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MSKsara > tumours > Flashcards

tumours Flashcards

1
Q

The majority of bone tumours are…

A

metastasis from lung, kidney, prostate, breast and thyroid.
Then the second most common are benign primary bone tumours
Finally the least common are primary malignant bone tumours.

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2
Q

which malignant tumours that metastasise to bone produce

a) lytic lesions
b) sclerotic/blastic lesions?

A

a) lytic = breast and Renal

b) sclerotic = prostate.

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3
Q

what type of lung tumour most commonly metastasises to the bone?

A

non small cell

bronchial carcinomas

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4
Q

what is the most common site for metastasis to bone?

A

spine

then pelvis, ribs and proximal limb girdle.

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5
Q

List the primary bone tumours that are

a) malignant
b) benign

A

a) malignant:
- multiple myeloma
- osteosarcoma
- Ewings tumour
- fibrosarcoma
- chondrosarcoma
b) benign:
- osteoid ostoma
- osteochondroma
- Giant cell tumour
- osteoblastoma
- brown tumour
- endochondroma

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6
Q

which bone tumours are

a) bone forming
b) cartilage forming?

A

a) osteosarcoma, osteoid ostoma, osteoblastoma

b) osteochondroma, chondrosarcoma and fibrosarcoma.

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7
Q

multiple myeloma:

  • who do they mainly affect?
  • where do they mainly present?
  • what cells do they involve?
A

affect mainly 50-60s
usually in spine, pelvis, scapula, skull, but also head of humerus and head of femur.

involve the bone marrow - proliferation of plasma cells

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8
Q

what is the most common and second most common type of primary malignant bone tumour?

A

most common - multiple myeloma

second - osteosarcoma

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9
Q

what are the symptoms of multiple myeloma?

A

dull ache worse on movement
may have high Ca due to bone turnover
pathological fractures

anaemia
deranged clottting
renal failure
repeated infections

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10
Q

osteosarcoma:

  • where are they most common?
  • who are they most common in?
  • lytic or sclerotic?
A

around the knee - distal femur/proximal tibia metaphysis (also at hip and shoulder)
most common 10yr-20yrs
can be either lytic or sclerotic

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11
Q

other than teenagers who can osteosarcomas affect?

A

secondary to radiotherapy or pagets disease in older individuals

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12
Q

what are the symptoms of osteosarcoma?

A

pain and swelling of bone with no history of trauma
often a pass too.
may present with a pathological fracture

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13
Q

what is the growth pattern of osteosarcoma like?

A

rapidly growing
rapidly metastasises to lungs
in 70% of cases it has already metastasised by the time it presents

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14
Q

how does osteosarcoma present on Xray?

A

may be lytic: moth eaten appearance I.e. edges are not well defined. more likely to present as pathological fracture.

or can be sclerotic and lead to a sunburst appearance or codmans triangle

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15
Q

what is an Ewings tumour?

A

A tumour arising from medullary canal of bone and spreads via haversian system.
mainly affects the upper and lower leg, pelvis, ribs, humerous and clavicle

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16
Q

how does Ewings tumour present?

A

fever, anaemia, pain and sweats

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17
Q

Who does Ewings tumours affect?

A

5yrs - 20yrs

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18
Q

what is a fibrosarcoma?

A

malignant tumour forming fibrous (cartilage) tumour cells. similar characteristics to osteosarcoma.

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19
Q

who do fibrosarcomas mainly affect?

A

30-60s

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20
Q

where do chondrosarcomas arise from?

A

can arise from osteoid ostomas or osteochondromas

21
Q

who do chondrosarcomas affect?

A

40-70 yrs

22
Q

where in the body do chondrosarcomas mainly occur?

A

hip, pelvis and humerus

23
Q

what are the symptoms of chondrosarcomas?

A

pain, swelling, deep ache
sciatica
bladder symptoms

24
Q

what are the Xray changes seen in chondrosarcomas?

A

low grade: well defined osteolytic chondroid matrix and scalloping (eating away at cortex)
high grade: large lesion, extension into soft tissue

25
Q

what is multiple hereditary exstosis?

A

autosomal dominant condition whereby there is formation of osteochondromas. Tibia and humerus are most common sites. this starts in childhood and often no problem however they can develop into chondrosarcomas.

26
Q

out of the benign primary bone tumours, which are more aggressive?

A

osteoblastoma

giant cell tumours have 1%chance of metastasising and 1% chance of becoming osteosarcomas.

27
Q

who do giant cell tumours mainly affect?

A

20-40s females

28
Q

what are brown tumours?

A

tumours that deposit haemosiderin and thus appear brown.

associated with primary hyper parathyroidism

29
Q

when taking a history in someone with bone pain what is important to consider?

A

age
pain - nocturnal? at rest? deep ache?
systemic symptoms - weight loss, fever, sweats, cachexia, fatigue
symptoms related to a primary tumour e.g. kidney, prostate etc.
symptoms related to mass e.g. nerve compression

history of malignancy, radiotherapy, smoking

30
Q

how may a bone tumour present?

A

bone pain - deep ache
lump, swelling, mass
local tenderness
pathological fracture

symptoms related to cancer e.g. weight loss
symptoms related to primary tumour

31
Q

what are the symptoms you would expect in someone with a bone met from

a) kidney
b) prostate
c) breast

A

both have haematuria, dysuria, frequency and urgency
but prostate the haematuria is early in stream and for kidney late in stream.

breast: nipple discharge (bloody), visual changes to boob and nipple, tender, lump

32
Q

what are the symptoms you would expect in someone with a bone met from

a) lung
b) thyroid

A

a) cough, haemoptysis , SoB, reduced exercise tolerance, wheeze, consider occupation
b) hyper/hypo thyroid

33
Q

what are cannabol mets?

A

Renal cell carcinoma can produce metastasis and their appearance appears like cannabols
these may deposit in lungs to give lung symptoms
deposit in peritoneum - distended abdomen.
deposit in prostate.

34
Q

what investigations are needed for someone you suspect may have bone cancer?

A

Bloods:

  • FBC - rule out infection with WCC, anaemia in cancer
  • U&Es, TFTs, PSA - look for primary tumour
  • LFTs: ALP raised in bone cancers (but also osteoporosis and pagets).
  • CRP and blood cultures (rule out infection)

imaging:

  • xray bone
  • CXR - rule out metastasis, primary lung cancer and cannabol mets
  • MRI - more detail of lesion
  • CT chest, abdo, pelvis to look for primary

urinalysis:

  • bence jones
  • haematuria

bone scan - DXA and isotope bone scan.

serum electrophoresis - myeloma.
TB test
biopsy bone

35
Q

why may U&Es be deranged in someone with a bone tumour?

A
  • U&Es may be disrupted in RCC
  • multiple myeloma - bence jones proteins (Ig light chains) deposit in renal tubules and are toxic. also increased risk of kidney infection in myeloma. AND hyperuricaemia due to high cell turnover.

due to hyperCa (due to bone turnover) and dehydration

36
Q

what is an isotope bone scan?

A

radioactive dye given and well vasculised areas will take it up more. e.g. tumours are well vascularised. so when scanned they appear more black. allows you to pick up other metastasis in bone

37
Q

in general how are malignant primary bone tumours treated?

A

resection in combination with: neoadjuvant chemo (shrinks tumour and defines margin to make resection easier), adjuvant chemo, radiotherapy.

alleviate pain and manage symptoms

38
Q

what is the Mirells scoring system?

A

It tells you how stable a bone is and whether pathological fracture is likely. This helps to decide whether to prophylactically fix a bone (that has a tumour) to prevent fracture. Especially if they patient is about to undergo radiotherapy.

uses the site of the lesion, degree of pain, type of lesion and size of lesion in relation to bone diameter to calculate a score. e.g. lower limb, peritrochanteric and lytic lesions are more at risk of fracture.

if he score >8 the bone needs fixing.

39
Q

how are multiple myelomas treated?

A

chemo and radio for local diseae
can give stem cell transplant after chemo/radio

50% 5yr survival

40
Q

how are osteosarcomas treated?

A

resection and adjuvant chemo to get micromets. doesn’t respond well to radiotherapy. 60-80% survival if no mets but usually lung mets and thus 15-30%

41
Q

how are Ewings tumours treated?

A

6-9 months of chemo

70% 5yr survival

42
Q

how are chondrosarcomas treated?

A

surgery is only treatment - excise with wide margins

43
Q

how are metastatic bone tumours treated?

A

symptom relief
can prophylactically fix to prevent path fracture.
can give local radiotherapy
ultimately need to treat primary cancer.

dexamethasone can be given to someone with spinal mets (palliative) to reduce infiltation

44
Q

what is DXT?

A

deep xray therapy - radiotherapy

45
Q

what are the 4 types of multiple myelomas that are distinguished via Xrays?

A

disseminated forms:

1. multiple well defined punched out lesions affecting axial skeleton
2. OR generalised axial osteopenia
  1. one large expansible lesion - usually vertebral body/pelvis
  2. osteosclerosing myeloma
46
Q

how do osteoblastomas appear on Xray?

A

lytic with rim of sclerosis
sometimes internal calcification
rapid increase in size associated with cortical expansion

47
Q

how do Ewings tumours appear on Xray?

A

very variable appearance but not well defined.
laminated periosteal reaction (onion skin appearance)
both lytic and sclerotic types
can affect shaft of long bones.

48
Q

what are the differential diagnosis for bone cancers?

A

osteomyelitis
- present very similar and on Xray lytic lesion.
stress fracture
- cortical destruction and overlying periosteal reaction. also histology of healing callus can be similar to osteosarcoma

gouty tophi

MSKsara (9 decks)

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