MS1: Tumors Flashcards
basic definition of a tumor
neoplastic growth of bone tissue - abnormal and uncontrolled
3 most common manifestations of tumors
pain
mass
pathologic fracture
general clinical presentation of tumors
localized pain or swelling of weeks or months - dull to severe
minor trauma may be initiating event - pathologic fracture
clinical presentation of benign tumors
often asymptomatic - mass lang ganun
clinical presentation of malignant tumors
mild pain - severe aggravated by activity or at night
what are the goals of diagnostic evaluation
establish tissue diagnosis
evaluate disease extent - metastasis
assess feasibility of surgical resection for malignant - limb-sparing surgery
primary choice of imaging
xrays
describe xray as imaging for tumors
good for differentiating lesions from bone - so na iidentify na if malignant or not
describe MRI as imaging for tumors
to define tumor size and intra/extra osseous extent
describe CT scan as imaging for tumors
less useful than MRi but for thorax metastasis
explain how bone reacts to the tumor
periosteum responds to trauma or pressure from any growth and will deposit new bone
what is solid buttress
slow growing tumors on the cortical surface will cause a buttress sa periosteum
what is onion-skin
more rapid growth - layered sha tas eroded na cortex
what is spiculated
sunburst apperance - verry aggressive tumor perpendicular to cortical surface
what is codman’s triangle
rapid advancing neoplastic processes
cortical destruction tas periosteal elevation
discuss the xray finding to the least to most malignant
solid buttress - onion skin - sunburst - codman’s
what is the significance of technetium 99
screening for focal or multiple skeletal involvement - for distant metastases
indications for biopsy
significant doubt if benign or malignant
histologic distinction can alter treatment
confirmation needed before treatment
advantages of needle biopsy
no need for GA or OR
readily scheduled
directed to lesion
disadvantages of needle biopsy
limited amount of tissue for testing
sampling
what are the 2 types of open or operative biopsy
incisional and excisional
what are the systematic approach in diagnosing a tumor
age
periosteal reaction
zone of transition
cortical destruction
location and bone involved
single or multiple
compare a small zone of transition to a wide one
small - high chance na benign
wide - malignant or infection in bone
how does periosteal reaction help in diagnosis
mag rrreact sa tumor - yung kind of reaction can determine if benign or agressive
solid - lamellated - spiculated - codman’s
how does cortical destruction help in diagnosis
common finding and not rlly useful to distungish betw malignant and benign
affected cortex = malignancy
how does location help in diagnosis
location has common types of tumors kaya pwde mag help to identify
what are benign tumors
lacking ability to invade neighboring tissue
what are malignant tumors
cancers w ability to invade neighboring tissue or to metastasize - sacroma, myeloma, phoma
what is the enneking system
for staging non-metastatic malignant tumors and their extent
stage 1A of enneking system
low grade and intra-compartmental
stage 1B of enneking system
low grade and extra-compartmental
stage 2B of enneking system
high grade and extra-compartmental
stage 2A of enneking system
high grade and intra-compartmental
stage 3 of enneking system
metastatic
what does intra-compartmental
bone, joint, muscle and skin
what does extra-compartmental
neurovascular bundles and spaces
paraarticular and paratendon
what are the goals of surgery for primary MSK tumors
complete removal of tumor and to preserve or restore limb function
what are the excisions for primary MSK tumors
intralesional, marginal, wide and radical
describe intralesional excision
for benign tumors
plane of dissection is within the tumor
describe marginal excision
for low-grade malignant
plane of dissection is through the pseudo-capsule
describe wide excision
for low-high-grade
plane of dissection is in normal tissue bcs tumor is surrounded by cuff of normal tissue
describe radical excision
for high-grade
all compartments that contain the tumor is resected - amputation
what is limb salvage
usually done in lower ex to preserve function - alternative for amputation
pre-conditions for limb salvage
local tumor control
long-term survival
function will be better if not amputated
requisites for limb salvage
accurate tumor staging
adequate margins
reconstructible defect
painless function through rehab
what are adjuvant or allied therapy for tumors
chemotherapy
radiotherapy
pain management
rehabilitation
what is a chondroma
slow growing benign - cartialge
if a chondroma occurs the medullary cavity what is it
enchondroma
most common sites for chondroma
phalanges
metacarpals and metatarsals
humerus and femur
common population for chondroma
20-30 yo
SSx of chondroma
slight discomfort
rounded area w decreased density in xray
what is a complication of chondroma
may become malignant - chondrosarcoma
where is chondrosarcoma common
esp in enchondroma of large tubular bones
treatment or chondroma
curretage/excision and packing
what is chondroblastoma
codmans tumor - cartilage also usually in epiphyseal region
BENIGN
common population for chondroblastoma
adolescent males
common sites for chondroblastoma
epiphyseal region of large bones - femur, tibia and humerus
clinical features of chondroblastoma
gradual pain on motion and LOM
swelling, tenderness and palpable mass
round and ovoid in epiphyseal region sa xray
treatment for chondroblastoma
curretage and packing w bone grafts
most common benign bone tumor
osteochondroma
common population of osteochondroma
10-25 yo
common sites for osteochondroma
femur and tibia
upper humerus
scapula
what is osteochondroma
stems out or pedunculate at end of long bones - bony overgrowth
SSx of osteochondroma
swelling and palpable lump
slight discomfort
treatment for osteochondroma
no need for surgery if far from joint
but can be removed if loc is natataman bcs of pain
what is an osteoid osteoma
small solitary lesion in cancellous or cortical bone
reactive bone lesion - from inflamations
common population of osteoid osteoma
10-25 yo males
most common sites for osteoid osteoma
femur and tibia
carpal and tarsal
posterior vertebrae
SSx of osteoid osteoma
aching local pain for several months
stiffness and weakness - limp
pain worst at night - relieved by aspirin
treatment of osteoid osteoma
excision w bone graft
if no surgery may regress but pain may still persist
what is a giant cell tumor
slow growing tumor at epiphyseal-metaphyseal regions of long bones but can become aggressive and malignant
AKA osteclastoma
most common sites for GCT
lower femur
upper tibia
lower radius
sacrum
common popu for GCT
young adults 20-35 yo.
clinical features of GCT
swelling and mild pain
sever pain if pathologic fracture
most common clinical feature of GCT
swelling and mild pain
treatment for GCT
curettage and bone graft
amputation for malignant
what is simple bone cyst
slowly growing fluid filled lesion
AKA solitary bones cyst
common sites of simple bone cyst
proximal metaphysis of humerus - MOST COMMON
metaphysis of femur, tibia and fibula
common population of simple bone cyst
BOYS
SSx of simple bone cyst
asymptomatic unless mag karon ng pathologic fracture
single or multilocular in xray
simple bone cyst treatment
> 10 yo - curretage and bone graft
intralesional corticosteroid injection - 90% healing
what is aneurysmal bone cyst
uncommon and solitary benign
unknown etiology pero baka disorder of vasculature in bone marrow
cyst in cavernous vascular spaces
most common sites for anuerysmal bone cyst
posterior vertebrae
long bones
most common primary malignant tumor
osteogenic sarcoma
what is osteogenic sarcoma
aggressive tumor w rapid growth and early pulmonary metastasis
common complication of osteogenic sarcoma
pulmonary metastasis
popu of osteogenic sarcoma
10-20 yo males
osteogenic sarcoma cause
unknown but irradiation and paget’s
most common sites for osteogenic sarcoma
proximal tibia
distal femur
proximal humerus
SA EPIHYSIS or METAPHYSIS
clinical features of osteogenic sarcoma
dull, constant aching pain - interferes w sleep
tender bony enlargement
LOM and limp
venous distention and high skin temp
sunburts in xray or codmans
prognosis for osteogenic sarcoma
15-20% - 5 yr survival rate
pulmonary mets are found 1 yr after diagnosis
treatment for osteogenic sarcoma
wide resection, amputation or limb salvage
chemo after surgery - monitor for mets
what is chondrosarcoma
malignant tumor from cartilage
types of chondrosarcoma
central - interior of bones
peripheral - surface of bone
popu of chondrosarcoma
5th and 6th decade
most common sites of chondrosarcoma
pelvis and proximal femur
clinical features of chondrosarcoma
slow growing tumor so slow naman to metastasize
bulky opaque calcification in xray
treatment for chondrosarcoma
amputation and wide resection
NOT CHEMO OR RADIO SENSITIVE
what is ewing’s sarcoma
malignant arising from marrow cavity
what does ewing’s sarcoma stimulate
low grade osteomyelitis
popu of ewing’s sarcoma
10-25 yo
common sites for ewing’s sarcoma
matephyseal or diaphyseal
clinical features of ewing’s sarcoma
pain, fever and leukocytosis
palpable soft tissue mass
metastasis to lungs or other bones
onion skin in xray
what is plasma cell myeloma
multiple myeloma - highly malignant tumor from bone marrow
popu for plasma cell myeloma
50-60 yo
most common site for plasma cell myeloma
axial skeleton - skull, ribs, sternum, vertebrae
clinical features for plasma cell myeloma
not early symptoms
insidious vague pain and swelling - sa lahat masakit
pathologic fracture - 1st manifestation
back pain - 1st complain
scusceptibility to bacterial infecitons
punch out lesions in xray
lab findings for plasma cell myeloma
bence jones proteinuria - confirmatory
hypercalcemia, hyperurecemia and anemia
treatment for plasma cell myeloma
radiotherapy best treatment
pwd immob for pathologic fracture
surgical if compression of pathologic
most common tumors metastasizing to bone
breast
lungs
prostate
kidney
thyroid
most common sites of tumors metastasizing to bone
vertebrae and pelvis
femur, skull and humerus
clinical features of tumors metastasizing to bone
deep aching night pains and pathologic fractures - most common
anemia and elevated ESR
hypercalcemia
elavated acid phospatase if in prostate
treatment for tumors metastasizing to bone
surgery for weakened bone
radiation - pain relief
endocrine - breast or prostate
prognosis for tumors metastasizing to bone
generally poor
breast - 2 yrs after metastasis
lungs - few months after metastasis
types of tumor of joints
synovial chondromastosis
synovial sarcoma
synovial chondromatosis
knee most common - multiple loose bodies
synovial sarcoma
only primary malignant tumor within the joints
excision or amputation and radiotherapy
discuss occurence of benign muscle tumors
uncommon outside of abdomen
leiomyosarcoma
malignant from smooth muscle - abdominal and pelvic viscera
what is rhabdomysarcoma
malignant from striated
types of rhabdomysarcoma
embryonal - most common in children sa face and neck and genitourinary
pleomorphic - adults
prognosis and treatment of tumor of muscle
metastasis to lungs or lymph nodes are early
radical resections and radiotherapy
lipoma
common benign fatty tumor - any part of body
excision for cosmetics
liposarcoma
buttocks or thigh - most common
wide local excision or amputation
recurrence is common tas metastasis to lungs
hemangiomas
benign vascular lesions - almost any tissue
glomus tumor
small localized painful lesions beneath nails
excision cures
neurilemoma
aka schwannoma - benign tumor from scwhann cells
malignant schwanomma
malignant common in - recklinghausen’s disease
nuerofibroma
non-encapsulated tumors - firm and non-tender
slow growing and maybe attached to larger nerves
surgical if may nerve irritations or block
amputation in advanced
nuerofibromatosis
slow growing non tender but tendency for malignant
from local mechanical pressure
excision
clinical features of nuerofibromatosis
von recklinghausens or inheriyed
numerous pedunculated soft tissue tumors - outpouching of skin
cafe au lait spots
scoloiosis and limb deformity
in head and neck
what are cafe au lait spots
small scattered areas of skin pigmentation w smooth edges
aka as codmans tumor
osteoblastoma
