Primary Malignant Bone Tumours Flashcards
What are primary malignant bone tumours commonly misdiagnosed as?
Muscular Pains
Presentation of primary malignant bone tumours?
-Red flags
-Unexplained persistent pain
(Warrant investigation wit atleast an x-ray)
What will an x-ray show for primary malignant bone tumours?
Substantial ill-defined bony swelling
- Aggressive & destructive signs
- Cortical destruction
- Periosteal reaction: raised periosteum producing bone
- New bone formation: sclerosis
- Extension into surrounding soft tissue envelope
What is the most common primary malignant tumour producing bone?
Osteosarcoma
Who gets osteosarcoma?
Younger- adolescence, early adulthood
Areas affected by osteosarcoma?
- 60% of bones around the knee
- Other= proximal femur, proximal humerus, pelvis
Common methods of spreading of osteosarcoma?
Haematogenous
Lymphatic
-10% have pulmonary mets at diagnosis
Treatment of osteosarcoma?
- Not radiosensitive
- Adjuvant chemotherapy can prolong survival
What is chondrosarcoma?
Cartilage producing primary bone tumour
What age group is susceptible to chondrosarcoma?
Older age group
-45y
Features of chondrosarcoma?
Large
Slow to metastasize
Areas affected by chondrosarcoma?
Pelvis
Proximal femur
What does the prognosis of chondrosarcoma depend on?
Histological grading
Treatment of chondrosarcoma?
Not radiosensitive
Unresponsive to adjuvant chemotherapy
What is fibrosarcoma & malignant fibrous histiocytoma?
Fibrous malignant primary bone tumours
Who is more likely to get fibrosarcoma & malignant fibrous histiocytoma.
adolescents & young adults
What is Ewing’s sarcoma?
Malignant tumour of primitative cells in the marrow
What is the 2nd most prevalent primary bone tumour?
Ewing’s sarcoma
Prognosis of Ewing’s sarcoma?
Poor prognosis
Age range for Ewing’s sarcoma?
10-20 years
Symptoms of Ewing’s sarcoma?
Fever
Raised inflammatory markers
Warm swelling
What can Ewing’s sarcoma be misdiagnosed as?
Osteomyelitis
Treatment of Ewing’s Sarcoma?
Radiosensitive
Chemosensitive
Staging investigations of Primary bone tumours?
-Bone scan
-CT chest
-MRI & CT
Biopsy
What do MRI & CT scans show of primary bone tumours?
Determine local extent of the tumour & muscle, nerve and vessel involvement
What does a biopsy tell you about primary bone tumours?
Histological diagnosis & grading prior to definitive surgery
Aim of surgery for Primary bone tumours
Remove tumour & surrounding tissue
Types of surgery for primary bone tumours?
- Limb salvage surgery (since adjuvant chemo)
- Wide margin of 2-4cm bone removed and cut off normal muscle around
- Biopsy tract also removed with tumour
- Joint involved needs reconstruction
What is lymphoma?
Cancer of round cells of the lymphocytic system/macrophages
Primary bone tumour from the marrow is?
Non-hodgkins lymphoma
Treatment of non-hodgkins lymphoma?
Surgical resection
Where non-hodgkins affects?
Pelvis
Femur
Where can lymphoma metastasize to?
Bone (20%)
Presentation of lymphoma?
- Lymphadenopathy
- Splenomegaly
Treatment of lymphoma?
Radio or chemotherapy
Prognosis of lymphoma?
Less than 2 years
What is myeloma?
Malignant B cell proliferation
Where does myeloma arise from?
Arises from the bone marrow
What is a solitary lesion of myeloma?
Plasmacytoma
What is multiple myeloma?
Multiple osteolytic lesions throughout the whole skeleton
Presentation of myeloma?
- Weakness
- Back pain
- Bone pain
- Fatigue
- Weight loss
- May have marrow suppression-> anaemia, recurrent infection
- May present with pathologic fracture
Likely age range for myeloma?
45-56 years
Investigations for myeloma?
- Plasma protein electrophoresis (high paraprotein levels)
- Early morning urine collection (Bence Jones protein array)
- Lytic lesions
- Skeletal survey of x-rays
Treatment of myeloma?
- Plasmacytoma- radiotherapy
- Multiple myeloma: chemotherapy (5years < 30%)
