Primary Malignant Bone Tumours

Question 1

What are primary malignant bone tumours commonly misdiagnosed as?

Answer 1

Muscular Pains

Question 2

Presentation of primary malignant bone tumours?

Answer 2

-Red flags
-Unexplained persistent pain
(Warrant investigation wit atleast an x-ray)

Question 3

What will an x-ray show for primary malignant bone tumours?

Answer 3

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

Question 4

What is the most common primary malignant tumour producing bone?

Answer 4

Osteosarcoma

Question 5

Who gets osteosarcoma?

Answer 5

Younger- adolescence, early adulthood

Question 6

Areas affected by osteosarcoma?

Answer 6

• 60% of bones around the knee

- Other= proximal femur, proximal humerus, pelvis

Question 7

Common methods of spreading of osteosarcoma?

Answer 7

Haematogenous
Lymphatic
-10% have pulmonary mets at diagnosis

Question 8

Treatment of osteosarcoma?

Answer 8

• Not radiosensitive

- Adjuvant chemotherapy can prolong survival

Question 9

What is chondrosarcoma?

Answer 9

Cartilage producing primary bone tumour

Question 10

What age group is susceptible to chondrosarcoma?

Answer 10

Older age group

-45y

Question 11

Features of chondrosarcoma?

Answer 11

Large

Slow to metastasize

Question 12

Areas affected by chondrosarcoma?

Answer 12

Pelvis

Proximal femur

Question 13

What does the prognosis of chondrosarcoma depend on?

Answer 13

Histological grading

Question 14

Treatment of chondrosarcoma?

Answer 14

Not radiosensitive

Unresponsive to adjuvant chemotherapy

Question 15

What is fibrosarcoma & malignant fibrous histiocytoma?

Answer 15

Fibrous malignant primary bone tumours

Question 16

Who is more likely to get fibrosarcoma & malignant fibrous histiocytoma.

Answer 16

adolescents & young adults

Question 17

What is Ewing’s sarcoma?

Answer 17

Malignant tumour of primitative cells in the marrow

Question 18

What is the most prevalent primary bone tumour?

Answer 18

Ewing’s sarcoma

Question 19

Prognosis of Ewing’s sarcoma?

Answer 19

Poor prognosis

Question 20

Age range for Ewing’s sarcoma?

Answer 20

10-20 years

Question 21

Symptoms of Ewing’s sarcoma?

Answer 21

Fever
Raised inflammatory markers
Warm swelling

Question 22

What can Ewing’s sarcoma be misdiagnosed as?

Answer 22

Osteomyelitis

Question 23

Treatment of Ewing’s Sarcoma?

Answer 23

Radiosensitive

Chemosensitive

Question 24

Staging investigations of Primary bone tumours?

Answer 24

-Bone scan
-CT chest
-MRI & CT
Biopsy

Question 25

What do MRI & CT scans show of primary bone tumours?

Answer 25

Determine local extent of the tumour & muscle, nerve and vessel involvement

Question 26

What does a biopsy tell you about primary bone tumours?

Answer 26

Histological diagnosis & grading prior to definitive surgery

Question 27

Aim of surgery for Primary bone tumours

Answer 27

Remove tumour & surrounding tissue

Question 28

Types of surgery for primary bone tumours?

Answer 28

- 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

Question 29

What is lymphoma?

Answer 29

Cancer of round cells of the lymphocytic system/macrophages

Question 30

Primary bone tumour from the marrow is?

Answer 30

Non-hodgkins lymphoma

Question 31

Treatment of non-hodgkins lymphoma?

Answer 31

Surgical resection

Question 32

Where non-hodgkins affects?

Answer 32

Pelvis | Femur

Question 33

Where can lymphoma metastasize to?

Answer 33

Bone (20%)

Question 34

Presentation of lymphoma?

Answer 34

- Lymphadenopathy | - Splenomegaly

Question 35

Treatment of lymphoma?

Answer 35

Radio or chemotherapy

Question 36

Prognosis of lymphoma?

Answer 36

Less than 2 years

Question 37

What is myeloma?

Answer 37

Malignant B cell proliferation

Question 38

Where does myeloma arise from?

Answer 38

Arises from the bone marrow

Question 39

What is a solitary lesion of myeloma?

Answer 39

Plasmacytoma

Question 40

What is multiple myeloma?

Answer 40

Multiple osteolytic lesions throughout the whole skeleton

Question 41

Presentation of myeloma?

Answer 41

- Weakness - Back pain - Bone pain - Fatigue - Weight loss - May have marrow suppression-> anaemia, recurrent infection - May present with pathologic fracture

Question 42

Likely age range for myeloma?

Answer 42

45-56 years

Question 43

Investigations for myeloma?

Answer 43

- Plasma protein electrophoresis (high paraprotein levels) - Early morning urine collection (Bence Jones protein array) - Lytic lesions - Skeletal survey of x-rays

Question 44

Treatment of myeloma?

Answer 44

- Plasmacytoma- radiotherapy | - Multiple myeloma: chemotherapy (5years < 30%)