Musculoskeletal Malignancy

Question 1

What is the most common cause of destructive bone disease in adults?

Answer 1

Metastatic bone disease

Question 2

Where are metastatic deposits in bone most commonly found?

Answer 2

Axial skeleton

Question 3

How does metastatic bone disease commonly present?

Answer 3

Pain
   -unremitting, dull
   -worse at night, sharp upon wt bearing
Features of hypercalcaemia
Pathological fractures
B sx

Question 4

What are the signs on examination of metastatic bone disease?

Answer 4

Bone tenderness
Reduced range of movement
Local lymphadenopathy

Question 5

What are the atypical presentations of metastatic bone disease?

Answer 5

Spinal cord compression

• radicular pain
• autonomic dysfunction

Question 6

What are the most common tumours metastasising to bone?

Answer 6

Breast
Lung (bronchial)
Thyroid
Kidney
Prostate

Question 7

What are the differentials for metastatic bone disease?

Answer 7

Multiple myeloma
Lymphoma
Osteomyelitis

Question 8

What investigations are appropriate in suspected metastatic bone disease?

Answer 8

Skeletal radioisotope scans
Skeletal XR
CT/MRI
Ct guided biopsy
General bloods +/- tumour markers

Question 9

What are the management options for metastatic bone disease?

Answer 9

Establish 1o diagnosis
Analgesics/local radiotherapy
Bisphosphonates (reduce fracture risk)
Chemo/hormone therapy
Prophylactic surgical stabilisation

Question 10

How does multiple myeloma present?

Answer 10

Pathological fractures (vertebral)
Bone marrow infiltration/renal impairment
   -CKD
   -recurrent infections
   -anaemia
   -hypercalcaemia

Question 11

What investigations are appropriate in multiple myeloma?

Answer 11

See haem

XR (lytic lesions)

Question 12

What is the management of multiple myeloma?

Answer 12

Radiotherapy (local disease)

Spinal decompression + fusion

Question 13

What are the most common tumours of bone?

Answer 13

Bloodborne mets (BLT KB)
Tumours of haemopoietic marrow cells (myeloma)

Question 14

What are the common 1o bone malignancies?

Answer 14

Osteosarcoma

Chondrosarcoma

Question 15

What are Osteosarcomas?

Answer 15

Malignant tumour of osteoblasts

• grow rapidly to invade soft tissues
• metastasise early (often to lung)

Question 16

What is the prognosis of Osteosarcomas?

Answer 16

Very poor (5-10% 5yr survival)
   -often advanced at presentation

Question 17

In which groups are Osteosarcomas more common?

Answer 17

Children (knee)

Elderly pts, associated w/ long-standing Paget’s

Question 18

What are Chondrosarcomas?

Answer 18

Malignant cartilage forming lesions

• slow growing
• metastasise late
• large at presentation, stay w/i defined border

Question 19

Where do Chondrosarcomas most commonly form?

Answer 19

Pelvis

Question 20

How do Chondrosarcomas present?

Answer 20

Adults
Pain
Mechanical sx
Pathological fracture

Question 21

What are the benign tumours of bone?

Answer 21

Osteoma
Chondroma
Osteochondroma

Question 22

What investigations are always required when investigating bone tumours?

Answer 22

Imaging

Biopsy

Question 23

What conditions can commonly mimic the sx of bone tumours?

Answer 23

Chronic osteomyelitis

Stress fractures

Question 24

What is the general approach to the management of bone tumours?

Answer 24

Survival
-limb preservation 2o
En-bloc resection w/ adjunctive chemo/radio commonly seen