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academic weapon > MS1: Tumors > Flashcards

MS1: Tumors Flashcards

1
Q

basic definition of a tumor

A

neoplastic growth of bone tissue - abnormal and uncontrolled

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2
Q

3 most common manifestations of tumors

A

pain
mass
pathologic fracture

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3
Q

general clinical presentation of tumors

A

localized pain or swelling of weeks or months - dull to severe
minor trauma may be initiating event - pathologic fracture

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4
Q

clinical presentation of benign tumors

A

often asymptomatic - mass lang ganun

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5
Q

clinical presentation of malignant tumors

A

mild pain - severe aggravated by activity or at night

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6
Q

what are the goals of diagnostic evaluation

A

establish tissue diagnosis

evaluate disease extent - metastasis

assess feasibility of surgical resection for malignant - limb-sparing surgery

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7
Q

primary choice of imaging

A

xrays

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8
Q

describe xray as imaging for tumors

A

good for differentiating lesions from bone - so na iidentify na if malignant or not

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9
Q

describe MRI as imaging for tumors

A

to define tumor size and intra/extra osseous extent

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10
Q

describe CT scan as imaging for tumors

A

less useful than MRi but for thorax metastasis

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11
Q

explain how bone reacts to the tumor

A

periosteum responds to trauma or pressure from any growth and will deposit new bone

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12
Q

what is solid buttress

A

slow growing tumors on the cortical surface will cause a buttress sa periosteum

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13
Q

what is onion-skin

A

more rapid growth - layered sha tas eroded na cortex

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14
Q

what is spiculated

A

sunburst apperance - verry aggressive tumor perpendicular to cortical surface

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15
Q

what is codman’s triangle

A

rapid advancing neoplastic processes

cortical destruction tas periosteal elevation

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16
Q

discuss the xray finding to the least to most malignant

A

solid buttress - onion skin - sunburst - codman’s

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17
Q

what is the significance of technetium 99

A

screening for focal or multiple skeletal involvement - for distant metastases

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18
Q

indications for biopsy

A

significant doubt if benign or malignant
histologic distinction can alter treatment
confirmation needed before treatment

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19
Q

advantages of needle biopsy

A

no need for GA or OR
readily scheduled
directed to lesion

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20
Q

disadvantages of needle biopsy

A

limited amount of tissue for testing
sampling

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21
Q

what are the 2 types of open or operative biopsy

A

incisional and excisional

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22
Q

what are the systematic approach in diagnosing a tumor

A

age
periosteal reaction
zone of transition
cortical destruction
location and bone involved
single or multiple

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23
Q

compare a small zone of transition to a wide one

A

small - high chance na benign
wide - malignant or infection in bone

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24
Q

how does periosteal reaction help in diagnosis

A

mag rrreact sa tumor - yung kind of reaction can determine if benign or agressive

solid - lamellated - spiculated - codman’s

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25
Q

how does cortical destruction help in diagnosis

A

common finding and not rlly useful to distungish betw malignant and benign

affected cortex = malignancy

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26
Q

how does location help in diagnosis

A

location has common types of tumors kaya pwde mag help to identify

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27
Q

what are benign tumors

A

lacking ability to invade neighboring tissue

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28
Q

what are malignant tumors

A

cancers w ability to invade neighboring tissue or to metastasize - sacroma, myeloma, phoma

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29
Q

what is the enneking system

A

for staging non-metastatic malignant tumors and their extent

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30
Q

stage 1A of enneking system

A

low grade and intra-compartmental

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31
Q

stage 1B of enneking system

A

low grade and extra-compartmental

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32
Q

stage 2B of enneking system

A

high grade and extra-compartmental

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33
Q

stage 2A of enneking system

A

high grade and intra-compartmental

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34
Q

stage 3 of enneking system

A

metastatic

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35
Q

what does intra-compartmental

A

bone, joint, muscle and skin

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36
Q

what does extra-compartmental

A

neurovascular bundles and spaces

paraarticular and paratendon

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37
Q

what are the goals of surgery for primary MSK tumors

A

complete removal of tumor and to preserve or restore limb function

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38
Q

what are the excisions for primary MSK tumors

A

intralesional, marginal, wide and radical

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39
Q

describe intralesional excision

A

for benign tumors

plane of dissection is within the tumor

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40
Q

describe marginal excision

A

for low-grade malignant

plane of dissection is through the pseudo-capsule

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41
Q

describe wide excision

A

for low-high-grade

plane of dissection is in normal tissue bcs tumor is surrounded by cuff of normal tissue

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42
Q

describe radical excision

A

for high-grade

all compartments that contain the tumor is resected - amputation

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43
Q

what is limb salvage

A

usually done in lower ex to preserve function - alternative for amputation

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44
Q

pre-conditions for limb salvage

A

local tumor control
long-term survival
function will be better if not amputated

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45
Q

requisites for limb salvage

A

accurate tumor staging
adequate margins
reconstructible defect
painless function through rehab

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46
Q

what are adjuvant or allied therapy for tumors

A

chemotherapy
radiotherapy
pain management
rehabilitation

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47
Q

what is a chondroma

A

slow growing benign - cartialge

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48
Q

if a chondroma occurs the medullary cavity what is it

A

enchondroma

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49
Q

most common sites for chondroma

A

phalanges

metacarpals and metatarsals

humerus and femur

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50
Q

common population for chondroma

A

20-30 yo

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51
Q

SSx of chondroma

A

slight discomfort

rounded area w decreased density in xray

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52
Q

what is a complication of chondroma

A

may become malignant - chondrosarcoma

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53
Q

where is chondrosarcoma common

A

esp in enchondroma of large tubular bones

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54
Q

treatment or chondroma

A

curretage/excision and packing

55
Q

what is chondroblastoma

A

codmans tumor - cartilage also usually in epiphyseal region

BENIGN

56
Q

common population for chondroblastoma

A

adolescent males

57
Q

common sites for chondroblastoma

A

epiphyseal region of large bones - femur, tibia and humerus

58
Q

clinical features of chondroblastoma

A

gradual pain on motion and LOM

swelling, tenderness and palpable mass

round and ovoid in epiphyseal region sa xray

59
Q

treatment for chondroblastoma

A

curretage and packing w bone grafts

60
Q

most common benign bone tumor

A

osteochondroma

61
Q

common population of osteochondroma

A

10-25 yo

62
Q

common sites for osteochondroma

A

femur and tibia

upper humerus

scapula

63
Q

what is osteochondroma

A

stems out or pedunculate at end of long bones - bony overgrowth

64
Q

SSx of osteochondroma

A

swelling and palpable lump
slight discomfort

65
Q

treatment for osteochondroma

A

no need for surgery if far from joint

but can be removed if loc is natataman bcs of pain

66
Q

what is an osteoid osteoma

A

small solitary lesion in cancellous or cortical bone

reactive bone lesion - from inflamations

67
Q

common population of osteoid osteoma

A

10-25 yo males

68
Q

most common sites for osteoid osteoma

A

femur and tibia
carpal and tarsal
posterior vertebrae

69
Q

SSx of osteoid osteoma

A

aching local pain for several months

stiffness and weakness - limp

pain worst at night - relieved by aspirin

70
Q

treatment of osteoid osteoma

A

excision w bone graft

if no surgery may regress but pain may still persist

71
Q

what is a giant cell tumor

A

slow growing tumor at epiphyseal-metaphyseal regions of long bones but can become aggressive and malignant

AKA osteclastoma

72
Q

most common sites for GCT

A

lower femur
upper tibia
lower radius
sacrum

73
Q

common popu for GCT

A

young adults 20-35 yo.

74
Q

clinical features of GCT

A

swelling and mild pain

sever pain if pathologic fracture

75
Q

most common clinical feature of GCT

A

swelling and mild pain

76
Q

treatment for GCT

A

curettage and bone graft

amputation for malignant

77
Q

what is simple bone cyst

A

slowly growing fluid filled lesion

AKA solitary bones cyst

78
Q

common sites of simple bone cyst

A

proximal metaphysis of humerus - MOST COMMON

metaphysis of femur, tibia and fibula

79
Q

common population of simple bone cyst

A

BOYS

80
Q

SSx of simple bone cyst

A

asymptomatic unless mag karon ng pathologic fracture

single or multilocular in xray

81
Q

simple bone cyst treatment

A

> 10 yo - curretage and bone graft

intralesional corticosteroid injection - 90% healing

82
Q

what is aneurysmal bone cyst

A

uncommon and solitary benign

unknown etiology pero baka disorder of vasculature in bone marrow

cyst in cavernous vascular spaces

83
Q

most common sites for anuerysmal bone cyst

A

posterior vertebrae
long bones

84
Q

most common primary malignant tumor

A

osteogenic sarcoma

85
Q

what is osteogenic sarcoma

A

aggressive tumor w rapid growth and early pulmonary metastasis

86
Q

common complication of osteogenic sarcoma

A

pulmonary metastasis

87
Q

popu of osteogenic sarcoma

A

10-20 yo males

88
Q

osteogenic sarcoma cause

A

unknown but irradiation and paget’s

89
Q

most common sites for osteogenic sarcoma

A

proximal tibia
distal femur
proximal humerus

SA EPIHYSIS or METAPHYSIS

90
Q

clinical features of osteogenic sarcoma

A

dull, constant aching pain - interferes w sleep
tender bony enlargement
LOM and limp
venous distention and high skin temp

sunburts in xray or codmans

91
Q

prognosis for osteogenic sarcoma

A

15-20% - 5 yr survival rate

pulmonary mets are found 1 yr after diagnosis

92
Q

treatment for osteogenic sarcoma

A

wide resection, amputation or limb salvage

chemo after surgery - monitor for mets

93
Q

what is chondrosarcoma

A

malignant tumor from cartilage

94
Q

types of chondrosarcoma

A

central - interior of bones

peripheral - surface of bone

95
Q

popu of chondrosarcoma

A

5th and 6th decade

96
Q

most common sites of chondrosarcoma

A

pelvis and proximal femur

97
Q

clinical features of chondrosarcoma

A

slow growing tumor so slow naman to metastasize

bulky opaque calcification in xray

98
Q

treatment for chondrosarcoma

A

amputation and wide resection

NOT CHEMO OR RADIO SENSITIVE

99
Q

what is ewing’s sarcoma

A

malignant arising from marrow cavity

100
Q

what does ewing’s sarcoma stimulate

A

low grade osteomyelitis

101
Q

popu of ewing’s sarcoma

A

10-25 yo

102
Q

common sites for ewing’s sarcoma

A

matephyseal or diaphyseal

103
Q

clinical features of ewing’s sarcoma

A

pain, fever and leukocytosis
palpable soft tissue mass
metastasis to lungs or other bones

onion skin in xray

104
Q

what is plasma cell myeloma

A

multiple myeloma - highly malignant tumor from bone marrow

105
Q

popu for plasma cell myeloma

A

50-60 yo

106
Q

most common site for plasma cell myeloma

A

axial skeleton - skull, ribs, sternum, vertebrae

107
Q

clinical features for plasma cell myeloma

A

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

108
Q

lab findings for plasma cell myeloma

A

bence jones proteinuria - confirmatory

hypercalcemia, hyperurecemia and anemia

109
Q

treatment for plasma cell myeloma

A

radiotherapy best treatment

pwd immob for pathologic fracture

surgical if compression of pathologic

110
Q

most common tumors metastasizing to bone

A

breast
lungs
prostate
kidney
thyroid

111
Q

most common sites of tumors metastasizing to bone

A

vertebrae and pelvis

femur, skull and humerus

112
Q

clinical features of tumors metastasizing to bone

A

deep aching night pains and pathologic fractures - most common

anemia and elevated ESR

hypercalcemia

elavated acid phospatase if in prostate

113
Q

treatment for tumors metastasizing to bone

A

surgery for weakened bone

radiation - pain relief
endocrine - breast or prostate

114
Q

prognosis for tumors metastasizing to bone

A

generally poor

breast - 2 yrs after metastasis
lungs - few months after metastasis

115
Q

types of tumor of joints

A

synovial chondromastosis

synovial sarcoma

116
Q

synovial chondromatosis

A

knee most common - multiple loose bodies

117
Q

synovial sarcoma

A

only primary malignant tumor within the joints

excision or amputation and radiotherapy

118
Q

discuss occurence of benign muscle tumors

A

uncommon outside of abdomen

119
Q

leiomyosarcoma

A

malignant from smooth muscle - abdominal and pelvic viscera

120
Q

what is rhabdomysarcoma

A

malignant from striated

121
Q

types of rhabdomysarcoma

A

embryonal - most common in children sa face and neck and genitourinary

pleomorphic - adults

122
Q

prognosis and treatment of tumor of muscle

A

metastasis to lungs or lymph nodes are early

radical resections and radiotherapy

123
Q

lipoma

A

common benign fatty tumor - any part of body

excision for cosmetics

124
Q

liposarcoma

A

buttocks or thigh - most common

wide local excision or amputation

recurrence is common tas metastasis to lungs

125
Q

hemangiomas

A

benign vascular lesions - almost any tissue

126
Q

glomus tumor

A

small localized painful lesions beneath nails

excision cures

127
Q

neurilemoma

A

aka schwannoma - benign tumor from scwhann cells

128
Q

malignant schwanomma

A

malignant common in - recklinghausen’s disease

129
Q

nuerofibroma

A

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

130
Q

nuerofibromatosis

A

slow growing non tender but tendency for malignant

from local mechanical pressure

excision

131
Q

clinical features of nuerofibromatosis

A

von recklinghausens or inheriyed
numerous pedunculated soft tissue tumors - outpouching of skin

cafe au lait spots
scoloiosis and limb deformity

in head and neck

132
Q

what are cafe au lait spots

A

small scattered areas of skin pigmentation w smooth edges

133
Q

aka as codmans tumor

A

osteoblastoma

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