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? AND in older people?

Answer 2

Osteosarcoma- young

Myeloma- old

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 and a malignant adipose tissue tumour

Answer 6

Benign - Lipoma

Malignant- Liposarcoma

Question 7

Name some malignant marrow tumours?

Answer 7

Myeloma
Lymphoma
Ewing’s Sarcoma

Question 8

How could a malignant bone tumour present?

Answer 8

Deep Boring Bone pain
- Progressive at rest & at night

A mass

Often just as an incidental X-ray finding

Question 9

List various types of scans for bone tumours?

Answer 9

X-ray
CT
MRI
Angiography
Isotope Bone Scan
PET
Biopsy

Question 10

What tests would you run before a biopsy?

Answer 10

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

Question 11

Describe the clinical findings for an osteosarcoma?

Answer 11

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

• diffuse
• near the end of a long bone
• +/- warmth & venous congestion: active tumour

Pathological Fracture: related to minimal trauma or osteoporosis

~Joint effusion, deformity, neurovascular effects & systemic effects

Question 12

What about a fracture would suggest a malignancy?

Answer 12

Minimal trauma + pain prior to the trauma

Question 13

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

Answer 13

A soft tissue tumour

The most common is a lipoma

Question 14

How do you test for a soft tissue tumour?

Answer 14

An MRI

Question 15

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

Answer 15

Metastatic tumours are 25x more likely

Question 16

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

Answer 16

Lungs - smokers
Breasts
Prostate
KIdney
Thyroid
GI tract
Melanoma

Question 17

Whats the most likely metastatic thyroid cancer to hit bone?

Answer 17

Medullary thyroid cancer

Question 18

How would you test for the various source metastases?

Answer 18

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 19

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

Answer 19

Commonest first:
Vertebrae
Proximal Femur
Pelvis
Ribs
Sternum
Skull

Question 20

How do we prevent pathological fractures?

Answer 20

Early Chemo
Prophylactic Internal Fixation +/- bone cement
Embolisation

Question 21

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

Answer 21

PIF if:

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

Embolisation esp for renal/thyroid mets

Question 22

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

Answer 22

With Mirel’s Scoring System