Ortho Oncology Flashcards
what is the most common reason for destructive bone lesions in adults?
metastatic cancer
which carcinomas most commonly spread to bone?
Breast
Lung
Thyroid
Kidney
Prostate
“BLT and a Kosher Pickle”
what is the most common site of bony metastasis?
thoracic spine
what is the most common site of fracture secondary to metastasis?
proximal femur
what are the 3 symptoms of bone metastasis?
pain in affected limb with movement/load
pain that awakens pt at night
metastatic hypercalcemia
what is the full workup for a patient who presents without a known primary cancer? (3)
plain xray
CT chest/abdomen/pelvis
CT guided core biopsy
what is the tumor marker for bones?
alkaline phosphatase
what lab finding is more common in lytic lesions?
hypercalcemia
what is the goal of treatment in metastatic bone lesions? (2)
pain control
maintain patient independence
what is the non-op treatment for metastatic bone lesions? (2)
radiation
bisphosphonates (IV pamidronate)
what do all patients with metastatic bone lesions require?
postop radiation to stabilize bone
benign tumor located in the soft tissues
lipoma
a patient presents with a mobile, painless, and palpable mass. Dx? Tx?
lipoma
non-op (unless symptomatic or rapidly growing)
malignant tumor that arises from transformed cells of mesenchymal origin (connective tissue)
sarcoma
what part of the body does sarcoma most commonly metastasize to?
lungs
a patient presents with a painless rapidly growing mass. Dx?
sarcoma
what imaging must be done for a possible sarcoma?
MRI w/ contrast
what is the treatment for a sarcoma? (2)
careful wide excision
radiation
neoplastic proliferation of plasma cells that result in osteoclastic stimulation, most common primary bone malignancy in adults
multiple myeloma
how is multiple myeloma frequently discovered?
through fracture
labs show pancytopenia, hypercalcemia, renal failure, and Bence-Jones Proteins on UPEP. Dx?
multiple myeloma
what would an xray show in multiple myeloma?
punched out lesions
what is the treatment for multiple myeloma?
chemo
most common malignant bone tumor in kids that typically arises as solitary lesions within the fastest growing areas of the long bones
osteosarcoma
what are the 2 most common sites of osteosarcoma?
distal femur
proximal tibia
what is the most common site of metastasis of osteosarcoma?
lungs
what is the diagnostic for osteosarcoma?
core needle biopsy
what is the treatment for osteosarcoma? (3)
preop + postop chemo
wide resection
limb salvage/amputation
second most common malignant bone tumor in children
ewing’s sarcoma
where does ewing’s sarcoma most commonly occur? (3)
pelvis
distal femur
proximal tibia
an xray shows a large destructive lesion in the diaphysis or metaphysis with a moth-eaten appearance lesion. Dx?
ewing’s sarcoma
what must we get to diagnose ewing’s sarcoma?
core needle biopsy
what is required as a workup of Ewing’s sarcoma?
bone marrow biopsy to r/o mets to marrow
what is the treatment for ewing’s sarcoma? (3)
pre-op and post-op chemo
wide dissection
limb salvage/amputation
which one of the kid’s carcinoma DOES respond to radiation?
ewing’s sarcoma
most common benign bone tumor in childhood
non-ossifying fibroma
where do most non-ossifying fibromas occur?
lower extremity
an xray shows a bubbly lytic lesion. Dx?
non-ossifying fibroma
what is the treatment for non-ossifying fibroma?
resolves spontaneously
self-limited benign bone lesion that presents with pain unrelated to activity; occurs in the diaphysis or metaphysis
osteoid osteoma
what is the most common location of osteoid osteomas?
proximal femur
what is important to note about pain d/t osteoid osteoma?
relieved by NSAIDs
an xray shows an intensely reactive bone around a radiolucent nidus. Dx?
osteoid osteoma
what is the study of choice for a osteoid osteoma?
CT
what is the first line treatment for osteoid osteoma?
NSAIDs
when does pain from osteoid osteoma usually resolve?
when does the lesion spontaneously resolve?
after 3 yrs
5-7 yrs
