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MBChB3 > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

What are the types of bone tumours?

A
  • secondary tumours from metastasis
  • myeloma (plasma cell cancer)
  • primary bone tumours (rare)
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2
Q

What cancers commonly spread to the bone?

A
  • bronchus
  • breast
  • prostate
  • kidney
  • thyroid (follicular)
  • childhood: neuroblastoma, rhabdomyosarcoma
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3
Q

What bones are commonly affected with tumours?

A
  • long bones
  • vertebrae
    haematogenous spread
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4
Q

What are the effects of metastasis to bone?

A
  • can be asymptomatic
  • bone pain
  • bone destruction
  • long bones = pathological fracture (from event that shouldn’t cause a fracture)
  • spinal metastases = vertebral collapse, spinal cord compression, nerve root compression, back pain
  • hypercalcaemia (from osteoclast activation)
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5
Q

What can be viewed in a PET CT of a bone with a tumour in it?

A

areas of high metabolic activity

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6
Q

Describe the mechanism of lytic lesions in the bone

A
  • tumour cells stimulate cytokine release which activates osteoclast activity to resorb bone
  • inhibited by biphosphonates
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7
Q

What are the common causes of sclerotic lesions?

A
  • prostatic carcinoma
  • breast carcinoma
  • carcinoid tumour
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8
Q

Describe the mechanism of sclerotic lesions in the bone

A
  • reactive new bone formation
  • tumour cells induce cytokines that activate osteoblast activity
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9
Q

What are the common causes of a single bone metastasis and the treatment?

A
  • renal and thyroid carcinomas
  • surgical resection
  • can be curative
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10
Q

Describe the clinical effects of myeloma

A
  • bone lesions (lytic): can cause pain and fracture
  • marrow replacement with plasma cells (anaemia, bleeding and infections)
  • immunoglobulin excess (produced by plasma cells)
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11
Q

How can you differentiate between a normal plasma cell reaction to infection vs myeloma?

A
  • in response to an infection, the plasma cells of the bone marrow will produce many different types of immunoglobulin
  • in myeloma (clonal disorder), only 1 type of immunoglobulin is present - kappa/lambda
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12
Q

How can you measure immunoglobulin levels?

A
  • serum electrophoresis
  • urine (detect immunoglobulin light chains (Bence Jones protein)
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13
Q

What are the consequences of marrow replacement with plasma cells in myeloma?

A
  • pancytopenia
  • anaemia
  • leucopenia: infections
  • thrombocytopenia: haemorrhage
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14
Q

List the primary bone tumours

A

Benign:
- osteoid osteoma (bone forming)
- chondroma (cartilage forming)
- osteocartilagenous exostosis

Malignant:
- osteosarcoma
- chrondrosarcoma
- Ewing’s sarcoma

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15
Q

Describe the features of osteoid osteoma

A
  • small benign osteoblastic proliferation
  • commonly long bones, and spine
  • pain which is worse at night and relieved by NSAIDs (not paracetamol)
  • if it is near a joint = synovitis
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16
Q

How does an osteoid sarcoma look on imaging?

A

blacker area with a sclerotic surrounding

17
Q

Describe an osteosarcoma

A
  • a malignant tumour which cells form osteoid or bone
  • metaphysics of long bones, 50% form around the knee
  • peaks 10-25y and again in adulthood (esp if Paget’s, previous necrosis or radiotherapy)
  • presents with bone pain, swelling and pathological fracture
  • non-specific symptoms
18
Q

What signs can you see on imaging for an osteosarcoma?

A
  • lytic lesion
  • cortical destruction with soft tissue mass
  • Codman triangle
  • sometimes soft tissue mass
19
Q

What is the treatment for osteosarcoma?

A
  • neoadjuvant chemotherapy
  • wide local excision, limb sparing
  • further chemotherapy
  • +/- radiotherapy for local control
20
Q

List the cartilaginous tumours

A

Benign: enchondroma, osteocartilaginous exostosis

Malignant: chondrosarcoma

21
Q

Describe the features of osteocartilaginous exostosis

A
  • benign outgrowth of cartilage with end-chondral ossification
  • derived from growth plate
  • common in children
  • multiple-diaphysial aclasis (AD)
  • long bones
22
Q

Describe the features of enchondroma

A
  • lobulated mass of cartilage within the medulla
  • hands, feet, long bones (asymptomatic in long bones)
  • causes swelling and pathological fracture in the hands
  • popcorn calcification on imaging
23
Q

Describe features of chrondrosarcoma

A
  • can be primary, from endochondroma that has transformed, or exostosis
  • central in medullary canal or peripheral on bone surface
  • axial skeleton, pelvis, ribs, shoulder girdle, proximal femur and humerus
  • presents with bone pain, swelling, pathological fracture, neurological symptoms
  • popcorn calcifications, lytic lesions, cortical destruction with soft tissue mass
24
Q

Describe features of Ewing’s sarcoma

A
  • long bones, flat bones or limb girdle
  • metastasises early to lung, bone marrow, bone
  • micrometastases
  • presents with pain, swelling, night sweats, fever, weight loss
  • imaging signs show lytic lesion, periostea new bone formation
25
Q

How is a Ewing’s sarcoma tumour identified?

A
  • translocation between chromosomes 11 and 22
  • identified by FISH and PCR
26
Q

What is the treatment for Ewing’s sarcoma?

A
  • neoajuvant chemotherapy (doxorubicin, cyclophosphamide, vincristine)
  • surgery
  • more chemo
  • +/- radiotherapy

MBChB3 (100 decks)

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