malignant primary bone tumours

Question 1

when should it be considered?

Answer 1

alongside other forms of primary malignancy

Question 2

what are causes?

Answer 2

most idiopathic

Question 3

who does it occur in?

Answer 3

any age, mainly young - 10% of childhood cancers

Question 4

what are the risk factors?

Answer 4

previous radiotherapy
predisposing conditions: Paget’s, fibrous dysplasia, multiple enchondromas
genetic: Li Fraumeni syndrome (p53), familial retinoblastoma (Rb)

Question 5

what are the symptoms?

Answer 5

presentation often late in disease
higher index of suspicion in younger patients
persistent, increasing pain:
- not assoc. with movement
- well localised
- worse at night
pathological fractures

Question 6

what are the signs?

Answer 6

swelling and erythema over joint (especially in Ewing’s sarcoma)
palpable mass

Question 7

what are the types of malignancy?

Answer 7

multiple myeloma
osteosarcoma
chondrosarcoma
fibrosarcoma and malignant fibrous histiocytoma
Ewing’s sarcoma

Question 8

what investigations are used?

Answer 8

x-ray - 2 views, biopsy, bone scan, CY and MRI for staging

Question 9

what is seen on x-ray?

Answer 9

aggressive and destructive signs - cortical destruction, periosteal reaction, new bone formation, reactive cortical thickening, extension into sounding soft tissue envelope

Question 10

what is biopsy needed for?

Answer 10

histological diagnosis and grading before surgery