Pathology - Malignant Bone Tumours

Question 1

Malignant primary bone tumours can occur at any age but commonly ______________

Answer 1

Young people

Question 2

Malignant primary bone tumours in young people are often misdiagnosed as muscular pains and so treatment is late in the disease - true/false

Answer 2

True

Question 3

Any red flags or persistent unexplained bone merits at least a scan - which scan would you do first?

Answer 3

X-ray

Question 4

If there is an ill defined bony swelling this should be given an urgent referral to orthopaedics for investigation - true/false

Answer 4

true

Question 5

What signs would you see on x-ray from a malignant bony tumour?

Answer 5

Aggressive and destructive signs including cortical destruction, periosteal reaction, new bone formation (sclerosis and lysis) and extension into soft tissue surroundings.

Question 6

What is the most common malignant bony tumour? why is it named as such?

Answer 6

Osteosarcoma - sarcoma as it is a malignant tumour, osteo as it is a bone producing tumour. ergo, osteosarcoma - a bone producing malignant tumour.

Question 7

Which age group is most commonly associated with osteosarcoma?

Answer 7

Adolescence and early adulthood

Question 8

What bones are most likely to be affected by an osteosarcoma?

Answer 8

60% of cases involve bones surrounding the knees.

other sights include proximal humerus, proximal femur and pelvis.

Question 9

How does metastatic spread of an osteosarcoma most commonly occur?

Answer 9

Haematogenous but can be lymphatic.

Question 10

What percentage of osteosarcoma patients have pulmonary mets at presentation?

Answer 10

10%

Question 11

Are osteosarcomas susceptible to radio and chemotherapy?

Answer 11

they are not radiosensitive but chemotherapy may prolong survival.

Question 12

What is a chondrosarcoma? How does it get its name?

Answer 12

It is a cartilage producing tumour. Chondro = cartilage; sarcoma = malignant tumour.

Question 13

is a chondrosarcoma more or less common than osteosarcoma?

Answer 13

Less common

Question 14

Chondrosarcoma is less aggressive than osteosarcoma - true/false?

Answer 14

True

Question 15

What age group is most likely to get a chondrosarcoma?

Answer 15

older age group (mean age 45)

Question 16

Chondrosarcomas can be very large/small and metastasise quickly/slowly

Answer 16

They can be large and metastasise slowly.

Question 17

Name the two most common sites for a chondrosarcoma

Answer 17

Proximal femur and pelvis.

Question 18

Are chondrosarcomas radio/chemosensitive?

Answer 18

No they are not either.

Question 19

What are fibrosarcomas and fibrous histiocytomas? Where are they most likely to occur? Give examples

Answer 19

Fibrous malignant bone tumours - they are likely to occur in damaged bone e.g. infarcted bone, fibrous dysplasia, post-irradiation and paget’s disease

Question 20

What age group do fibrosarcomas affect most commonly?

Answer 20

young adults and adolescents

Question 21

Ewing’s sarcoma is a tumour of ___________

Answer 21

Primitive marrow cells

Question 22

Ewing’s sarcoma has the best/worst prognosis and is the ____ most prevalent bone tumour

Answer 22

Worst prognosis and is the 2nd most prevalent bone tumour

Question 23

Most cases of Ewing’s sarcoma occur between the ages of ___ and ___

Answer 23

Most cases occur between the ages of 10 and 20

Question 24

Why may Ewing’s sarcoma often be mistaken for osteomyelitis?

Answer 24

it is often associated with fever, inflammation including raised inflammatory markers hot swellings.

Question 25

Is Ewing’s sarcoma radio/chemo-sensitive?

Answer 25

It tends to be both

Question 26

How is a malignant bone tumour staged?

Answer 26

Staging involves: 
Bone scan
Chest CT, 
MRI - shows the extent of invasion of soft tissues. 
Biopsy

Question 27

What margin(s) are removed for a surgical removal of a bone tumour?

Answer 27

3-4cm of bone and a cuff of normal muscle all around.

Question 28

When a bone tumour is removed, “special” joint replacement may be needed; what is special about it and why is this needed?

Answer 28

they are larger than normal to compensate for the larger amount of bone removed.

Question 29

Chemo and radiotherapy are used, when appropriate to reduce recurrence rates after surgery - true/false

Answer 29

True

Question 30

Improvement in adjuvant therapy (e.g. chemo/radiotherapy) has increased survival by 30% for 5years, from 50% to 80% - true/false

Answer 30

true

Question 31

Lymphoma can occur as a primary bone tumour or metastasise from elsewhere to bone - which is non-hodgekins lymphoma? Which cells are cancerous?

Answer 31

Non-hodgekin’s lymphoma is the primary bone tumour lymphoma.
Cells that become cancerous are round cells of the lymphatics/macrophages.

Question 32

Primary lymphoma of the bone tends to affect which bones?

Answer 32

Femur and pelvis

Question 33

Treatment for primary lymphoma of bone is ___________

Answer 33

surgical resection.

Question 34

Metastatic lymphoma may have lymphadenopathy, splenomegaly and hepatomegaly - true/false

Answer 34

False - no hepatomegaly, just splenomegaly and lymphadenopathy.

Question 35

What is the treatment for metastatic lymphoma? What is the usual survival time?

Answer 35

Chemotherapy and radiotherapy. Less than 2 years normally.

Question 36

Name (in order of likeliness) the 5 most common tumours to metastasise to bone

Answer 36

Breast carcinoma
Prostate carcinoma
Lung carcinoma
Renal cell carcinoma 
Thyroid adenocarcinoma

Question 37

Breast carcinoma metastases to bone tend to appear sclerotic and lytic - true/false

Answer 37

true

Question 38

What is the mean survival of breast carcinoma with metastatic bone disease?

Answer 38

24-26months.

Question 39

Prostate cancer commonly metastasizes to bone and forms sclerotic/lytic lesion

Answer 39

Prostate cancer commonly metastasizes to bone and forms sclerotic lesions

Question 40

Pathological fractures are more likely to heal with metastatic bone disease from prostate cancer - why/

Answer 40

There is an osteoblastic activity which makes it more likely to heal.

Question 41

What treatments can reduce the risk of pathological fracture for a prostate metastasis?

Answer 41

Hormone manipulation and chemotherapy

Question 42

What is survival at one year with metastatic bone disease from prostate cancer?

Answer 42

45%

Question 43

Lung cancer gives rise to sclerotic/lytic bone lesions

Answer 43

sclerotic

Question 44

Once bony metastases from the lung are present mean survival is about 1 year - true/false

Answer 44

false, mean survival is 6months

Question 45

Renal cell carcinoma usually causes very large/small vascular/avascular, lytic/sclerotic bony lesions

Answer 45

Renal cell carcinoma usually causes very large, vascular and lytic bony lesions.

Question 46

Renal cell carcinoma bone metastases are very likely/unlikely to bleed a lot on biopsy/surgery

Answer 46

Very likely to bleed a lot.

Question 47

For metastases from renal cell carcinoma, surgery can potentially be curable if __________-

Answer 47

if there is a single bone lesion and the primary tumour is operable

Question 48

If there are multiple bony lesions from renal cell carcinoma, the mean survival is 6months - true/false

Answer 48

False - mean survival is 12-18months

Question 49

Which bones are most commonly metastasized to?

Answer 49

Vertebra, skull, pelvis, ribs, humerus, long bones of lower limb