Bone Tumours Flashcards
Benign and malignant bone tumour
Benign = Osteoid osteoma / blastoma Malignant = osteosarcoma
Osteoid osteoma
- What relieves
- How do you Dx
- How do you Rx
Painful bone lesion of long bone
Pain relieved by Ibuprofen as tumour produces prostaglandin
Dx = CT + biopsy as X-ray may miss
Rx = ablation
Benign and malignant cartilage tumour
How do you Rx malignant
Benign = osteochondroma / endochondroma (present swelling / fracture)
Malignant = Chondrosarcoma (no response to chemo or RT)
Benign and malignant fibrous tumour
Benign = fibroma
Malignant = fibrosarcoma / MFH
Benign and malignant vascular tumour
Benign = Haemangioma
Malignant = angiosarcoma
Benign and malignant adipose tumour
Benign = lipoma
Malignant = liposarcoma
Benign marrow tumours?
Ewing’s sarcoma
Lymphoma
Myeloma
Commonest primary malignant in the young?
Osteosarcoma
Commonest primary malignant in the elderly?
Myeloma
What cancers metastasise to bone ?
Breast = most common Lung Prostate Kidney Follicular thyroid Neuroblastoma <4 Myeloma
What are common sites of bone mets
Vertebrae = most common
Femur
Pelvis
RIbs
What is the likelihood of malignant tumours?
Benign = common
Primary malignant are rare
Secondary mets are common
If >50 likely to be metastatic
How do you diagnose bone tumour
X-Ray = most useful Isotope bone scan for bone mets CT MRI = soft tissue PET Bone biopsy
How do you prevent pathological fractures
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
Can cartilage regenerate?
No as no blood vessels
What is the most common soft tissue tumour
Lipoma
What are suspicious symptoms of soft tissue tumours
Painless Deep Rapid grwoth Hard + craggy Recurrent after excision Indistinct margin
What is a classic sign of Ewings sarcoma
Onion skinning on X-ray
What score is used for risk of fracture
Mirel
What is a sarcoma
Malignant neoplasm arising from mesenchymal tissue
Can be soft tissue / GI / primary bone
What is a carcinoma
Malignancy of epithelial cells
Breast / bowel / lung
What are features of bone mets
Features primary cancer Bone pain Pathological fracture Hyperclacaemia Raised ALP
What are features of spinal mets before cord compression develops
Unrelenting lumbar back pain Throacic or cervical Worse sneezing, coughing or straining Nocturnal Associated tenderness
What do you do if neuro features
Think cord compression Whole spine MRI Bed rest Dexamethasone Refer for RT / spinal surgery
