomas?
20-50 Gy pre-op, 70-78 Gy post op
What are the dosages for
unresectable chondrosarcomas?
70 Gy
What type of tissues do fibrosarcomas typically occur in? Soft or Hard.
Soft tissue
What percentage of primary bone tumors are fibrosarcomas?
less than 6%
What is the preferred choice of treatment for fibrosarcoma’s?
aggressive surgery
What is the doses given for fibrosarcoma’s?
66-70 Gy
Fibrosarcoma’s are apart of what classification system?
Malignant Fibrous histiocytoma (MFH) Classification
Malignant Fibrous histiocytoma (MFH) Classification categorizes what types of tumors?
tumors that affect bone and soft tissue
What are giant cell tumors?
Tumors in the epiphysis of long bones
What are characteristics of giant cell tumors?
Aggressive, benign, and destructive
Giant cell tumors usually met. True or False?
False but they do recur
What are the two treatment methods used for giant cell tumors?
Surgery and XRT
What are the typical dosages for Giant cell tumors?
50-60 Gy
What percentage of bone tumors are Ewing’s Sarcomas?
16%
What structures are Ewing’s sarcomas most likely to occur?
bone and soft tissue
Ewing’s sarcomas are chemo sensitive. True or false?
True
What methods are used to treat Ewing’s Sarcomas?
Surgery, Chemotherapy and Radiation Therapy
What is the goal in the treatment of Ewing’s Sarcomas?
Complete removal of disease and preservation of function
When is XRT the typical treatment of Ewing’s Sarcomas?
For inoperable Ewing’s Sarcomas
What is the dosage of Ewing’s Sarcomas XRT?
55-60 Gy, 45 Gy with surgery
What margins are placed around the Ewing
Sarcoma during treatment?
2 cm margin around soft tissue, but entire bone are in the treatment volume
Post-surgery for Ewing’s Sarcoma, what are the primary treatment considerations?
Scar and Prosthesis Seeding
Soft tissue sarcomas are what type of tumor?
Malignant Extraskeletal Tumors
What is the cell origin of Soft tissue sarcomas?
Mesenchymal
What are the three properties that mesenchymal tissues provide?
Connection, Support and Locomotion
Soft tissue sarcomas are less frequent that primary bone tumors. True or False?
False, they are more frequent
What path do STS grow along?
Longitudinal axis, along the path of least resistance
As STS grow, what occurs?
a pseudocapsule forms
For intermediate and high grade STS, what is the most commonly seen method of spread?
Hematogenous spread
Aside from hematogenous spread, what other spread is to be considered with STS in the abdominal region?
Retroperitoneal spread to the lung, liver and other abdominal structures
Soft tissues sarcomas have high mortality rates. True or false?
True
What is the age range which STS are most prevalent?
50-60s
What are the four most common areas of the body in which STS are seen?
Extremities, Trunk, Retroperitoneum, and H&N
What portion of the body has the highest occurrence of Soft tissue sarcomas?
Extremities, 60%
What are 6 etiological factors that are associated with soft tissue sarcomas?
Genetic, Environmental, Viral infections, Neurofibromatosis, Industrial toxins, Agent Orange
What is neurofibromatosis?
a genetic disorder that affects cell growth, causing tumors to grow on nerves
STS can be linked to what?
Primitive Mesoderm
How do Soft tissue sarcomas present clinically?
symptoms and diagnosis time period are site specific
How many types of soft tissue sarcomas are there?
Over 50
What is the most common soft tissue sarcoma?
(MLH) Malignant Fibrous Histiocytoma, 28%
What are the four other types of soft tissue sarcomas besides MFH?
Liposarcoma, Leiomyosarcoma, Synovial Sarcoma, Rhabdomyosarcoma
What is the most common soft tissue sarcoma found in children?
Rhabdomyosarcoma
What is the staging system used for soft tissue sarcomas?
FNCLCC
What does the FNCLLS stand for?
French Federation of Cancer Centers Sarcoma Group
What are three factors utilized in the FNCLSS staging process?
Differentiation, Mitotic Count and Necrosis; all factors are added together
Where are STS most commonly aggressive in terms of site?
Aggressive along anatomically defined planes
Aside from Hematologic spread, what is the other way of spread for STS?
Lymphatics
What is the primary treatment of choice for STS?
Surgery, however it can be combined with chemotherapy and/or radiotherapy
What are the types of radiotherapy that can be utilized for STS?
EBRT, IORT, Brachy and Combination methods
Smaller soft tissue sarcomas tumors are typically candidates for radiotherapy. True or false?
False, larger tumors are typically common candidates for radiotherapy
Aside from radiotherapy being utilized for larger tumors, what other characteristic of the tumor is also utilized for that criteria?
Tumors that incomplete resections
What is the pre-op dosages for Soft tissue sarcomas?
50 Gy
What is the post-op dosages for soft tissue sarcomas?
up to 70 Gy, usually only high grade tumors
What is the in-op dosages for soft tissue sarcomas?
74-82 Gy IMRT or Protons
What is common age range of occurrence for liposarcoma’s?
40-70 Yo
Where are liposarcoma’s commonly prevalent?
Lower extremeties
Where are Leiomyosarcoma commonly prevalent?
Uterus, Pelvis and Abdomen
Synovial Sarcoma are commonly prevalent in what demographic of patients?
Young adults
Rhabdomyosarcomas are one of the most common STS in children, where are they most commonly seen anatomically?
Extremities
What other areas can rhabdomyosarcoma prevale?
H&N (around the eye), GU tract, Trunk
Rhabdomyosarcomas are NOT aggressive tumors. True or False?
False, they are aggressive
What methods are used for treatment in Rhabdomyosarcoma?
XRT, Chemo and Surgery
What is the surgical procedure for Rhabdomyosarcoma?
Enucleation
What is enucleation?
removal of the eye that leave the eye muscles and remain orbital contents intact
