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MSK > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

Benign and malignant bone tumour

A 
Benign = Osteoid osteoma / blastoma  
Malignant = osteosarcoma
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2
Q

Osteoid osteoma

  • What relieves
  • How do you Dx
  • How do you Rx
A

Painful bone lesion of long bone
Pain relieved by Ibuprofen as tumour produces prostaglandin
Dx = CT + biopsy as X-ray may miss
Rx = ablation

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3
Q

Benign and malignant cartilage tumour

How do you Rx malignant

A

Benign = osteochondroma / endochondroma (present swelling / fracture)

Malignant = Chondrosarcoma (no response to chemo or RT)

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4
Q

Benign and malignant fibrous tumour

A

Benign = fibroma

Malignant = fibrosarcoma / MFH

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5
Q

Benign and malignant vascular tumour

A

Benign = Haemangioma

Malignant = angiosarcoma

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6
Q

Benign and malignant adipose tumour

A

Benign = lipoma

Malignant = liposarcoma

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7
Q

Benign marrow tumours?

A

Ewing’s sarcoma
Lymphoma
Myeloma

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8
Q

Commonest primary malignant in the young?

A

Osteosarcoma

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9
Q

Commonest primary malignant in the elderly?

A

Myeloma

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10
Q

What cancers metastasise to bone ?

A 
Breast = most common
Lung 
Prostate
Kidney 
Follicular thyroid 
Neuroblastoma <4
Myeloma
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11
Q

What are common sites of bone mets

A

Vertebrae = most common
Femur
Pelvis
RIbs

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12
Q

What is the likelihood of malignant tumours?

A

Benign = common
Primary malignant are rare
Secondary mets are common
If >50 likely to be metastatic

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13
Q

How do you diagnose bone tumour

A 
X-Ray = most useful 
Isotope bone scan for bone mets 
CT
MRI = soft tissue
PET
Bone biopsy
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14
Q

How do you prevent pathological fractures

A

Early chemo

Internal fixation if

  • MIrel’s score >8
  • Lytic lesion + pain
  • > 2.5cm
  • > 50% destruction

Metastatic lesions rarely unit
High failure rate
Traction + splintage enough

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15
Q

Can cartilage regenerate?

A

No as no blood vessels

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16
Q

What is the most common soft tissue tumour

A

Lipoma

17
Q

What are suspicious symptoms of soft tissue tumours

A 
Painless
Deep 
Rapid grwoth
Hard + craggy 
Recurrent after excision
Indistinct margin
18
Q

What is a classic sign of Ewings sarcoma

A

Onion skinning on X-ray

19
Q

What score is used for risk of fracture

A

Mirel

20
Q

What is a sarcoma

A

Malignant neoplasm arising from mesenchymal tissue

Can be soft tissue / GI / primary bone

21
Q

What is a carcinoma

A

Malignancy of epithelial cells

Breast / bowel / lung

22
Q

What are features of bone mets

A 
Features primary cancer
Bone pain
Pathological fracture
Hyperclacaemia
Raised ALP
23
Q

What are features of spinal mets before cord compression develops

A 
Unrelenting lumbar back pain
Throacic or cervical
Worse sneezing, coughing or straining
Nocturnal
Associated tenderness
24
Q

What do you do if neuro features

A 
Think cord compression
Whole spine MRI
Bed rest
Dexamethasone 
Refer for RT / spinal surgery
25
Q

How do you treat bone tumours

A

RT
Prophylactic fixation
Analgesia
Possible biphosphonate rx to prevent fracture

26
Q

What are other soft tissue tumours apart from lipoma

A

Rhabdomyosarcoma = most common
Liposarcoma
Fibrosarcoma

27
Q

What is associated with soft tissue

A

NF1

28
Q

How do you Dx

A

MRI
Needle biopsy
Gene expression for response to chemo

29
Q

What is the Rx

A

Excision - wide margin
RT
Adjuvatn chemo

30
Q

What tumour has no response to chemo or RT

A

Chondrosarcoma

31
Q

What causes osteosarcoma

A

Primary - common in adolsscents in long bone e.g. around knee
Secondary to Paget’s / radiation

32
Q

What are the symptoms of osteosarcoma

A 
Pain - deep boring ache
Night pain
No relation to exercise
Analgesia doesn't help 
Limp 
Reduced ROM
Rapid swelling 
Venous congestion 
Joint effusion 
Deformity
Systemic 
Fractures
33
Q

How do you Dx osteosarcoma

A

MRI = scan of choice

Do X-ray within 48 hours if suspect

34
Q

What do you do to look for primary tumour

A

HRCT chest

Pulmonary - esp if raised ALP

35
Q

How do you treat osteosarcoma

A

Chemotherapy before as risk of micromets
RT
Surgery - amputation

36
Q

What signs raised suspicion of an osteosarcoma

A

Large >5cm soft tissue mass
Deep
Rapid growth
Painful lump

MSK (21 decks)

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