bone tumours Flashcards
whats the difference between primary and secondary bone tumours?
Primary tumours arise from cells which constitute the bone and can divided into benign and malignant types. They are rare.
secondary tumours are metastatic bone tumours. They make most of the disease burden.
where are common primary sites that cause metastatic spread to bone?
renal
thyroid
lung
prostate
breast
what is the most common site for bony metasteses?
the spine
how is metastatic disease treated?
rarely treated surgically
mainstay management is via systemic therapies and often pallative
prophylactic nailing of certain long bones can be performed in certain individuals at high risk of pathological fractures from metastatic disease, especially of the femur and humerus
what are the risk factors for primary bone cancer?
- genetic association e.g familial retinoblastoma is associated with increased risk of osteosarcomas
- previous exposure to radiation or alkylating agents in chemotherapy
- benign bone conditions
what are the clinical features of a primary bone tumour?
pain not associated with movement, worse at night
(red flag)
as tumour enlarges, a mass may be palpable
if a patient presents with a fracture without a history of trauma (pathological fracture) a bone tumour may be suspected
what are the differentials for for bone pain?
- osteomyelitis
- multiple myeloma
- metabolic bone disease
- pathological fracture
what is a giant cell tumour?
A primary benign bone tumour
Giant cell tumours, also called osteoclastomas, arise from the multinucleated giant cells and stromal cells.
usually occour at epiphysis of long bones
what is an osteosarcoma?
a metastatic type of bone cancer
most common malignant primary bone tumour
get medullary and cortical bone destruction on plain film radiograph
what is ewings sarcoma?
paediatric primary malignancies
present with a painful and enlarging mass with tenderness and warmth
manage with neoadjuvent chemo and surgical excision
what is a chondrosarcoma?
primary malignant tumours of the cartilage
what investigations are done into tumours?
depends on suspected tumour type
usually do plain film radiograph, but all cases should be discussed with MDT before further investigation
most cases will need MRI to asses lesion and for evidence of soft tissue involvement
CT can be used to determine cortical involvement
may need bone biopsy in some cases for definitive diagnosis
what staging system is used for orthopaedic tumours?
the enneking staging ststem
comprises of 2 components for both benign and malignant tumours
malignant tumours, staging is based on surgical grade, local extent and metastasis
how are primary bone tumours managed?
Management of bone tumours depends on patient factors and disease factors.
However, in general most benign bone tumours are managed with observation, whilst surgical treatment is the mainstay for malignant tumours.
