O: Bone Tumours Flashcards
what are the 3 main malignant cancers of bone?
osteosarcoma, Ewing’s sarcoma and chondrosarcoma
what is osteosarcoma?
formation of abnormal bone
epi of osteosarcoma?
most common malignant bone cancer, affects young
red flag symptoms of any malignant bone cancer?
persistent and inc pain, not associated with movement, worse at night
where is the most common presentation of osteosarcoma?
distal femur/ proximal tibia
what Is Ewing’s sarcoma?
caused by proliferation of endothelial cells in bone marrow
epi of Ewing’s sarcoma?
5-25yo, 2nd commonest bone cancer in kids
where are 50% of Ewing’s found?
diaphysis of long bones
is Osteosarcoma presents in elderly, what is the most likely cause?
Paget’s disease
what may Ewing’s sarcoma presentation mimic?
septic arthritis- pain associated with fever
what are some ix markers of Ewing’s sarcoma?
bloods- raised inflammatory markers: ESR, CRP
imaging: sunburst appearance
why is surgery a difficult option to consider with Ewing’s?
bone marrow involvement is extensive so amputation often insufficient
what is chondrosarcoma?
malignancy of chondrocytes
epi for chondrosarcoma?
40-75yo
common sites for chondrosarcoma?
pelvis/ distal femur
common imaging finding for chondrosarcoma?
blastic lesions with reactive cortical thickening
___ % of all child cancers are bone cancer?
10%
main risk factors for bone cancers?
previous injuries, conditions (Paget’s), genetic (p53), familial retinoblastoma
what may cancer present with?
fractures due to abnormal bone
main ix for malignant bone cancers?
bloods, radiographs (AP & lateral, MRI/CT, bone scan)
what part of bone looks like popcorn on scan if cancer present?
matrix
tx for bone cancer?
neoadjuvant chemo, surgery (limb salvage resection & reconstruction, amputation), adjuvant therapy
what rx is given for symptomatic relief with bone cancer?
bisphosphonates
which of the 3 malignant bone cancers has the worst prognosis?
Ewing’s sarcoma, although chondrosarcoma is slow growing and so often is caught late
name the acronym for 2y cancer spread to bone?
BLT with Kosher Pickle
breast, lung, thyroid, kidney, prostate
sites commonly affected by 2y spread to bone?
vertebrae, pelvis, ribs, femurs, skull
what are the 2 pathophysiological processes of bone mets?
can be bone loss or bone formation
what are common ix carried out for 2y cancer to bone?
x-ray, if -ve but high clinical suspicion do CT/MRI
bloods: inc serum alk phos
why are x-rays not always the best ix for bone cancer?
lesions not visible unless >50% of bone cortex destroyed
10-20% of patients with 2y bone cancer have ___________?
hypercalcaemia
what are the 3 main benign diseases of bone?
Osteoid Osteoma, osteochondroma, endochondroma
what is osteoid osteoma?
painful benign tumour of long bones
epi for osteoid osteoma?
5-25yo
s/s of osteoid osteoma?
pain worse at night, pain
ix finding for osteoid osteoma?
central nodule of woven bone with osteoblastic rim (halo)
mx for osteoid osteoma?
spontaneous resolution, radio frequency ablation
what is osteochondroma?
benign lesion formed by abnormal cartilage
which of the 3 is the most common benign bone tumour?
osteochondroma
what are the 2 types of osteochondroma?
solitary and multiple hereditary exostosis
aetiology for solitary osteochondroma?
salter harris fracture, surgery, radiotherapy
aetiology for multiple hereditary exostosis osteochondroma?
mutation of EXT 1,2,3 genes
where is a common site for ostechondromas?
knee- may be palpable mass
MHE ostechondroma may also present with…
jt pain and deformity of limb
ix for osteochondroma?
x-rays and MRI for cartilage cap
tx for osteochondroma?
syonvectomy, observe/ surgically excise
what is main complication of osteochondroma?
formation of loose bodies within joint
which of the 3 benign cancers are most likely to undergo malignant transformation and when to be worried about this?
osteochondroma- specifically MHE. consider this is lesion is rapidly inc in size/ systemic symptoms
what is endochondroma?
benign intramedullary lesion
endochondroma is __ most common benign tumour and is mainly found in __- __ year olds
2nd, 20-50yo
T/F: endochondroma often presents with acute symptoms
F: it is often an incidental finding
what is mx for endochondroma?
symptomatic: curettage and bone grafting
asymptomatic: conservative mx
