MSK tumours

Question 1

What “red flags” in the history may suggest bone malignancy?

Answer 1

Unexplained constant, severe skeletal pain which is worse at night
Extremes of age
Systemic symptoms e.g. weight loss, loss of appetite, fatigue

Question 2

What signs may be seen on X-ray in primary bone malignancy?

Answer 2

Cortical destruction
Sclerosis
Periosteal reaction
Extension into surrounding soft tissue

Question 3

What is the most common primary bone malignancy?

Answer 3

Osteosarcoma

Question 4

Which age groups are most commonly affected by osteosarcoma?

Answer 4

Adolescence and early adulthood

Question 5

What are the most commonly affected sites in osteosarcoma?

Answer 5

Knee (60%)
Pelvis
Proximal femur
Proximal humerus

Question 6

How does chondrosarcoma differ from osteosarcoma?

Answer 6

Produces cartilage
Affects older people (mean age 45)
More aggressive (unresponsive to chemo/radio)
Less common

Question 7

What name is given to malignant tumours of the marrow endothelium? How do these present?

Answer 7

Ewing’s sarcoma

Present like osteomyelitis- fever, raised inf. markers, warm swelling

Question 8

How are primary bone tumours typically treated?

Answer 8

Wide margin removal of bone and surrounding muscle
Joint reconstruction/replacement
+/- adjuvant chemo/radio

Question 9

How are bone tumours typically staged?

Answer 9

Bone scan

Chest CT

Question 10

In order of frequency, which primary tumours commonly metastasize to bone?

Answer 10

Breast
Prostate
Lung
Renal
Thyroid

Question 11

What kind of bone metastases does prostate cancer produce? What does this mean for pathological fracture healing?

Answer 11

Sclerotic. Means that fractures are more likely to heal due to osteoblast activity

Question 12

What kind of metastases does lung cancer produce? What is the mean survival once these are present?

Answer 12

Lytic. 6 months

Question 13

What kind of primary tumour gives rise to highly vascularised “blow-out” lytic bone metastases?

Answer 13

Renal cell carcinoma

Question 14

Which bones are most commonly involved in metastases?

Answer 14

Vertebrae
Skull
Humerus
Long bones of lower limb
Pelvis
Ribs

Question 15

What blood tests may be carried out when malignancy is suspected, and where appropriate, why?

Answer 15

Serum calcium (for hypercalcaemia)
LFTs (liver mets)
Plasma protein electrophoresis (myeloma)
Full blood count
U&Es