BONE TUMOURS

Question 1

Are primary bone tumours common?

Answer 1

NO - rare and usually seen only in children and young adults

Question 2

What are the most common bone tumours?

Answer 2

tumours that metastasise from the bronchus, breast and prostate

Question 3

What are the types of primary bone tumours?

Answer 3

• Osteosarcomas
• Fibrosarcomas
• Chondromas
• Ewing’s tumour

Question 4

Where can secondary bone tumour metastasise from?

Answer 4

• Lungs - bronchus
• Breast
• Prostate - often osteosclerotic too
• Thyroid - less common
• Kidney - less common

Question 5

What are the signs and symptoms of bone tumours?

Answer 5

Signs
-May be tender at site of tumour

Symptoms

• Pain - Unremitting and worse at night
• Weight loss
• Malaise
• Pyrexia
• Aches and pains occasionally related to hypercalcaemia

Question 6

What are the investigations for bone tumour?

Answer 6

-Skeletal isotope scan:
Show bony metastases as ‘hot’ areas BEFORE radiological changes occur
-X-rays
-MRI-Used for vertebral lesions
-Bloods; Serum alkaline phosphatase (from bone) is usually raised, Hypercalcaemia occurs in 10-20%, PSA is raised in the presence of prostatic metastases

Question 7

What might be seen on x-rays for bone tumours?

Answer 7

• May show metastases as osteolytic areas (for lytic tumour to be visible it must have lost greater than 60% bone density) with bony destruction
• Osteosclerotic (increased bone density) metastases are characteristic of prostatic carcinoma

Question 8

What is the treatment and management of bone tumours?

Answer 8

• Analgesics and anti-inflammatory drugs
• Local radiotherapy to bone metastases relieves pain and reduces the risk of pathological fracture
• Some tumours respond to chemotherapy
• Some tumours are hormone-dependent and respond to hormonal therapy
• Bisphosphonates e.g. Alendronate can help symptomatically

Question 9

Describe an osteosarcoma

Answer 9

• Most common primary bone malignancy in children
• Usual peak onset 15-19 yrs
• Associated with Paget’s disease in adult life
• Occurs in metaphyses of long bones
• Common sites are knee (75%) or proximal humerus
• Often presents as a relatively painless tumour
• Destroys bone and spreads into the surrounding tissue
• Rapidly metastasises to the lung
• X-ray shows bone destruction&formation with soft tissue calcification (sunburst appearence)

Question 10

Describe Ewing’s sarcoma

Answer 10

• Thought to arise from mesenchymal stem cells
• Very rare
• Average age of onset is 15 yrs
• Presents with a mass/swelling, most commonly in the long bones of the:arms, legs, pelvis, chest and occasionally in skull/flat bones of trunk
• Painful swelling, redness in the area surrounding the tumour, malaise, anorexia, weight loss, fever, paralysis and/or incontinence if affecting the spine, numbness in affected limb

Question 11

Describe Chondrosarcoma

Answer 11

-Cancer of the cartilage
-Most common adult none sarcoma
-Associated with dull, deep pain and affected area is swollen & tender
Common sites affects; pelvis, femur, humerus, scapula and ribs