Bone Tumors

Question 1

Primary Tumors

Answer 1

• Mainly in kids 8-22 yo
• Ex) osteosarcoma, Ewing’s sarcoma(mesodermal origin)
• Tx - chemo (for micro mets) then large surgery

Question 2

Mets to Bone

Answer 2

• in adults > 50 yo
• from breast, thyroid, prostate, renal cell carcinoma, lung
• Usually carcinomas (glandular) and stage IV one metastasize
• may require surgery and stabilization but focus on treating primary cancer

Question 3

Osteosarcoma Presentation and Dx

Answer 3

• Most common primary bone tumor
• Usually in metaphyses of bone
• Distal femur, proximal humerus, proximal tibia (most active in growing kids)
• Presentation -
  
  • Age 9-20
  • Insidious onset of pain; progressively worse (to pain at rest)
• Dx - X-rays show bone growth in metaphysis (ends) BUT must biopsy to confirm

Question 4

Where do osteosarcomas travel to?

Answer 4

• Mets follow Batson’s plexus (low flow, runs back of body, drains spine, scapula, pelvis and proximal femurs)
• So mets go to lungs, spine, pelvis, acetabulum, proximal femur
• W/o tx 90% will met to lungs (SCREEN CHEST CT)

Question 5

Ewing’s Sarcoma Presentation and Dx

Answer 5

• Presentation
  
  • Age 6-16
  • Also insidious onset of pain; progressively worse (to pain at rest)
• Dx - Xray shows growth in diaphysis (mid bone); (permeation and bone destruction) ALSO need biopsy

Question 6

Genetic Abnormality Associated w/ Ewing’s

Answer 6

Caused by genetic translocation between chromosomes 11 and 22