Bone & Soft Tissue Tumours

Question 1

Name a benign and a malignant bone forming tumours?

Answer 1

Benign - Osteoid Osteoma or Osteoblastoma

Malignant - Osteosarcoma

Question 2

Whats the commonest primary malignant bone tumour in young people?

Answer 2

Osteosarcoma

Question 3

Name a benign and a malignant Cartilage formine tumour?

Answer 3

Benign - Enchondroma or osteochondroma

Malignant - Chondrosarcoma

Question 4

Name a benign and a malignant fibrous tissue tumour?

Answer 4

Benign - Fibroma

Malignant - Fibrosarcoma and Malignant Fibrous Histiocytoma (MFH)

Question 5

Name a benign and a malignant Vascular tumour?

Answer 5

BEnign - Haemangioma And Aneurysmal bone cyst

Malignant - Angiosarcoma

Question 6

Name a benign adipose tissue tumour?

Answer 6

Benign - Lipoma

Question 7

Name some malignant marrow tumours?

Answer 7

Myeloma
Lymphoma
Ewing’s Sarcoma

Question 8

Whats the commonest Primary Malignant Bone Tumour in Older patients?

Answer 8

Myeloma

Question 9

How could a malignant bone tumour present?

Answer 9

Deep Boring Bone pain
- Progressive at rest & at night

A mass

Often just as an incidental X-ray finding

Question 10

List various types of scans for bone tumours?

Answer 10

X-ray
CT
MRI
Angiography
Isotope Bone Scan
PET
Biopsy

Question 11

What tests would you run before a biopsy?

Answer 11

Bloods
X-ray
MRI
Bone Scan
CT Chest/abdo/pelvis

Question 12

Describe the clinical findings for a bone tumour:

Answer 12

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

Question 13

What about a fracture would suggest a malignancy?

Answer 13

Minimal trauma + pain prior to the trauma

Question 14

Patient presents with a rapid growing, hard, craggy & non-tender swelling in the leg. Its painless. Whats likely?

Answer 14

A soft tissue tumour

The most common is a lipoma

Question 15

How do you test for a soft tissue tumour?

Answer 15

An MRI

Question 16

Whats more likely a metastatic tumour or a primary bone tumour?

Answer 16

Metastatic tumours are 25x more likely

Question 17

What are the common sites for a metastatic bone tumour to originate?

Answer 17

Lungs - smokers
Breasts
Prostate
KIdney
Thyroid
GI tract
Melanoma

Question 18

Whats the most likely metastatic thyroid cancer to hit bone?

Answer 18

Medullary thyroid cancer

Question 19

How would you test for the various source metastases?

Answer 19

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

Question 20

What are the commonest sites for metastatic bone cancer to arise?

Answer 20

Commonest first:
Vertebrae
Proximal Femur
Pelvis
Ribs
Sternum
Skull

Question 21

How do we prevent pathological fractures?

Answer 21

Early Chemo
Prophylactic Internal Fixation +/- bone cement
Embolisation

Question 22

When would we do prophylactic internal fixation or embolisation to prevent a pathological fracture?

Answer 22

PIF if:

• LYtic lesion causing pain
• > 2.5cm
• > 50% cortical destruction

Embolisation esp for renal/thyroid mets

Question 23

How do we risk assess for pathological fracture in patients at risk of metastatic bone cancer?

Answer 23

With Mirel’s Scoring System