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.
