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CHI302 - Diagnosis and Chiro skill > Tumors and tumor like processes > Flashcards

Tumors and tumor like processes Flashcards

1
Q

Metastatic bone tumors- primary tumor sights

A 
prostate
breast
lung
kidney
thyroid
bowel
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2
Q

cancer below the knees and elbows is usually what stage of cancer

A

primary cancer

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3
Q

clinical features of metastatic bone tumors

A

patients over 40yrs old
weight loss, cacexia, bone pain (worse at night)
pain may not be presenting feature
not all metastasis lead to neurological disorders

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4
Q

metastatic spine disease can involve one of 3 location

A

vertebral collumn-85%
paravertebral region-10-15%
epidural/ subarachnoid/ intramedullary space

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5
Q

Cancers metastasise by three routes

A
  1. direct extension
  2. lymphatic channels
  3. hematogenous dissemination
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6
Q

what plexus provides a rapid pathway for cancer cells to seed the bone bypassing the liver and lungs

A

Batson’s venous plexus

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7
Q

What are the two types of metastatic lesions

A

lytic lesion- occur as a result of pressure erosion from the medullary tumor deposits and are unrelated to osteoclastic activity (breaks bone down)
blastic lesion- reactive repair response of local osteoid tissue to the presence of tumor (builds bone)

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8
Q

What are the general conditions of a patient with a metastatic tumor?

A
  • cachexia (weight loss)
  • anemia (fatigue, lethargic)
  • hydration
  • nutritional
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9
Q

In a blood investigation of a patient with cancer, what are you likely to find?

A
  • Anemia
  • Thrombocytopenia
  • Increased LDH, uric acid, cal., ALP
  • Increased acid phosphotase (prostate), TFT
  • Serum marker
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10
Q

A lytic lesion may not be visible until what?

A

it reached 2-3cm in diameter, need 30-50% of bone destruction to become visible

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11
Q

what is it called when only one pedicle is visible

A
  • this is called the winking owl sign (metastasis to one pedicle)
  • if this is genetic in nature rather than a metastasis then the visible pedicle will be sclerotic
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12
Q

A blind vertebra represents what?

A

bilateral, pedicular destruction from metastatic disease, leaving no eyes in the spine

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13
Q

In which order do you approach a patient who you suspect has a metastatic tumor, or any cancer in general?

A
  • x-ray
  • bone scan
  • CT
  • MRI
  • biopsy
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14
Q

What are you looking for on a bone scan?

A

looking for black area, this indicates raised metabolic activity

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15
Q

OSTEOID OSTEOMA (benign tumor) - clinical features

A
  • 2:1male predominance
  • 10-25 years of age
  • pain is worse at night (nothing relieves it)
  • alleviated by aspirin (65% of patients)
  • painful rigid scoliosis with the lesion on the concave side of the curve, usually in lumbar spine (exam)
  • 50% occur in femur and tibia, 10% in spine (usually in neural arch)
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16
Q

OSTEOID OSTEOMA (benign tumor) - treatment and prognosis

A
  • surgical excession is possible
  • it is not necessary to remove the reactive sclerosis even though this may be the major part of the radiologic presentation
  • prognosis is very good, with little chance of recurrence
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17
Q

OSTEOBLASTOMA (Benign tumor)- clinical features

A
  • accounts for 1% of all primary bone tumors
  • 70%occur before the age of 20, peak range is 10-20years of age
  • GIANT NIDUS
  • localised pain, not noctural (doesnt keep you awake at night), less severe than osteoid osteoma
  • painful scoliosis is a common presentation in over 50% of cases
  • may cause spinal stenosis
  • neural arch is the most common side for osteoblastoma to occur
  • dull aching pain over the bone
18
Q

OSTEOCHONDROMA (Benign tumor)- defintion

A
  • bony exostosis projecting from the external surface of a bone
  • usually has a hyaline lined cartilaginous cap
  • when the lesion is seen in a single bone, it is called osteochondroma
  • if two or three bones are involved with no familial history, it is called multiple osteochondromas
  • widespread osteochondromas are associated with a positive family history
  • 50% of all benign tumors
  • 2:1 male dominance
  • occurs in childhood or adolescence
  • 75% occur before age of 20
  • UNCOMMON IN SPINE
19
Q

Metastatic bone tumors

A
  • most common malignant tumors of the skeleton

- approx. 70% of malignant bone tumors are metastatic in nature

20
Q

What are the two types of osteochondromas (benign tumor)?

A
  • sessile variant

- pedunculated variant

21
Q

What is a sessile variant of osteochondroma (benign tumor)?

A

outgrowth of a bone, broad based

  • uncommon
  • located on proximal humerus and scapula
22
Q

What is a pedunculated variant osteochondroma (benign tumor)?

A

growth of bone that looks like a stalk

  • common
  • located in knee, hip and ankle
23
Q

Clinical features of a osteochondroma (benign tumor)

A
  • most are asymptomatic
  • symptoms arise as a result of:
  • location
  • size
  • pressure effects on adjacent stuctures
  • usual complaint is hard palpable mass
24
Q

Giant Cell Tumor- Benign

A
  • 5% of bone neoplasm
  • 20-40 years of age
  • female more than males
  • benign but pulmonary metastasis can occur
  • lesions are purely lytic
  • usually occur in long bones
25
Q

Giant cell Tumor (benign tumor)- clinical features?

A
  • Pain

- Pathological fractures

26
Q

Aneurysmal Bone Cyst (Benign tumors)

A
  • locally destructive blood filled reactive lesions of bone
  • Proximal humerus, distal femur, proximal tibia and spine
  • less than 20 years of age
  • mild to moderate pain
  • neuro symptoms in spinal patients
  • radiographically expansile LYTIC lesion that elevates the periosteum, but remains contained by a thin shell of cortical bone
27
Q

MULTIPLE MYELOMA (malignant)- incidence

A

most common primary malignant bone tumor

28
Q

MULTIPLE MYELOMA (malignant)- clinical features

A
  • 50-70 years of age
  • male predominance 2:1
  • pain initial symptom, relieved by bed rest and aggravated by weight bearing
  • pathological fracture is a common complication
    occurs in:
    *spine, pelvis, ribs and scapula (spine most common)
29
Q

MULTIPLE MYELOMA (metastatic tumor)- laboratory findings

A
  • thrombocytopenia
  • hypercalcemia
  • hyperglobulinemia
    40% SHOW BENCE JONES PROTEINURIA
30
Q

MULTIPLE MYELOMA (metastatic tumor)- pathological features

A
  • myeloma kidney occurs as a result of permanent tubular damage, LEADING TO RENAL FAILURE
  • THE MOST COMMON SITE FOR EXTRA-MEDULLARY PLASMACYTOMA IS THE NASOPHARYNX
31
Q

CHONDROSARCOMA (metastatic)- clinical features

A
  • 40-60 years of age
  • male predominance 2:1
  • pain presents late in disease
  • severe pain follows pathological fracture
  • common sites:
  • pelvis, proximal femur, humerus, ribs, scapula, sternum, craniofacial bones, distal femur, proximal tibia
32
Q

CHONDROSARCOMA (Metastatic)- Definition

A
  • Lobules of greyish-white or bluish cartilagenous tissue
33
Q

CHONDROSARCOMA (Metastatic) -treatment and prognosis

A
  • local excisions, segmental resection or amputation

- prognosis is good 90% survival rate after early surgery

34
Q

CHONDROMA (metastatic)- definition

A
  • Rare primary malignant bone tumor arises from the vestigial remanence of the notochord
  • aggressive, very slow growth rate
  • known to cross the intervertebral disc, involving adjacent spinal segments ( because it is a remanent of the notochord)
35
Q

CHONDROMA (metastatic)- clinical features

A
  • Sacrococcygeal Chondroma: may be silent until lesion expands then will cause localised pain with pressure symptoms from the bladder and rectum
  • Spheno-occipital Chondroma: most consistent symptom is headache, often present for years, pressure from enlarging midline mass may cause ocular disturbances, increased intracranial pressure, ataxia,deafness, signs of central canal stenosis, chorda equina syndromes, cervical myelopathy and tinnitus
  • Vertebral Chondroma: in cervical spine, dysphagia common presenting symptom. sensory compliants include numbness in arms or legs usually followed by pain, motor symptoms include paraplegia or quadriplegia as a late complication
36
Q

LYMPHOMA (metastatic) - Definition

A
  • non-Hodgkin’s lymphoma also know as reticulum cell sarcoma of bone
  • it is a rare extra-nodal lymphoma presenting initially as a localised solitary bone lesion
  • represents only 3-4% of all primary malignant bone tumors
37
Q

LYMPHOMA (metastatic)- clinical features

A
  • 20-40 years usual range
  • male predominance 2:1
  • localised pain of a intermittent nature
  • contrast between the apparent well being of the patient and the size of the lesion
38
Q

NEUROFIBROMATOSIS (metastatic)- definition

A
  • inherited disorder
  • cafe au lait spots, fibroma mulluscum
  • fibroma mulluscum is a multiple asymptomatic cutaneous nodule which is elevated above the skin’s surface
39
Q

PAGET’S DISEASE (metastatic)- clinical features

A
  • male predominance 2:1
  • rare before age of 40
  • 90% of patients are asymptomatic
  • pain when present is of low intensity
  • increasing hat size is common because of enlargement of the calvarium
  • deformity of bone is common (shephards crook of proximal femur and saber-shin deformity, protrusio acetabuli, frontal and parietal bossing and basilar invagination (odontoid process moves superiorly into foramen magnum)
  • pathological fractures of vertebral body and transverse banana-like fracture of long bone is common
40
Q

PAGET’S DISEASE

A

-pseudofractures: are notes representing local areas of demineralisation within bone which are replaced by fibrous tissue
- spinal stenosis: may occur as a result of bony expanision of a vertebrae, leading to compressive neuropathy
- malignant degeneration: rare under age of 40, average age 57-66, symptoms of localised pain most common in femur, humerus, innominate, skull and tibia, uncommon in vertebrae,
OSTEOSARCOMA is the most common tumor to complicate paget’s disease, 50%of lesions are LYTIC, 25% sclerotic, 25% mixed, 5 YEAR SURVIVAL RATE IS VERY POOR (

41
Q

NEUROBLASTOMA

A
  • Second most common abdominal neoplasm in childhood, WILMS TUMOR most common
  • 75% arise in adrenal glands, 20% in posterior mediastinum, 5% in sympathetic ganglionate chain
  • 80% are found in children under 2 and a half, remander before 5yrs
  • 2/3 show granular calcification radiographically
  • skeletal metastasis are very common and are diffuse and fairly symmetric
  • spine, pelvis, skull and end of long bones common sites
  • skull deposits widen the sutures, creating a sunburst spiculation of the skull tables which is pathognomonic of metastatic neuroblastoma

CHI302 - Diagnosis and Chiro skill (15 decks)

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