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Surg Dz > Malignant Bone Tumors > Flashcards

Malignant Bone Tumors Flashcards

1
Q

Periosteum

A

Thick, fibrous membrane covering outer surface of the bone; serves as attachment for muscles and tendons

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2
Q

Endosteum

A

Layer of cells lining the inner surface of bone in the central medullary cavity

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3
Q

Marrow cavity

A

Contains the bone marrow in the diaphysis

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4
Q

Nutrient foramen

A

External opening for entrance of blood vessels in a bone

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5
Q

Red bone marrow

A

Marrow containing the developmental stages of erythrocytes, leukocytes, and is megakaryocytic. Gradually replaced by yellow marrow

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6
Q

Yellow bone marrow

A

Storage layer, reticular network filled with fat. Contains abundant capillaries and specialized lipid storage tissue. Replaces red marrow early in life but can convert to haemotopoetic red marrow in severe blood loss

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7
Q

Compact (cortical) bone

A

Dense, rigid outer shell of bones formed from osteons (formed from osteoclasts and osteoblasts)

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8
Q

Spongy (cancellous) bone

A

Porous, highly vascularized bone containing red bone marrow

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9
Q

Primary bone tumor

A

Originates in the bone (benign/malignant)

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10
Q

Secondary bone tumor

A

Originates elsewhere and metastasizes to bone

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11
Q

Chondro

A

Cartilage

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12
Q

Osteo

A

Bone

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13
Q

Curettage

A

Special instruments used to scrape the tumor out of the bone

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14
Q

Bone graft

A

After curettage, filling the cavity with a bone graft to help stabilize the bone. A bone graft is either taken from a donor (allograft) or from another bone in your body (autograft)—most often the pelvis

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15
Q

Primary Bone Cancer

A

Tumors of mesenchymal (adult stem cell) origin that reflect skeletal tissues (bone, cartilage, connective tissue) and tumors developing in bones that are hematopoietic, nerve, vascular, fat cell, and notochordal origin.

Can be benign or malignant.

Can grow rapidly and metastasize widely, but more are benign and rarely metastasize

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16
Q

Is Primary Bone Cancer common ?

A

Primary bone cancer is relatively uncommon in comparison with secondary or metastatic neoplasms

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17
Q

Where do most metastatic bone cancers arise from?

A

Prostate, breast, kidney, thyroid, and lung.

PbKTL= “lead kettle”

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18
Q

What are risk factors for primary bone cancer?

A 
—Retinoblastoma
—Li Fraumeni syndrome
—Rothmund Thomas syndrome
—Werner syndrome
—Pagets disease
—Radiation exposure
—Fibrous dysplasia
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19
Q

What are the s/sx of primary bone cancer?

A

Many can be asymptomatic

Pain, usually in the area of the tumor
—Persistent
—Dull, achy
—Worse at night **Hallmark of primary bone tumors**
—Increased with activity
Others:
—Fever
—Night sweats
—Injury in the area, possible fracture
—swelling
—tenderness
—skin changes
—+/- limited ROM
—Fatigue, anorexia, weight loss
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20
Q

What’s the best initial imaging diagnostic study for primary bone cancer?

A

X rays:
—radiographs are the best initial modality for evaluation of primary bone lesions, viewed in at least 2 planes
—looking for evidence of erosion, bone formation, or fracture
—Primary malignant cancer shows cortical destruction, radiolucency, extraosseous extension, permitting destruction with poorly defined borders

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21
Q

What’s the imaging modality of choice if a malignant bone tumor is suspected in primary bone cancer?

A

MRI
—Modality of choice when malignant bone tumor suspected
—Provides best contrast resolution for demonstrating soft tissue masses and invasion of adjacent structures

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22
Q

What are the different imaging modalities you can use for suspected primary bone cancer?

A

X rays

MRI

CT

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23
Q

What does CT do for diagnosing primary bone cancer?

A

—Better defines location (periosteal, cortex, medullary)
—More accurately evaluate changes (focal destruction or endosteal scalloping)
—Better delineate matrix mineralization
—Better guide therapy

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24
Q

What other diagnostic studies/labs do you get for suspected primary bone cancer?

A

—Bone scan
—CBC, Urinalysis to R/O other pathology
—Biopsy: either needle biopsy or an open biopsy in operating room

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25
Q

Characteristics of Malignant (or aggressive non malignant) primary bone cancer

A

Border= Poorly defined

Periosteal reaction= often present e.g spiculated, interrupted, wedge shaped.
—The absence of periosteal rxn does not exclude malignant lesion

Cortical destruction= typical moth eaten or permeative pattern

Extension- Extends into the soft tissues

26
Q

Characteristics of Non malignant and non aggressive primary bone cancers

A

Border= well defined or sclerotic border
—sharp zone of transition from normal to abnormal bone

Periosteal rxn= absent

Cortical destruction= usually absent

Extension= Confined by natural barriers like the growth plate or cortex, and does not extend into the soft tissues

27
Q

What are the 3 primary Malignant bone tumor types?

A

Osteosarcoma

Chondrosarcoma

Ewings Sarcoma

28
Q

Primary malignant bone tumors represent how many cancer cases in the US?

A

0.2% of cases in the US

2,900 cases annually

29
Q

What is Osteosarcoma?

A

—The most common primary bone cancer (including children)
—Prevalence is 2-5 people per 1 million each year
—Age: mostly children and teenagers
—Location= most common in the femur and tibia (around the knee) at the growth plates
—Usually appears after a sports related injury

30
Q

What do Osteosarcoma labs look like?

A

Elevated serum alkaline phosphatase (broken/remodeled bone)

Can be used to assess response to chemotherapy

31
Q

How do you confirm a diagnosis of Osteosarcoma?

A

Biopsy needed to confirm. Shows a “spindle shaped” appearance

32
Q

What is the treatment for Osteosarcoma?

A

Chemotherapy and surgical resection

33
Q

What Are osteosarcoma characteristics on x ray?

A

SUN RAY or SUN BURST appearance: the formation of new bone

—Presence of Codman triangle: elevation of periosteum from the bone surface

—Cumulus cloud appearance/Cloud like lesions

34
Q

What is Chrondrosarcoma?

A

Primary Malignant tumor composed of cartilage producing cells.

Located around the pelvis, proximal femur, hip, or shoulders.
Generally located in the metaphases of long bones

35
Q

What are the sx of Chondrosarcoma?

A

Progressive pain, constant, not relieved with rest, and slow growing

36
Q

How do you diagnose Chrondrosarcoma?

A

X ray, CT, MRI, and biopsy

37
Q

Is there a significant difference in 10 year survival rates between low grade and high grade lesions in chondrosarcoma?

A

Yes

38
Q

Less than 1% of solitary _______ and ______ dedifferentiate into chondrosarcomas

A

— enchondromas

—Osteochondromas

39
Q

What patients have a definable risk for developing secondary chondrosarcomas?

A

Only patients with HMO (Hereditary Multiple Osteochondromas) have a definable risk for developing secondary chondrosarcoma

40
Q

What is the treatment for Chondrosarcoma?

A

Surgery is the only definitive treatment

41
Q

What is an aggressive variant of chondrosarcoma that is seen in younger patients?

A

Mesenchymal chondrosarcoma

42
Q

What does the prognosis of chondrosarcoma depend on?

A

Prognosis depends on grade and location

Patients with pelvic chondrosarcoma have a poorer prognosis than those in the extremity

43
Q

What is Ewing’s sarcoma?

A

The second most common bone tumor in children and young adults> between ages 5 and 20 most commonly.

Unknown cause or type of cell. Known to occur in a mismatching of chromosomes 11 and 22, occurring after birth

44
Q

What labs are done for Ewings Sarcoma?

A

Serum lactate dehydrogenase will be elevated

45
Q

What does a biopsy of Ewing’s sarcoma show?

A

Round cell tumors

46
Q

Does Ewing’s sarcoma have a risk of metastasizing?

A

Yes

47
Q

What is treatment for Ewing’s sarcoma?

A

Combination= chemo, radiation, surgery (multiple specialists)

48
Q

What does an X ray of Ewing’s sarcoma show?

A

ONION PEEL EFFECT or “onion skinning”

Also bone destruction

49
Q

What is Multiple Myeloma?

A

a malignant tumor of the BONE MARROW, where cells come from changed plasma cells. Tends to involve the entire skeleton (infiltrates all bone marrow)
**Typically occurs spontaneously

Named for the clock face appearance of cells under the microscope

50
Q

What is the prevalence of Multiple Myeloma?

A

7 people per 100,000 each year

Mostly ages 50s-70s

M>F

2:1 African American: Caucasian

51
Q

What are risk factors for Multiple Myeloma?

A 
Typically occurs spontaneously but risk factors are 
—Radiation
—Dioxin
—HIV
—Herpesvirus 8
52
Q

What are the sx of Multiple Myeloma?

A

Diffuse bone tenderness in sternum and hips.

Pathologic fractures are common — Spine most common (spinal cord compression)

53
Q

What is treatment for Multiple Myeloma?

A

Multiple myeloma is not curable. Chemotherapy may prolong life expectancy and decrease sx
—Melphalan=chemo drug
+ Prednisone

54
Q

What do multiple myeloma x rays look like?

A

PUNCHED OUT LESIONS of the bone “Plasma cell myeloma”

55
Q

What is Fibrosarcoma?

A

Malignant tumor derived from nonosteoblastic connective tissue.
Majority are high grade

56
Q

What populations do you see fibrosarcoma in?

A

Usually older pts >50yo

Infants: Most cases are congenital, almost never after 2 yo

57
Q

What are sx of fibrosarcoma?

A

Pain and swelling

58
Q

What do radiographs of fibrosarcoma show?

A

Lytic lesion with bone destruction, ill defined features

Hot bone scan

59
Q

What is the treatment for fibrosarcoma?

A

Wide surgical resection and chemotherapy if high grade

60
Q

What is the prognosis for fibrosarcoma?

A

Poor

High grade 30% 5 year survival

Low grade 80% survival at 10 years

Surg Dz (9 decks)

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