Primary tumour profoma- not PBL Flashcards
Epidemiology of primary tumours
commonly seen in young people at growth plates because bone is growing & turning over quicker.
Pathophysiology of primary tumours
How its spreads:
- Through blood - haematogenous spread
- Through lymph nodes
History and red flags of primary tumours
- bone pain
- weight loss, systemically unwell
- symptoms from the primary disease
- functional impairment - pain, difficulty weight bearing
- co-morbidities
- patient understanding & expectations
- social circumstances
- Previous diagnosis and treatment
Examination for primary tumours
- Beware of co-existing pathologies
- scarring & skin changes
- Neurology - cancer of bone can compress nerves
- vascularity
Investigations for primary tumours: blood tests
- Alkaline phosphatase
- Serum calcium
- FBC
- ESR/CRP
- Myeloma screen
Investigations for primary tumours: imaging
X-rays
- essential
- Lysis or sclerosis
- Might be able to see the tumour or features of the tumour
- Good for showing structure of bone
Isotope bone scan
- Highlights areas of metabolic activity - which are high in fast growing cells.
- e.g. can measure glucose uptake
- BUT has limited use in myeloma (bone marrow tumour)
- No value on assessing structure of bone
CT
- Good for showing bone structure - particularly pelvis & acetabular metastasis.
- Used to screen chest/abdomen & pelvis.
MRI
- Defines soft tissue involvement
- Essential in spinal disease
Bone biopsy
- Don’t do bone biopsy if it is a suspected primary bone tumour as it can cause seeding & metastasis.
- Bone biopsy for metastatic disease - helps to discover what the underlying cell is.
Management for primary tumour: pharmacological
- Pain - analgesia
- Bisphosphonates (reduce rate of bone turnover)
Management for primary tumour: surgical
Orthopeadic treatment:
- screws
- cement
- replace bone with joint replacement
- Plates
