Bone Tumours

Question 1

What are the Primary bone tumours ?

Answer 1

Bone - osteosarcoma
Cartilage - chondrosarcoma
Fibrous tissue - fibrosarcoma
Bone marrow - Ewing’s sarcoma, myeloma
Vascular - angiosarcoma
Uncertain - malignant giant cell tumour

Question 2

What is an osteosarcoma?

Answer 2

Malignant osteoblasts
Usually presents in children
Usually due to Paget’s in >40s

Question 3

What are the risk factors for osteosarcoma? (3)

Answer 3

Paget’s
Familial retinoblastoma
Radiation

Question 4

Wat are the clinical signs and investigations for osteosarcoma?

Answer 4

Pain and swelling around bone
Common in knee, humerus and femur
X-ray : bone expansion with surrounding soft tissue, possible pathological fracture, sunburst bone appearance, Codman’s triangle
MRI, CT and possible biopsy

Question 5

What is the management for osteosarcoma?

Answer 5

Surgical excision
Radio/chemotherapy
Amputation

Good prognosis in young but poor in elderly (espc with Paget’s)

Question 6

What is a chondrosarcoma?

Answer 6

Malignant chondrocytes
More common in males in 40s

Question 7

What are the clinical signs and investigations for chondrosarcoma?

Answer 7

Malignant tumour producing cartilage
Pain and swelling
Mainly in axial skeleton, shoulder and ribs
X-ray : lytic lesion with central calcification and cortical destruction
CT or MRI

Question 8

What is the management of chondrosarcoma?

Answer 8

Resistant to chemo/radiotherapy
Surgical excision possible before metastasise
Possible amputation
Good prognosis when low grade tumour

Question 9

What is Ewing’s sarcoma?

Answer 9

Malignant bone marrow cells
Almost exclusively in under 40s
Tumour cells derived from neuroectoderm cells

Question 10

What are the clinical signs and investigations fo Ewing’s sarcoma?

Answer 10

Small, round, and blue tumour cell appearance
Pain, swelling, fever
X-ray - onion skin periosteum, diaphysis of long bones

Question 11

What is the management of Ewing’s sarcoma?

Answer 11

Surgical excision
Possible preoperative chemo/radiotherapy
Good prognosis before metastasis

Question 12

What are metastatic tumours?

Answer 12

Malignant cells from other parts of the body - commonly prostate, breast, lungs, kidneys, thyroid.
Usually osteolytic (except prostate which is osteoblastic)
Secondary bone tumour
Most common in older pts

Question 13

What are the clinical signs and investigations for metastatic bone tumours?

Answer 13

General or local progressive pain
Pain from acute pathological fracture
Symptoms of spinal cord compression
Systemic - weight loss, anorexia
Check ESR, CRP and WCC for possible infection
X-rays to determine whether it is osteolytic or sclerotic lesion

Question 14

What is the management for metastatic bone tumours?

Answer 14

Treatment depends heavily on age and primary tumour
Pain - analgesia, bisphosphonates, focal radiotherapy, DXT, surgery
Orthopaedic treatment - intramedullary nails , joint replacement, plate/screw constructs, cement augmentation - all ways to achieve skeletal integrity and stabilise abnormal bone which my be causing symptoms at risk of fracture.

Question 15

How does metastasise occur?

Answer 15

Complex series of steps
Endothelial progenitor cells essential to lead to angiogenesis
Induce osteoclasts
Osteoblastic response variable depending on tumour cell

Question 16

What to ask in pt history ?

Answer 16

Bone pain
Red flags - e.g weight loss
Symptoms from primary if diagnosed first
Function impairment - bc of pain, difficult moving affected limb, difficulty performing certain actions
Co-morbidities and pt expectations and understanding
Social circumstance - support?
Previous diagnosis of cancer and chemo?

Question 17

Why is using a CT good?

Answer 17

Structure
Good for pelvis and abdominal mets (3D)
Screening of chest/abdonmen and pelvis

Question 18

Why is using an MRI good?

Answer 18

Defines soft tissue involvement
Essential in spinal disease
SeeSkip lesions in long bones
Evaluation of suspected primary bone turnovers