December 7, 2015 - MSK Oncology

Question 1

Incidence of Sarcoma

Answer 1

Rare.

Makes up about 1% of all cancers.

Question 2

Presentation of Bone Sarcoma

Answer 2

Wide range of presentations.

Might present with corresponding pain to the aggressiveness of the neoplasm, night pains, or pains that are not alleviated by rest. Swelling or masses can present too.

Rarely asymptomatic

Question 3

Red Flags for Bone Malignancy

Answer 3

Night pain or resting pain

Bone pain with soft tissue mass

Low energy bone fractures

Constitutional symptoms (sometimes)

Question 4

When to Order X-Ray

Answer 4

If you ever suspect anything for MSK, order an X-Ray. It is low radiation and can give you valuable information.

Radiographs should be part of the orthopedic physical exam. If you deny your patient an X-Ray, you deny them a full MSK workup.

Question 5

Big 3 Primary Bone Sarcomas

Answer 5

Osteosarcoma

Chondrosarcoma

Ewing Sarcoma

All have a peak incidence between 10-20 years old when the bones are rapidly growing, and then risk drops off until much later in life.

Question 6

Bone Sarcoma Presentation

Answer 6

Bone pain

Joint pain

Limp

Localized swelling

Fracture (10-15%)

15-20% will present with metastatic disease.

Question 7

Steps for Suspected Osteosarcoma

Answer 7

Protected weightbearing

Local imaging: MRI

Systemic imaging: bone scan & CT chest

Urgent referral to an oncology center

Question 8

Chondrosarcoma

Answer 8

Second most common primary bone sarcoma

Cartilage forming bone tumor

Peak incidence is 40-70 years old

More likely to present in the pelvis

Not chemo or radiation sensitive; purely surgical.

Question 9

Steps for Suspected Chondrosarcoma

Answer 9

Protected weightbearing

Local imaging: MRI

Systemic imaging: bone scan & CT chest

Urgent referral to an oncology center

Three different grades (1, 2, 3)

Question 10

Ewing Sarcoma

Answer 10

Third most common primary bone sarcoma

Cellular proliferation within bone

Pediatric disease with peak incidence of 10-20 years

Most likely to present in pelvis or diaphysis of long bones

Chemo and radiation sensitive.

Question 11

Steps for Suspected Ewing Sarcoma

Answer 11

Protected weightbearing

Local imaging: MRI

Systemic imaging: bone scan, CT chest, and bone marrow aspirate

Urgent referral to an oncology center

Question 12

Chemo and Radiation Sensitivities

Answer 12

Osteosarcoma - chemo sensitive

Chondrosarcoma - not sensitive to any

Ewings Sarcoma - radiation sensitive

Question 13

Skeletal Maturity Girls vs Boys

Answer 13

Girls - 14 years

Boys - 16 years

Question 14

Benign Bone Tumors

Answer 14

Most bone tumors are benign, the sarcomas are RARE.

Some can cause pain, but many are asymptomatic or are incidental findings.

Question 15

Osteochondromas

Answer 15

Bony outgrowths with a cartilage cap.

Benign

Originate from the physis

Stop growing at maturity

Low malignant transformation

Remove only if symptomatic

Question 16

Enchondromas

Answer 16

Benign intramedullary cartilage tumor

“Nest of cartilage cells”

Most common benign bone tumor

Very common incidental finding

Don’t biopsy