Bone & Soft Tissue Tumours Flashcards
Name a benign and a malignant bone forming tumours?
Benign - Osteoid Osteoma or Osteoblastoma
Malignant - Osteosarcoma
Whats the commonest primary malignant bone tumour in young people?
Osteosarcoma
Name a benign and a malignant Cartilage formine tumour?
Benign - Enchondroma or osteochondroma
Malignant - Chondrosarcoma
Name a benign and a malignant fibrous tissue tumour?
Benign - Fibroma
Malignant - Fibrosarcoma and Malignant Fibrous Histiocytoma (MFH)
Name a benign and a malignant Vascular tumour?
BEnign - Haemangioma And Aneurysmal bone cyst
Malignant - Angiosarcoma
Name a benign adipose tissue tumour?
Benign - Lipoma
Name some malignant marrow tumours?
Myeloma
Lymphoma
Ewing’s Sarcoma
Whats the commonest Primary Malignant Bone Tumour in Older patients?
Myeloma
How could a malignant bone tumour present?
Deep Boring Bone pain
- Progressive at rest & at night
A mass
Often just as an incidental X-ray finding
List various types of scans for bone tumours?
X-ray
CT
MRI
Angiography
Isotope Bone Scan
PET
Biopsy
What tests would you run before a biopsy?
Bloods
X-ray
MRI
Bone Scan
CT Chest/abdo/pelvis
Describe the clinical findings for a bone tumour:
Deep boring achy pain worse at night, often at rest & not activity related.
Progressive pain.
Loss of function –> Limp, reduced joint movement & stiff back
Swelling +/- warmth & venous congestion
Fracture
~Joint effusion, deformity, neurovascular effects & systemic effects
What about a fracture would suggest a malignancy?
Minimal trauma + pain prior to the trauma
Patient presents with a rapid growing, hard, craggy & non-tender swelling in the leg. Its painless. Whats likely?
A soft tissue tumour
The most common is a lipoma
How do you test for a soft tissue tumour?
An MRI
Whats more likely a metastatic tumour or a primary bone tumour?
Metastatic tumours are 25x more likely
What are the common sites for a metastatic bone tumour to originate?
Lungs - smokers
Breasts
Prostate
KIdney
Thyroid
GI tract
Melanoma
Whats the most likely metastatic thyroid cancer to hit bone?
Medullary thyroid cancer
How would you test for the various source metastases?
CXR & Sputum cytology - for lung cancer
Examine breasts, thyroid and skin.
DRE & PSA for prostate
IVP + US for kidney
FOBT + Endoscopy + Tumour markers for GI tract cancers
What are the commonest sites for metastatic bone cancer to arise?
Commonest first:
Vertebrae
Proximal Femur
Pelvis
Ribs
Sternum
Skull
How do we prevent pathological fractures?
Early Chemo
Prophylactic Internal Fixation +/- bone cement
Embolisation
When would we do prophylactic internal fixation or embolisation to prevent a pathological fracture?
PIF if:
- LYtic lesion causing pain
- >2.5cm
- >50% cortical destruction
Embolisation esp for renal/thyroid mets
How do we risk assess for pathological fracture in patients at risk of metastatic bone cancer?
With Mirel’s Scoring System
