Bone Tumours Flashcards
which is the most common primary bone tumour
myeloma
Name some common sites for cancer to metastasise from to the bone
bronchus, breast, prostate, kidney, thyroid (follicular), renal, bowel
give some effects of metastases in bone
Bone pain, bone destruction, pathological fractures in long bones, spinal metastases can cause wedge fracture in the vertebral column which can progress to vertebral collapse, spinal cord compression etc.
Hypercalcaemia
name the two types of metastases you see in bones
lytic and sclerotic
name two cancers that give sclerotic bone metastases
prostate cancer and breast cancer
how will a sclerotic metastasis appear on x-ray
brighter as it is more dense due to the woven bone that has been deposited
what type of bone do sclerotic metastases induce the production of and which cells lay it down
woven bone
Laid down by osteoblasts
how does a lytic metastasis lead to bone destruction
tumour releases cytokines which activate osteoclasts which then destroy the bone
which cancers typically cause a solitary bone metastasis
renal and thyroid carcinoma
Name some of the clinical effects of myeloma
bone lesions - punched out lytic foci, generalised osteopaenia, tendency to fracture.
Marrow replacement - anaemia, infections (WBCs), thrombocytopaenia - bleeding risk.
Immunoglobulin excess - can have major effect on the kidney and lead to kidney failure.
name some lab/imaging findings in myeloma
pepper-pot skull
Huge proliferations of either kappa or lambda only - mono-proliferation is occurring.
ESR>100. Serum electrophoresis will show a monoclonal band. Urine - immunoglobulin light changes: Bence Jones protein.
how is osteoid osteoma treated
radio-frequency ablation
what causes osteoid osteoma
nidue of osteoblasts located in the cortex of the bone. It is a benign proliferation and is self-limiting
what are the symptoms of osteoid osteoma and how are they relieved
pain, which is worse at night. Scoliosis of the spine is often present.
Pain is completely relieved by aspirin.
what is an osteosarcoma?
Where does it normally affect ?
Primary bone tumour.
Malignant tumour whose cells form osteoid or bone.
Metaphysis of long bones, with half affecting the area around the knee.
what is the peak age for osteosarcoma
10-25 but can be seen in later years in those who have received radiotherapy earlier in life for another reason.
describe the natural history of osteosarcoma
highly maligant, destroys local cortex and metastasises early, often to the lugs.
how is osteosarcoma treated?
8 weeks of chemotherapy followed by excision.
what is Codman’s sign (or triangle)
where there is a triangle appearance in the cortex of the bone as the tumour has spread out very quickly through the cortex and has begun to form a new cortex
what is Paget’s disease
disease of excessive bone remodelling. Caused by osteoclasts - osteoblasts are then activated in response to the osteoclasts and lay down weak, disorganised bone.
Areas of bone becoming abnormally large and deformed with increased vascularity
what symptoms would someone with Paget’s disease have and what are the effects of the disease
- Bone pain
- Deformity – bowing of long bones
- Pathological fracture, especially in the hip. Osteoarthritis can develop.
- Osteoarthritis
- Deafness – thickened skull can compress the 8th cranial nerve
- Spinal cord compression – due to the effect on the vertebral body.
- High cardiac output – cardiac failure. Bone formed is very vascular so puts high demands on blood output from the heart.
- Paget’s sarcoma
what is an endochondroma ?
lobulated mass of acrtilage within the medulla. Benign. Occurs in hands, feet, long bones.
what is an Osteocartilaginous exostosis
benign outgrowth of cartilage with endo-chondral ossification.
Probably occurs from the growth plate and are very common, especially in adolescence. Only danger is if they grow very large as a chondrosacroma can arise within it
describe a chondrosarcoma
Can be a primary lesion or can be secondary - conversion of a benign cartilagenous tumour such as a osteochondroma or chondroma.
Can be low or high grade. Most common areas are in the pelvis and around the hip.
Can be central, within the medullary canal or peripheral: on the bone surface.
Managed using surgery
