O: Bone Tumours

Question 1

what are the 3 main malignant cancers of bone?

Answer 1

osteosarcoma, Ewing’s sarcoma and chondrosarcoma

Question 2

what is osteosarcoma?

Answer 2

formation of abnormal bone

Question 3

epi of osteosarcoma?

Answer 3

most common malignant bone cancer, affects young

Question 4

red flag symptoms of any malignant bone cancer?

Answer 4

persistent and inc pain, not associated with movement, worse at night

Question 5

where is the most common presentation of osteosarcoma?

Answer 5

distal femur/ proximal tibia

Question 6

what Is Ewing’s sarcoma?

Answer 6

caused by proliferation of endothelial cells in bone marrow

Question 7

epi of Ewing’s sarcoma?

Answer 7

5-25yo, 2nd commonest bone cancer in kids

Question 8

where are 50% of Ewing’s found?

Answer 8

diaphysis of long bones

Question 9

is Osteosarcoma presents in elderly, what is the most likely cause?

Answer 9

Paget’s disease

Question 10

what may Ewing’s sarcoma presentation mimic?

Answer 10

septic arthritis- pain associated with fever

Question 11

what are some ix markers of Ewing’s sarcoma?

Answer 11

bloods- raised inflammatory markers: ESR, CRP

imaging: sunburst appearance

Question 12

why is surgery a difficult option to consider with Ewing’s?

Answer 12

bone marrow involvement is extensive so amputation often insufficient

Question 13

what is chondrosarcoma?

Answer 13

malignancy of chondrocytes

Question 14

epi for chondrosarcoma?

Answer 14

40-75yo

Question 15

common sites for chondrosarcoma?

Answer 15

pelvis/ distal femur

Question 16

common imaging finding for chondrosarcoma?

Answer 16

blastic lesions with reactive cortical thickening

Question 17

___ % of all child cancers are bone cancer?

Answer 17

10%

Question 18

main risk factors for bone cancers?

Answer 18

previous injuries, conditions (Paget’s), genetic (p53), familial retinoblastoma

Question 19

what may cancer present with?

Answer 19

fractures due to abnormal bone

Question 20

main ix for malignant bone cancers?

Answer 20

bloods, radiographs (AP & lateral, MRI/CT, bone scan)

Question 21

what part of bone looks like popcorn on scan if cancer present?

Answer 21

matrix

Question 22

tx for bone cancer?

Answer 22

neoadjuvant chemo, surgery (limb salvage resection & reconstruction, amputation), adjuvant therapy

Question 23

what rx is given for symptomatic relief with bone cancer?

Answer 23

bisphosphonates

Question 24

which of the 3 malignant bone cancers has the worst prognosis?

Answer 24

Ewing’s sarcoma, although chondrosarcoma is slow growing and so often is caught late

Question 25

name the acronym for 2y cancer spread to bone?

Answer 25

BLT with Kosher Pickle | breast, lung, thyroid, kidney, prostate

Question 26

sites commonly affected by 2y spread to bone?

Answer 26

vertebrae, pelvis, ribs, femurs, skull

Question 27

what are the 2 pathophysiological processes of bone mets?

Answer 27

can be bone loss or bone formation

Question 28

what are common ix carried out for 2y cancer to bone?

Answer 28

x-ray, if -ve but high clinical suspicion do CT/MRI | bloods: inc serum alk phos

Question 29

why are x-rays not always the best ix for bone cancer?

Answer 29

lesions not visible unless >50% of bone cortex destroyed

Question 30

10-20% of patients with 2y bone cancer have ___________?

Answer 30

hypercalcaemia

Question 31

what are the 3 main benign diseases of bone?

Answer 31

Osteoid Osteoma, osteochondroma, endochondroma

Question 32

what is osteoid osteoma?

Answer 32

painful benign tumour of long bones

Question 33

epi for osteoid osteoma?

Answer 33

5-25yo

Question 34

s/s of osteoid osteoma?

Answer 34

pain worse at night, pain

Question 35

ix finding for osteoid osteoma?

Answer 35

central nodule of woven bone with osteoblastic rim (halo)

Question 36

mx for osteoid osteoma?

Answer 36

spontaneous resolution, radio frequency ablation

Question 37

what is osteochondroma?

Answer 37

benign lesion formed by abnormal cartilage

Question 38

which of the 3 is the most common benign bone tumour?

Answer 38

osteochondroma

Question 39

what are the 2 types of osteochondroma?

Answer 39

solitary and multiple hereditary exostosis

Question 40

aetiology for solitary osteochondroma?

Answer 40

salter harris fracture, surgery, radiotherapy

Question 41

aetiology for multiple hereditary exostosis osteochondroma?

Answer 41

mutation of EXT 1,2,3 genes

Question 42

where is a common site for ostechondromas?

Answer 42

knee- may be palpable mass

Question 43

MHE ostechondroma may also present with...

Answer 43

jt pain and deformity of limb

Question 44

ix for osteochondroma?

Answer 44

x-rays and MRI for cartilage cap

Question 45

tx for osteochondroma?

Answer 45

syonvectomy, observe/ surgically excise

Question 46

what is main complication of osteochondroma?

Answer 46

formation of loose bodies within joint

Question 47

which of the 3 benign cancers are most likely to undergo malignant transformation and when to be worried about this?

Answer 47

osteochondroma- specifically MHE. consider this is lesion is rapidly inc in size/ systemic symptoms

Question 48

what is endochondroma?

Answer 48

benign intramedullary lesion

Question 49

endochondroma is __ most common benign tumour and is mainly found in __- __ year olds

Answer 49

2nd, 20-50yo

Question 50

T/F: endochondroma often presents with acute symptoms

Answer 50

F: it is often an incidental finding

Question 51

what is mx for endochondroma?

Answer 51

symptomatic: curettage and bone grafting asymptomatic: conservative mx