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MSK malignancy Flashcards

1
Q

Which types of bone and surrounding tissue tumours are rare?

A

primary malignant bone tumours

tumours of soft tissue

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2
Q

Which is the most common tumour pathology of bone ?

A

bone mets

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3
Q

which sarcomas affect adolescents?

A

osteosarcoma

Ewing’s sarcoma

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4
Q

Give an example of a sarcoma whose incidence increases with age

A

chondrosarcoma

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5
Q

what is a sarcoma?

A

malignant tumour of connective tissue

think connection is when things ‘SAR COMing together’

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6
Q

what is a carcinoma?

A

malignant epithelial/endothelial tumour

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7
Q

Are sarcomas more common in males or females?

A

males

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8
Q

Are soft tissue tumours more common in males or females?

A

equal distribution between makes and females

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9
Q

what age group tends to get the most soft tissue tumours?

A

incidence increases with age - peaks at 64-80 yrs old

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10
Q

What features of a history are important in MSK tumours?

A

age = epidemiology
presenting complaint - mass, growing in size?, pain, loss of function, socrates
history of PC - duration of symptoms, full pain/mass history, how the issue came pt the pt’s attention, anything that makes it worse/better, lump in more than one site?
PMH
DH- drugs and drug history
FH
SH - current level of function? - affects treatment and epidemiology

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11
Q

What are the red flags for MSK tumours?

A 
pain at rest 
pain at night 
lump present - tender, enlarging, deep to fascia and above 5cm in diameter 
loss of function
neurological symptoms 
unwell/weight loss
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12
Q

What are the aspects of examination for MSK tumours?

A

look, feel, move

  • look at the pt as a whole, look at all four limbs, how they walk, lumps, scars, transilluminescence
  • feel - for masses, size, shape, painful, smooth, irregular, tethered to skin or deep tissues
  • move - what function do they have when they move, range of motion, neurovascular status
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13
Q

What initial investigations are done for MSK tumours?

A 
blood tests - FBC, U/E, Ca2+, ALP
XR
ultrasound 
CT
MRI
Technetium bone scan
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14
Q

If someone has widespread bone mets, what will happen to their calcium?

A

it will be high

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15
Q

What is a CT scan good for here?

A 
assessing bone quality 
solid tumours 
staging using CT chest, abdo, pelvis if mets suspected 
3D reconstruction of bony lesions
helps plan for surgery
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16
Q

What is an MRI scan good for here?

A

reactive changes of soft tissue/ bone marrow
periosteal and endosteal reactions
skip lesions
can do whole body MRI to stage

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17
Q

what is a technetium bone scan good for?

A

assessing skeletal mets
can see how fast blood is flowing into a lesion, whether there is capillary dilation ie inflammation around a lesion, whether there is increased bone turnover

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18
Q

What is an XR good for here?

A

can look at the bone density, zone of transition, periosteal reaction
lytic or sclerotic (benign)
is the border well defined or irregular
can distinguish between benign and malignant

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19
Q

What are the characteristics of a malignant bone tumour on XR?

A

periosteal reaction
wide zone of transition (from abnormal bone to normal bone)
increased density
ill-defined lesion

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20
Q

What are the special signs of periosteal reactions seen on XR?

A

Codman’s Triangle
Sunburst appearance
Onion-skin appearance

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21
Q

Is the tumour likely to be benign or malignant with sunburst appearance?

A

malignant

22
Q

In which cancers is the sunburst appearance seen?

A

osteosarcoma

Ewing’s

23
Q

what is ultrasound scan good for here?

A

assessing soft tissues

can differentiate normal and abnormal and solid V. cystic

24
Q

How is a technetium bone scan taken?

A

Inject the radioactive isotope and the gamma camera takes pictures at different times

25
Q

what should you do if you suspect a primary bone or soft tissue sarcoma?

A

discuss the pt with MDT before proceeding with ANY invasive intervention

26
Q

If a malignant process is found to be occurring, what is the next line of investigation?

A

biopsy

27
Q

What are the principles of taking a biopsy for MSK tumours?

A
  • needs to be done by the operating surgeon or consultant radiologist in the specialist centre where the operation will be carried out
  • longitudinal incision in line with the planned incision for future surgical procedure
  • shortest route to tumour, ie little soft tissue disturbance
  • Access only one muscular compartment
  • Ensure sample(s) is representative of tumour
  • Meticulous Haemostasis (also, use a Tourniquet)
  • Drain to be placed in line with Incision
  • Send sample(s) to BOTH Histology and Microbiology
28
Q

How is local staging done?

A

XR of the WHOLE bone

MRI to assess skip lesions

29
Q

What scans are good for staging distally?

A

CT chest, abdo, pelvis
technetium bone scans
whole body MRI

30
Q

how are MALIGNANT MSK tumours GRADED?

A

by the Enneking system
G0 - histologically benign
G1 - low grade malignant
G2 - high grade malignant

31
Q

What does G0 mean in grading?

A

histologically benign, well differentiated, resembling the cell of origin, low mitotic count

32
Q

What does G1 mean in grading?

A 
low grade malignant 
moderate differentiation
few mitosis 
local spread only 
low risk of mets
33
Q

what does G2 mean in in grading?

A

high grade malignant
poorly differentiated - don’t look anything like their tissue of origin
frequent mitoses
high risk of mets

34
Q

how are BENIGN MSK tumours GRADED?

A

Grade 1 - latent
grade 2 - active
grade 3 - aggressive

35
Q

What does grade 1 benign mean?

A

LATENT
well defined margin
grows slowly and then stops
may heal spontaneously very low risk of recurrence

36
Q

What does grade 2 benign mean?

A

ACTIVE
progressive growth limited by natural barriers
well defined margin but may expand and thin cortical bone
negligible recurrence after marginal resection

37
Q

What does grade 3 benign mean?

A

AGGRESSIVE
growth not limited by natural barriers eg GCT
mets present in 5% of pts
high recurrence after marginal resection, so extended resection is needed

38
Q

How are malignant MSK tumours STAGED?

A

TNM system

39
Q

What does the prefix ‘rhabdomyo-‘ mean?

A

smooth muscle

40
Q

What does the prefix of a tumour tell you?

A

the tissue of origin eg chondro-, osteo-, lipo-, rhabdomyo-

41
Q

what does the suffix of a tumour tell you?

A

whether it is benign or malignant eg -oma, -carcinoma, -sarcoma, -blastoma

42
Q

What happens if the tissue of origin is unclear?

A

the tumour will be described by its cellular appearance eg small cell carcinoma

43
Q

If the tumour doesn’t resemble any kind of normal tissue, what is it called?

A

pleomorphic

44
Q

Which type of tumours tend to permeate through bone, benign or malignant?

A

malignant

45
Q

Which types of tumour tend to have a sclerotic rim, benign or malignant?

A

benign

46
Q

What steps would you go through when describing an XR with a suspected tumour?

A 
Name, DOB, time the XR was taken 
Describe radiographic view 
Describe anatomical location
Epiphysis / metaphysis / diaphysis
Bone forming / cartlilage forming
Bone destruction / bone reaction
Talk about the zone of transition
47
Q

Name 3 types of bone cysts in children

A

Unicameral Bone Cyst (UBC)
Aneurysmal Bone Cyst (ABC)
Fibrous dysplasia

48
Q

Name 3 types of destructive bone lesion in a young adult ie adolescent

A

osteosarcoma
Ewings
giant cell tumour

infection is a differential

49
Q

Name 6 types of destructive lesion in over 50s

A 
osteosarcoma 
chrondrosarcoma 
mets 
myeloma/lymphoma 
GCT

differential is infection

50
Q

In which part of the bone is mets most likely to occur and why?

A

in the metaphysis as this is where there is anastamoses ie good blood supply to the bone

MSK (12 decks)

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