Bony Metastasis- Week 13 PBL

Question 1

4 types of Primary bone tumours?

Answer 1

Bone: Osteosarcoma
Cartilage: Chondrosarcoma
Fibrous tissue: fibrosarcoma
Bone marrow: Ewing’s sarcoma / myeloma

Question 2

Who does osteosarcoma, chondrosarcoma present in?

Answer 2

Osteosarcoma - under age of 20
Chondrosarcoma - in 40s

Question 3

Which cancers are most likely to metastasise into bone?

Answer 3

Myeloma (bone marrow cancer)
Breast
Thyroid
Kidney
Lungs
Prostate

Question 4

What type of tumour is bony metastasis?

Answer 4

Secondary tumour

Question 5

Describe the metastatic process?

Answer 5

Three phases

1) break away of cancer cells from the primary tumour
2) adhesion to and invasion into a distant organ
3) settlement in bone micro environment causing osteolytic or osteoblastic disease

Question 6

Presentation of bone pain?

Answer 6

Pain
Pathological fractures
Spinal chord compressions
Pain worse at night

Question 7

Investigation of bone metastasis?

Answer 7

High ALP
Plain X-ray film
CT for clear bone structure
MRI for soft tissues
Biopsy

Question 8

Management and prognosis of bone metastasis ?

Answer 8

Pain relief - IV bisphosphonates
Skeletal stabilisiation if needed (surgery)
Chemo
Radiotherapy