Oncology - Bone tumour

Question 1

Definition

Answer 1

Type of bone caner = usually presents in adolescents and younger aged adults 10-20 years.
MC bone affected = femur
Other common sites:
- Tibia
- Humerus

Question 2

Presentation

Answer 2

Persistent bone pain = particularly worse at night time
This may disturb them or wake them from sleep
Bone swelling
Palpable mass
Restricted joint movement

Question 3

Diagnosis

Answer 3

• Very urgent direct access xray within 48 hours of children presenting with unexplained bone pain or swelling
• If the x-ray suggests possible sarcoma = very urgent specialist assessment within 48 hours
• Blood test = raised ALP
• Further investigations to better define lesion and stage cancer:
• CT scan
• MRI scan
• Bone scan
• PET scan
• Bone biopsy

Question 4

Positive X-ray findings

Answer 4

Poorly defined lesion in the bone with destruction of the normal bone and a “fluffy” appearance.
There will be periosteal reaction = irritation of the lining of the bone = classically described as “SUN-BURST” appearance. This can be associated with soft tissue mass.

Question 5

Treatment

Answer 5

Surgical resection of lesion, often with a limb amputation.
Adjuvant chemotherapy = usually alongside surgery to improve outcomes.
They will require support and input from the multidisciplinary team in addition to treatment of the tumour.

Question 6

Complications

Answer 6

Pathological bone fractures and metastasis