Musculoskeletal Neoplasms Flashcards
1
Q
Describe cancer
A
- uncontrolled cell proliferation = tumor = neoplasm
- benign = contained/stable
- malignant = continued proliferation/potential to metastasize (cancer)
2
Q
Describe radiation
A
- targeted therapy that kills cancer cells or slows growth by damaging cancer’s DNA
- effect takes weeks/months
- external beam (treats all cancers) or internal beam (treats head/neck, breast, cervix, prostate, eye, & thyroid cancers), solid or liquid form
3
Q
Describe chemotherapy
A
- limit proliferation by attenuating cell growth
- inhibit DNA/RNA synthesis & function
- inhibit cell division (mitosis)
4
Q
Typically what ending does a benign versus a malignant tumor have
A
- Benign = -oma
- Malignant = -sarcoma
5
Q
Describe benign neoplasms
A
- well differentiated in terms of cell maturation
- look similar to normal tissue
- tend to grow slowly
- possible secondary problems
6
Q
Clinical presentation of benign neoplasms
A
- early diagnosis is better, but often elusive: early tumors are not well defined & may not cause symptoms
- pain not attributable to position
- night pain
- pathologic fractures
- presence of a mass
- swelling, fever, unexplained weight loss…
7
Q
Diagnosis & classification of benign neoplasms
A
- imaging
- biopsy
- labs: ESR, CBC, calcium, phosphorous, alkaline phosphatase
- detailed knowledge of location, appearance, & interaction with nearby tissues helps inform diagnosis
- stage/grade I = differentiated to stage/grade IV = undifferentiated
8
Q
Treatment strategies for benign neoplasms
A
- observation
- resection: complete/wide/en bloc(tumor and surrounding tissue removed) or marginal (most but not all of tumor removed)
- chemotherapy
- radiation
- newer options (stem cell transplants, biologic response modifiers, gene-based therapies)
9
Q
Describe Osteochondroma
A
- benign
- cartilage-capped bony spur/outgrowth on bone surface
- usually occurs at end of long-bone growth plates, interfering with joint function
- symptom of pain on joint movement
- most comely form at shoulder or knee
10
Q
Symptoms of Osteochondroma
A
- hard, immobile, detectable mass that is painless
- loss of joint ROM
- soreness of the adjacent muscles
- limb length discrepancies
- pressure or irritation with exercise
- possibility for changes in blood flow
11
Q
Treatment for Osteochondroma
A
- observation for neuromuscular compromise
- excision
12
Q
Describe Osteoid Osteoma
A
- benign skeletal neoplasm consisting of a nidus of osteoid tissue in the cortex
- no malignant transformation
- initial treatment includes pain control (NSAIDs) and observation
- excision if growing and/or interfering with active lifestyle
13
Q
Symptoms of Osteoid Osteoma
A
- pain at night
- pain with activity
- pain relieved with NSAIDs
- can affect bone growth in individuals with open growth plates
14
Q
Describe Osteoblastoma
A
- benign but larger than Osteoid Osteoma & likely to grow
- usually in the vertebral column (unlike Osteoid Osteoma) or long bones along diaphysis
15
Q
Symptoms of Osteoblastoma
A
- pain for several months
- pain is not as severe as osteoid osteoma
- pain is less likely to be relieved with NSAIDs
- poorly localized pain
- possible scoliosis
- nerve root impingement
16
Q
Treatment for Osteoblastoma
A
- curettage (scraping)
- because of high recurrence a wider excision margin is often used
- reconstruction or implants may be necessary depending on extent of bone/joint tissue resection
17
Q
Describe Enchondroma
A
- benign
- cartilage cyst found in bone marrow often found incidentally
- usually found in metacarpals/metatarsals but also found in humerus & femur
18
Q
Symptoms of Enchondroma
A
- mostly asymptomatic
- possible fractures of the affected bone
- enlargement of affected finger
19
Q
Treatment for Enchondroma
A
- observation
- curettage (scraping) considered if bone health is compromised
20
Q
Describe Chondroblastoma
A
- benign but locally aggressive & usually must be excised
- slow growing tumor usually at epiphyseal plate usually femur/tibia/humerus
21
Q
Symptoms of Chondroblastoma
A
- localized pain
- limited joint motion
- swelling at end of long bones
- tenderness at end of long bones
22
Q
Describe a Hemanginoma
A
- growth of the endothelial cells that line blood vessels
- may involve skin, showing up in neonates (self-resolving or permanent)
- some involve vertebral bodies: 10% of population, females > males between 40-60 years old
23
Q
Describe giant cell tumor of bone
A
- historically considered benign: low-grade malignant
- 6th most common bone tumor (rare)
- wide age distribution
- center of the epiphysis of long bones
- develop slowly
- 50% recurrence
24
Q
Symptoms of giant cell tumor
A
- mild pain that progresses with tumor growth
- limited ROM
- swelling (large growth)
- pathologic fracture
25
Q
Treatment for giant cell tumor
A
- removal of tumor
- high recurrence rate may be due to bleeding at surgical site with reseeding (of tumor cells) in the area
26
Q
Describe malignant neoplasms
A
- capacity to expand & travel
- spread by local invasion or blood
- sarcomas develop in connective & supportive tissue
- considered primary bone tumors
- relatively rare
27
Q
Prevalence of different sarcoma in bone, cartilage, & synovium
A
- Osteosarcoma: 35% of all bone tumors
- Chondrosarcoma: 25% of all bone tumors
- Ewing’s sarcoma: 16% of all bone tumors
- Synovial sarcome
28
Q
What is the most common bone tumor in childhood and adult
A
- Childhood: Osteosarcoma/Osteogenic sarcoma is No. 1 and Ewing’s sarcoma is No. 2
- Adult: Chondrosarcoma
29
Q
General diagnosis & treatment of malignant tumors
A
- pain
- biopsy
- imaging
- labs
- surgery, radiation, chemotherapy
30
Q
Two types of bone tumor pathogenesis
A
- Osteoblastic: neoplastic cells produce osteoid & known as tumor bone or neoplastic bone
- Osteolytic: neoplastic cells incite local osteoclastic resorption of bone
- both processes occur at the same time
31
Q
Describe Chordoma
A
- develop from notochord: sacrococcygeal & sphenooccipital
- slow-growing, locally aggressive
- treatment involves resection, often after chemo
- poor long term prognosis: complete resection often difficult due to midline location
32
Q
Describe Osteosarcoma
A
- most common primary malignant bone tumor
- develops in the metaphysis: distal end of femur, proximal end of tibia/fibula, & proximal end of humerus
- mainly osteoblastic
- extremely malignant
- radiation resistant
33
Q
Manifestations & treatment for Osteosarcoma
A
- continuous pain that increases quickly (period of weeks)
- early metastasis to lungs
- excision with pre and/or post chemotherapy
- expandable prostheses (in children)
- rotationplasty: removing knee & rotating the ankle/foot to create a new knee joint with the use of prosthesis
- prognoses are getting better but still relatively poor compared to other sarcomas
34
Q
Describe Chondrosarcoma
A
- relatively slow growing tumor of cartilage
- pelvic & shoulder girdles
- secondary Chondrosarcoma: previously benign osetochondroma or Paget’s disease
- men in their 40 to 60s
- surgical intervention
35
Q
Treatment for Chondrosarcoma
A
- surgery
- chemotherapy & radiation are not effective
- complete resection a high priority
36
Q
Describe Ewing’s Sarcoma
A
- non-osteogenic primary tumor
- see in bone (diaphysis) or soft tissue
- 2nd most common in children 10-15 years old
- favors long tubular bones: femur, tibia, proximal fibula, humerus
- pelvis
- early metastasis to the lung
37
Q
Pathogenesis of Ewing’s Sarcoma
A
- soft tumor with hemorrhagic necrosis caused by rapid tumor growth
- medullary cavity is affected
- bone marrow is infiltrated
- “onion skin” appearance on X-ray
- periosteum is elevated
38
Q
Diagnosis of Ewing’s Sarcoma
A
- radiograph of involved bone
- CT, MRI, bone scan
- sedimentation rate
- X-ray of chest
- local pain may be attributed to injury & fever possible in young children both may delay accurate diagnosis
39
Q
Treatment & outcome of Ewing’s Sarcoma
A
- local tumors responsive to high-dose radiation
- metastases require aggressive combination therapy
- selective surgery: amputation or limb-sparing
- 5 year survival: no metastasis = up to 85% and if metastasis has occurred = 25%
40
Q
Describe Multiple Myeloma
A
- plasma cell myeloma
- malignant
- common clusters of signs/symptoms is CRAB: Calcium (elevated), Renal failure, Anemia, & Bone lesions
41
Q
Treatment for Multiple Myeloma
A
- treatable but not curable
- remission with medication
- radiation to decrease bone pain: for the thoracic spine, lumbar, spine, skull, pelvis, & ribs have tendency to increase in pain with activity
42
Q
Common complications for Multiple Myeloma
A
- hypercalcemia: weakness, confusion, fatigue, osteoporosis, & kidney failure
- headache
- vision changes
- radicular pain
- neuropathy
- loss of bowel & bladder control
- paraplegia
43
Q
Describe secondary bone tumors
A
- all secondary bone tumors are metastatic
44
Q
Sources of metastatic bone tumors
A
- prostate
- breast
- lung
- kidney
- thyroid
- GI
45
Q
Statistics of skeletal system involvement
A
- primary symptoms are pain, neurological findings
- spine involved 50% of the time with cord compression
- X-ray for early diagnosis but bone scan is preferable
- 1/3 will have a pos. bone scan but a neg. radiograph
- treatment is mostly palliative (treat to maintain QOL)
46
Q
Describe spinal metastasis
A
- from lung, breast, prostate, and/or kidney
- to thoracic, lumobosacral, & cervical spine
- initial diagnosis involves radiography (may miss many cases) & neurological exam
- presenting symptoms: weakness, sensory loss, bowel & bladder sphincter disturbance
47
Q
Treatment for spinal metastasis
A
radiotherapy to reduce pain, compress tumor, & restore neurological function
48
Q
Prognosis for spinal metastasis
A
- if paralyzed prior to radiation, patient will very likely remain non-ambulatory
- if ambulatory at start of radiation, 80% will be able to continue to walk
- because metastasis represents loss of containment, cure is not possible
