Metastatic Bone Disease & Primary Bone Tumours Flashcards
How does cancer spread to bone?
Spread is usually via the blood stream, ocassionally visceral tumours spread directly to adjacent bones.
What are the five most common mets cancers to bone, and indicate whether they are mixed, osteolytic or osteoblastic
- Breast – Mixed
- Prostate - Osteoblastic
- Lung - Osteolytic
- Kidney - Osteolytic
- Thyroid - Osteolytic
Give five examined red flag questions for spinal mets
- Age - new back pain with patient over new back pain with patient over
50 years, or age under 20 years 50 years, or age under 20 years - Previous history of cancer (e.g. Previous history of cancer (e.g.
possible metastases) possible metastases) - Systemic (constitutional) symptoms, ional) symptoms,
e.g. fever, chills, unexplained weight e.g. fever, chills, unexplained weight
loss - Pain that worsens when supine; Pain that worsens when supine;
severe night-time pain; thoracic pain
Give some paediatric red flags for cancer
- Joint swelling Joint swelling
- Bone tenderness to palpation Bone tenderness to palpation
- Muscle Weakness Muscle Weakness
- Fall in height or weight growth Fall in height or weight growth curve
Give five most common primary bone tumours
- Osteosarcoma
o Young adult, history of pain in distal femur/proximal tibia - Chondrosarcoma
o Fourth or fifth decade, history of pain in proximal femur or pelvis - Ewing’s Sarcoma
o Young adult, history of pain in Femur - Lymphoma
o Third or fourth decade, with pain in flat bone, spine or long bones - Giant Cell Tumour
When do you get osteosarcoma
o Young adult, history of pain in distal femur/proximal tibia
Why is it important to measure serum calcium
It is important to measure plasma calcium levels as hypercalcaemia can be caused by tumour osteolysis.
What enzymes may be raised on blood test
ALP
Acid Phosphatase
When and where do you get chondrosarcoma
o Fourth or fifth decade, history of pain in proximal femur or pelvis
When and where do you get Ewing’s Sarcoma?
o Young adult, history of pain in Femur
When and where do you get lymphoma?
o Third or fourth decade, with pain in flat bone, spine or long bones
What is osteosarcoma
Osteosarcoma is an aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma) and that exhibits osteoblastic differentiation and produces malignant osteoid.
What is fiveyear survival osteosarcoma
60% five year survival
What is the management of osteosarcoma
Multidisciplinary team. Tumour excision, limb salvage, multi-agent chemotherapy and radiotherapy.
What is chondrosarcoma
Chondrosarcoma is a cancer composed of cells derived from transformed cells that produce cartilage. Chondrosarcoma is a member of a category of tumours of bone and soft tissue known as sarcomas. About 30% of skeletal system cancers are chondrosarcomas.
What is five-year survival of chondrosarcoma
90% for least aggressive, 10% for most.
How is chondrosarcoma treated
Wide-excision and prosthetic replacement. Tumour does not respond to either radiotherapy or chemotherapy.
What is Ewing’s Sarcoma?
Ewing’s sarcoma or Ewing sarcoma is a malignant small, round, blue cell tumour. It is a rare disease in which cancer cells are found in the bone or in soft tissue. The most common areas in which it occurs are the pelvis, the femur, the humerus, the ribs and clavicle (collar bone).
What is the five-year survival for Ewing’s
70% five year survival rate for non-metastatic disease.
What is the management for Ewing’s?
Prognosis is always poor and surgery does little to improve it. Radiotherapy has a dramatic effect on the tumour but overall survival is not much enhanced. Chemotherapy is the best option.
What are two types of bone biopsy?
- Needle
Open biopsy
What is the bone scan you should do in possible mets?
- X-rays
- Radionuclide scans
- CT
- MRI
When is bone biopsy done?
Bone biopsy should be performed once all imaging is done, so as not to interfere with staging, margin measuring and surgical planning.
What precautions are taken in bone biopsy?
The biopsy can be delivered through needle or open biopsy, and is usually done so as little as the tumour as possible is exposed. If bone is removed the raw area is covered with bone wax or cement.
Give four complications of bone biopsy
Complications of biopsy include haemorrhage, wound breakdown, infection and pathological fracture, and should be performed by someone who knows what they’re doing.
