Bone Tumours Flashcards
Name 3 benign and 1 malignant OSTEOBLAST tumour
Benign
- Osteoid osteoma
- Osteoma
- Osteoblastoma
Malignant
- Osteosarcoma
Name 3 benign and 1 malignant CHONDROCYTE tumour
Chondrocyte (cartilage forming)
Benign
- Chondroma/enchondromas
- Osteochondroma
- Chondroblastoma
Malignant
- Chondreosarcoma
Name 2 malignant BONE MARROW CELL tumour
- Ewing Sarcoma
- Myeloma
Name a benign and malignant Giant Cell/OSTEOCLAST tumour
Benign
- Giant cell tumour/Benign Osteoclastoma
Malignant
- Malignant Giant cell tumour/Malignant osteoclastoma
What red flag would indicate bone cancer?
- Pain worse at night
- Night sweats
- Atypical bony swelling/masses
- Weight loss/loss of appetite
- Pathological fracture
- Mid thoracic pain
- Previous malignancy
- Bone pain in children
Urgent referral in the following cases
- Unexplained bone pain in children or young adult
- Unexplained bone swelling in children or young adult
- Suspicious x-ray
- Xray is clear but Sx persists
Rf for BENIGN Bone cysts/Tumours
- 10-20 years
- male Fx
- Radiation exposure
- occupation
- immune suppression
Sx of benign bone cyst/tumour
- Localised progressive pain
- Pain worse at night
- Typically made better with NSAIDs
- Swelling and tenderness
- Limping
Chondrosarcoma - what is it? common sites? Ix? Tx?
(1. ) 2nd most common primary bone tumour
(2. ) Malignant mass of chondrocytes
(3. ) Common sites = long bones, pelvis, ribs
(4. ) Imaging
- Xray = popcorn calcification
- CT/MRI = large unmineralized soft tissue mass associated with the lesion
(5.) Tx = surgical excision only as it is resistant to chemo and radio
Ewing Sarcoma - what is it? common sites? Sx? Ix? Tx?
(1. ) RF = Second most common in Children and young adults, 10-20yrs old, Caucasian
(2. ) Malignant mass of neural crest cells
(3. ) Common sites = long bones, pelvis, ribs, vertebrae
(4. ) Always high grade
(5. ) Signs and Sx = Painful and enlarging mass, tenderness and warmth
(6. ) Imaging = onion ring signs
(7. ) Tx = Combination of chemo and local surgery +/- radio
(8. ) 70% 3-year survival, lung metastasis in 40%
Common 5 cancers that have bone metastases
breast, lung, prostate, kidney, thyroid
Osteosarcoma pathophysiology
- Most common malignant primary bone tumour
- Bone cancer that leads to the formation of new bones (osteoid)
- Occurs at the end of long bones (metaphysis) surrounding the knee (distal femur or proximal tibia).
Osteosarcoma RF
- More common in children 10-14y or in >65y (typically in those with Paget’s disease)
- Male
- Hx of radiotherapy
- Chemotherapy
Osteosarcoma Presentation
- Local pain and swelling
- Pain worse at rest and at night
- Deep boring pain
- May cause individual to limp
- Initially mild but progresses to severe pain over weeks to months
Osteosarcoma Examination
- If there is a mass present: firm, tender and warm to touch
- Antalgic gait
- Occasionally limited ROM
- Occasionally there may be an overlying skin ulceration
Osteosarcoma Investigations
(1. ) Physical examination
- Localised constant pain and a tender soft tissue mass may be palpable
(2. ) Bloods
- LFT = ALP elevated
- Lactate dehydrogenase (LDH) = elevated
(3. ) X-ray (1st line)
- Medullary and cortical bone destruction (moth eaten appearance)
- Codman’s Triangle - elevation of outer layer of bone from surface
- Sunburst pattern
(4.) Tissue biopsy (diagnostic)
