Musculoskeletal Malignancy Flashcards
what is the most common destructive bone disease in adults
metastatic bone disease
what is the presentation of metastatic bone disease
Unremitting dull pain, worse at night
Sharp upon weight bearing
Features of hypercalcaemia
B symptoms
what would you expect to find on examination with metastatic bone disease
joint tenderness
reduced range of movement
local lymphadenopathy
what are the 5 most common tumours that metastasise to bone
Thyroid
Breast
Kidney
Prostate
Lung
what are some differentials for bone carcinoma
Multiple myeloma
Lymphoma
Osteomyelitis
what are some investigations recommended for ?bone carcinoma
Skeletal radioisotope scans - mets
Skeletal XR - shows lytic lesions
CT/MRI - find primary lesions
CT guided biopsy - confirmation of diagnosis
General bloods +/- tumour markers
what are some haemotological tumour markers for musculoskeletal malignancy
raised alk phos/lactate is seen in some sarcomas
CEA/CA19-9 raised in axial skeletal metastases
what is the management for haemotological markers
Establish primary diagnosis
Analgesics/local radiotherapy for pain
Bisphosphonates to reduce fracture risk
May respond to chemo/hormone (breast prostate) therapy
Prophylactic surgical stabilisation may be required to prevent pathological fractures
what is the presentation of a myeloma
pathological fractures - including vertebral fractures
bone marrow infiltration/renal impairment leading to CKD, recurrent infection, anaemia, hypercalcemia
how does a myeloma present on X-ray
punched out lytic lesions
whats the management for myeloma
Radiotherapy for local disease
Spinal decompression and fusion if necessary
what are the most common malignant primary bone tumours
osteosarcoma
chondrosarcoma
what primary cell is osteosarcoma a tumour of
osteoblasts
Whats the 5 year survival of osteosarcomas
5-10% 5 year survival
where is osteosarcoma most commonly found
in the knee
