Cancer and the Skeleton

Question 1

What is a carcinoma?

Answer 1

A cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.

Question 2

What is a sarcoma?

Answer 2

A malignant tumour of connective or other non-epithelial tissue.

Question 3

How do you classify bone tumours according to the cell of origin?

Answer 3

Bone = osteoid 
Cartilage = chondroid 
Blood = angio 
Muscle = moo
- smooth = leiomyo
- skeletal = rhabdo

Question 4

What is the difference in presentation between benign and malignant tumours?

Answer 4

Margins
Rate of growth
Presence of metastases

Question 5

Which primary bone tumours most commonly occur in the paediatric population?

Answer 5

Aneurysmal bone cyst

Ewing’s sarcoma

Question 6

How does an aneurysmal bone cyst present?

Answer 6

An aneurysmal bone cyst is a blood-filled fibrous tumor-like cyst that expands the bone. It typically occurs in teenagers and can form in virtually any bone in the arms, legs, trunk or skull. The vertebrae and knee are the most common sites.
• pain
• swelling
• a mass that can be felt (sometimes)
• mild to severe neurological problems (if the cyst is in the spine)
• a fracture caused by the cyst (rarely)

Question 7

How does Ewing’s sarcoma present?

Answer 7

• Malignant neoplasm of undifferentiated cells arising within the bone marrow cavity
• Highly malignant
• Pain, swelling and tenderness
• Erythema and warmth
• Osteomyelitis often initial diagnosis

Question 8

What is the typical clinical presentation of primary bone tumours in the adult?

Answer 8

• Localised pain and swelling
• Fasst growing tumour
• Progressive weakness and weight loss
• Skin over the tumour is shiny and stretched with prominent veins
• Warm, tender and ill defined margins

Question 9

How does myeloma usually present?

Answer 9

• Bone damage or loss
• Low blood count
• Decrease in kidney function
• Bone pain
• Pathological fracture

Question 10

What is the difference between sclerotic and lytic lesions?

Answer 10

Sclerotic (pathologic thickening of the bone) - prostate metastases
Lytic (causing soft spots in bone) - breast, lung, thyroid, kidney metastases

Question 11

Describe the diagnostic and staging investigations needed for most suspected primary bone tumours

Answer 11

• Radiological investigations
• Blood tests
• Tumour markers

Question 12

What are the forms of management of primary bone tumours?

Answer 12

Wide surgical excision
Chemotherapy
Reconstruction