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Clinical Medicine II > Musculoskeletal Neoplasms > Flashcards

Musculoskeletal Neoplasms Flashcards

1
Q

Describe cancer

A
  • uncontrolled cell proliferation = tumor = neoplasm
  • benign = contained/stable
  • malignant = continued proliferation/potential to metastasize (cancer)
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2
Q

Describe radiation

A
  • targeted therapy that kills cancer cells or slows growth by damaging cancer’s DNA
  • effect takes weeks/months
  • external beam (treats all cancers) or internal beam (treats head/neck, breast, cervix, prostate, eye, & thyroid cancers), solid or liquid form
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3
Q

Describe chemotherapy

A
  • limit proliferation by attenuating cell growth
  • inhibit DNA/RNA synthesis & function
  • inhibit cell division (mitosis)
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4
Q

Typically what ending does a benign versus a malignant tumor have

A
  • Benign = -oma
  • Malignant = -sarcoma
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5
Q

Describe benign neoplasms

A
  • well differentiated in terms of cell maturation
  • look similar to normal tissue
  • tend to grow slowly
  • possible secondary problems
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6
Q

Clinical presentation of benign neoplasms

A
  • early diagnosis is better, but often elusive: early tumors are not well defined & may not cause symptoms
  • pain not attributable to position
  • night pain
  • pathologic fractures
  • presence of a mass
  • swelling, fever, unexplained weight loss…
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7
Q

Diagnosis & classification of benign neoplasms

A
  • imaging
  • biopsy
  • labs: ESR, CBC, calcium, phosphorous, alkaline phosphatase
  • detailed knowledge of location, appearance, & interaction with nearby tissues helps inform diagnosis
  • stage/grade I = differentiated to stage/grade IV = undifferentiated
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8
Q

Treatment strategies for benign neoplasms

A
  • observation
  • resection: complete/wide/en bloc(tumor and surrounding tissue removed) or marginal (most but not all of tumor removed)
  • chemotherapy
  • radiation
  • newer options (stem cell transplants, biologic response modifiers, gene-based therapies)
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9
Q

Describe Osteochondroma

A
  • benign
  • cartilage-capped bony spur/outgrowth on bone surface
  • usually occurs at end of long-bone growth plates, interfering with joint function
  • symptom of pain on joint movement
  • most comely form at shoulder or knee
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10
Q

Symptoms of Osteochondroma

A
  • hard, immobile, detectable mass that is painless
  • loss of joint ROM
  • soreness of the adjacent muscles
  • limb length discrepancies
  • pressure or irritation with exercise
  • possibility for changes in blood flow
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11
Q

Treatment for Osteochondroma

A
  • observation for neuromuscular compromise
  • excision
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12
Q

Describe Osteoid Osteoma

A
  • benign skeletal neoplasm consisting of a nidus of osteoid tissue in the cortex
  • no malignant transformation
  • initial treatment includes pain control (NSAIDs) and observation
  • excision if growing and/or interfering with active lifestyle
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13
Q

Symptoms of Osteoid Osteoma

A
  • pain at night
  • pain with activity
  • pain relieved with NSAIDs
  • can affect bone growth in individuals with open growth plates
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14
Q

Describe Osteoblastoma

A
  • benign but larger than Osteoid Osteoma & likely to grow
  • usually in the vertebral column (unlike Osteoid Osteoma) or long bones along diaphysis
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15
Q

Symptoms of Osteoblastoma

A
  • pain for several months
  • pain is not as severe as osteoid osteoma
  • pain is less likely to be relieved with NSAIDs
  • poorly localized pain
  • possible scoliosis
  • nerve root impingement
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16
Q

Treatment for Osteoblastoma

A
  • curettage (scraping)
  • because of high recurrence a wider excision margin is often used
  • reconstruction or implants may be necessary depending on extent of bone/joint tissue resection
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17
Q

Describe Enchondroma

A
  • benign
  • cartilage cyst found in bone marrow often found incidentally
  • usually found in metacarpals/metatarsals but also found in humerus & femur
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18
Q

Symptoms of Enchondroma

A
  • mostly asymptomatic
  • possible fractures of the affected bone
  • enlargement of affected finger
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19
Q

Treatment for Enchondroma

A
  • observation
  • curettage (scraping) considered if bone health is compromised
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20
Q

Describe Chondroblastoma

A
  • benign but locally aggressive & usually must be excised
  • slow growing tumor usually at epiphyseal plate usually femur/tibia/humerus
21
Q

Symptoms of Chondroblastoma

A
  • localized pain
  • limited joint motion
  • swelling at end of long bones
  • tenderness at end of long bones
22
Q

Describe a Hemanginoma

A
  • growth of the endothelial cells that line blood vessels
  • may involve skin, showing up in neonates (self-resolving or permanent)
  • some involve vertebral bodies: 10% of population, females > males between 40-60 years old
23
Q

Describe giant cell tumor of bone

A
  • historically considered benign: low-grade malignant
  • 6th most common bone tumor (rare)
  • wide age distribution
  • center of the epiphysis of long bones
  • develop slowly
  • 50% recurrence
24
Q

Symptoms of giant cell tumor

A
  • mild pain that progresses with tumor growth
  • limited ROM
  • swelling (large growth)
  • pathologic fracture
25
Q

Treatment for giant cell tumor

A
  • removal of tumor
  • high recurrence rate may be due to bleeding at surgical site with reseeding (of tumor cells) in the area
26
Q

Describe malignant neoplasms

A
  • capacity to expand & travel
  • spread by local invasion or blood
  • sarcomas develop in connective & supportive tissue
  • considered primary bone tumors
  • relatively rare
27
Q

Prevalence of different sarcoma in bone, cartilage, & synovium

A
  • Osteosarcoma: 35% of all bone tumors
  • Chondrosarcoma: 25% of all bone tumors
  • Ewing’s sarcoma: 16% of all bone tumors
  • Synovial sarcome
28
Q

What is the most common bone tumor in childhood and adult

A
  • Childhood: Osteosarcoma/Osteogenic sarcoma is No. 1 and Ewing’s sarcoma is No. 2
  • Adult: Chondrosarcoma
29
Q

General diagnosis & treatment of malignant tumors

A
  • pain
  • biopsy
  • imaging
  • labs
  • surgery, radiation, chemotherapy
30
Q

Two types of bone tumor pathogenesis

A
  • Osteoblastic: neoplastic cells produce osteoid & known as tumor bone or neoplastic bone
  • Osteolytic: neoplastic cells incite local osteoclastic resorption of bone
  • both processes occur at the same time
31
Q

Describe Chordoma

A
  • develop from notochord: sacrococcygeal & sphenooccipital
  • slow-growing, locally aggressive
  • treatment involves resection, often after chemo
  • poor long term prognosis: complete resection often difficult due to midline location
32
Q

Describe Osteosarcoma

A
  • most common primary malignant bone tumor
  • develops in the metaphysis: distal end of femur, proximal end of tibia/fibula, & proximal end of humerus
  • mainly osteoblastic
  • extremely malignant
  • radiation resistant
33
Q

Manifestations & treatment for Osteosarcoma

A
  • continuous pain that increases quickly (period of weeks)
  • early metastasis to lungs
  • excision with pre and/or post chemotherapy
  • expandable prostheses (in children)
  • rotationplasty: removing knee & rotating the ankle/foot to create a new knee joint with the use of prosthesis
  • prognoses are getting better but still relatively poor compared to other sarcomas
34
Q

Describe Chondrosarcoma

A
  • relatively slow growing tumor of cartilage
  • pelvic & shoulder girdles
  • secondary Chondrosarcoma: previously benign osetochondroma or Paget’s disease
  • men in their 40 to 60s
  • surgical intervention
35
Q

Treatment for Chondrosarcoma

A
  • surgery
  • chemotherapy & radiation are not effective
  • complete resection a high priority
36
Q

Describe Ewing’s Sarcoma

A
  • non-osteogenic primary tumor
  • see in bone (diaphysis) or soft tissue
  • 2nd most common in children 10-15 years old
  • favors long tubular bones: femur, tibia, proximal fibula, humerus
  • pelvis
  • early metastasis to the lung
37
Q

Pathogenesis of Ewing’s Sarcoma

A
  • soft tumor with hemorrhagic necrosis caused by rapid tumor growth
  • medullary cavity is affected
  • bone marrow is infiltrated
  • “onion skin” appearance on X-ray
  • periosteum is elevated
38
Q

Diagnosis of Ewing’s Sarcoma

A
  • radiograph of involved bone
  • CT, MRI, bone scan
  • sedimentation rate
  • X-ray of chest
  • local pain may be attributed to injury & fever possible in young children both may delay accurate diagnosis
39
Q

Treatment & outcome of Ewing’s Sarcoma

A
  • local tumors responsive to high-dose radiation
  • metastases require aggressive combination therapy
  • selective surgery: amputation or limb-sparing
  • 5 year survival: no metastasis = up to 85% and if metastasis has occurred = 25%
40
Q

Describe Multiple Myeloma

A
  • plasma cell myeloma
  • malignant
  • common clusters of signs/symptoms is CRAB: Calcium (elevated), Renal failure, Anemia, & Bone lesions
41
Q

Treatment for Multiple Myeloma

A
  • treatable but not curable
  • remission with medication
  • radiation to decrease bone pain: for the thoracic spine, lumbar, spine, skull, pelvis, & ribs have tendency to increase in pain with activity
42
Q

Common complications for Multiple Myeloma

A
  • hypercalcemia: weakness, confusion, fatigue, osteoporosis, & kidney failure
  • headache
  • vision changes
  • radicular pain
  • neuropathy
  • loss of bowel & bladder control
  • paraplegia
43
Q

Describe secondary bone tumors

A
  • all secondary bone tumors are metastatic
44
Q

Sources of metastatic bone tumors

A
  • prostate
  • breast
  • lung
  • kidney
  • thyroid
  • GI
45
Q

Statistics of skeletal system involvement

A
  • primary symptoms are pain, neurological findings
  • spine involved 50% of the time with cord compression
  • X-ray for early diagnosis but bone scan is preferable
  • 1/3 will have a pos. bone scan but a neg. radiograph
  • treatment is mostly palliative (treat to maintain QOL)
46
Q

Describe spinal metastasis

A
  • from lung, breast, prostate, and/or kidney
  • to thoracic, lumobosacral, & cervical spine
  • initial diagnosis involves radiography (may miss many cases) & neurological exam
  • presenting symptoms: weakness, sensory loss, bowel & bladder sphincter disturbance
47
Q

Treatment for spinal metastasis

A

radiotherapy to reduce pain, compress tumor, & restore neurological function

48
Q

Prognosis for spinal metastasis

A
  • if paralyzed prior to radiation, patient will very likely remain non-ambulatory
  • if ambulatory at start of radiation, 80% will be able to continue to walk
  • because metastasis represents loss of containment, cure is not possible

Clinical Medicine II (21 decks)

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