Malignancy Flashcards
Name 5 benign bone tumours/disorders?
- osteochondroma
- osteoid osteoma
- enchondroma (more common in young adults)
- bone cysts (more common in children)
- fibrous dysplasia
Name the 3 primary malignant bone tumours?
- osteosarcoma
- Ewing’s sarcoma
- chondrosarcoma
Name 6 tumours that are most likely to metastasise to bone.
- breast
- lung
- prostate
- renal
- thyroid
- bowel
Name 3 haemopoietic diseases?
- myeloma
- leukaemia
- lymphoma
What 3 general conditions can present with a bone lesion?
- infection of the bone
- metabolic bone disease
- cancer of the bone
Where do secondary bone metastases tend to be found?
- in the central skeleton and proximal limbs (hips and shoulders)
Lytic lesion on x-ray (suggestive of malignancy)…
Fibrous dysplasia (x-ray, what is it)…
- x-ray: ‘ground-glass’ appearance
- fibrous dysplasia: not strictly a bone tumour, caused by a developmental abnormality of bone with numerous fibrous proliferations
What blood tests should be done in suspected malignancy of the bone?
- FBC: may show anaemia of chronic disease
- LFTs: to see if liver metastases are present
- Calcium profile: elevated in generalised malignancy
- ALP: elevated in Pagets
- CRP/ESR: elevated in infection or malignancy
- (Prostate-specific antigen (PSA): elevated in prostate malignancy)
- (Carcinoembryonic antigen (CEA): elevated in bowel carcinoma)
Apart from x-rays and blood tests, what other investigations can be done if malignancy is suspected?
- Isotope bone scan: both malignancy and infection will show as hot
- CT: used to confirm osteoid osteoma
- MRI: can detect early metastatic lesions (before x-rays), also used to see the extent of tumours
- Biopsy: provides good detail of the tumour
What is an enchondroma?
- a benign bone lesion of cartilaginous origin
- enchondromas develop from aberrant cartilage (chondroma) left within the bone (‘en’)
- usually found within the metaphysis of long bones (femur or humerus)
Enchondroma and osteochondroma diagram…
What is an osteochondroma?
- the most common benign bone lesion
- develops from aberrant cartilage remaining on the surface of the cortex
What is an osteoid osteoma?
- painful, self-limiting benign bone lesion
- caused by an accumulation of osteoblasts located in the cortex of bone
X-ray and CT image of osteoid osteoma…
What is an osteosarcoma?
- Paget disease or radiation can predispose
- the tumour is highly malignant and secretes osteoid
- local spread occurs quickly, destroying the cortex, but it may also metastasise
- (most common in knee, proximal humerus, femur)
What is the treatment for an osteosarcoma and what is the treatment for a chondrosarcoma?
- BOTH: MDT approach important
- Osteosarcoma: chemotherapy, potentially amputation
- Chondrosarcoma: wide excision sometimes, potentially amputation
What is a chondrosarcoma?
- occurs in older patients (>40yrs)
- symptoms: pain and a lump
- many arise from previous chondromas that have undergone malignant change
- x-ray: ‘fluffy popcorn’ calcification
Mechanism of long-bone metastasis…
What is the conservative management for secondary bone tumours?
- Analgesia and splinting
- radiotherapy / chemotherapy
- IV bisphosphonates: to inhibit osteoclastic resorption of bone
What is the surgical management for secondary bone tumours?
- intramedullary fixation of long bones for fracture or impending fracture
- joint arthroplasty
- spinal cord decompression and stabilisation for acute cord compression
What is the prognosis for secondary bone tumours?
- prognosis depends on the primary tumour
What is lymphoma?
- Lymphoma is a malignant haematopoietic tumour, usually occurring secondarily in bone
- note: primary bone lymphoma has better prognosis
What is haematopoiesis?
- the process through which the body manufactures blood cells
- it occurs within the hematopoietic system (includes organs and tissues such as the bone marrow, liver, and spleen)
What investigations should be done for suspected lymphoma?
- X-ray: shows a long lesion with mottled bony destruction
- Isotope bone scan: excludes further lesions
- Biopsy: confirms diagnosis
- (most commonly affects the pelvis, spine, and ribs)
What is myeloma?
- a tumour, lesions are due to a plasma cell malignancy
- usually found in spine, ribs, or clavicle
- note: poor prognosis
What investigations should be done for suspected myeloma?
- X-ray: shows classic punched-out lytic lesions
- ESR: high
- Urinary analysis: Bence-Jones proteins (light-chain proteins)
What is leukaemia?
- a malignancy of white blood cells
- most common malignancy of childhood
- 1/3 of patients have bone pain
- Leukaemia can present with an acutely hot swollen joint (very similar to septic arthritis)
Ewing’s sarcoma (symptoms, investigations, x-ray)…
- occurs in adolescents (rare)
- symptoms: pain, eythema, mass along long bone diaphysis, systemic symptoms (fever, anaemia)
- investigations: raised ESR and WCC, x-ray
- x-ray shows onion skin periosteal reaction
- (histology: small-cell sarcoma)
Osteosarcoma (symptoms, x-ray)…
- most common primary bone malignancy, occurs mainly in adolescent males
- symptoms: warm, painful swelling, most commonly at knee
- x-ray: periosteal reaction with codman’s triangle and a sunburst appearance
