MSK malignancy

Question 1

What are the symptoms of a patient with metastasis?

Answer 1

Dull pain
Pain worse at night
Constant pain
Sharp pain on weight bearing or straining
Uncontrolled by analgesia
Pathological fractures 
Systemic symptoms
Decreased mobility
Neurological symptoms
Hypercalcaemia
-bone fractures
-stones
-abdo pain
-polyuria, polydipsia, constipation
-psychiatric e.g. depression

Question 2

What are symptoms of multiple myeloma?

Answer 2

Renal impairment
Backache due to pathological fractures
Consequence of bone marrow failure
-anaemia
-thrombocytopenia
-neutropenia

Question 3

What is found on examination?

Answer 3

Bloods

• FBC= low WCC and RBC
• U&Es- renal function
• CRP
• ESR
• Calcium and ALP
• PSA
• LEFT

For MM

• Blood film
• serum and urine electrophoresis

Imaging

• skeletal radioisotope scans
• skeletal XR
• CT/MRI

Question 4

What is the management?

Answer 4

Urgent 2ww
If neurological presentations- A&E
Establish primary

Conservative

• analgesics for pain
• bisphosphonates to decrease fracture risk
• chemo/hormone therapy
• radiotherapy for MM

Surgery

• stabilise long bones to prevent fractures
• arthroplasty for joint involvement
• prophylactic fixation preferred

Question 5

What are the different form of primary bone tumours?

Answer 5

Osteosarcoma
Chondrosarcoma

Primary bone cancer is rare

Normally secondary to breast, prostate, lung, thyroid or kidney

Question 6

What are features of osteosarcoma?

Answer 6

Malignant tumour of osteoblasts
Grow rapidly and invade surrounding soft tissue
Spread to lung early
Poor prognosis

Occurs in children

Knee is common site
Present with pain, swelling, warm palpable mass around knee

Question 7

What are features of chondrosarcoma?

Answer 7

Malignant cartilage forming lesion
Grows slowly and metastasize late
Occurs in adults- pelvic region

Present with pain, mechanical symptoms and sometimes pathological fracture