T&O: Primary Bone Cancer

Question 1

Outline the pathophysiology of Primary Bone Cancer

Answer 1

Osteosarcoma = most common type, typically starts in arms, legs or pelvis, 10-30 yrs, >males:females

Chondrosarcoma forms in cartilage cells = 2nd most common form, rarely in <20, risk factor - age

Ewing tumour (Ewing’s sarcoma) = typically starts in the bones, but can also start in other tissues and muscles, 3rd most common, most frequently in children/teenagers, rarely in >30

Question 2

What are the risk factors of Primary Bone Cancer?

Answer 2

Pagets disease = bones become thick and brittle

Multiple enchondromatosis = cartilage tumours

Radiation

Bone marrow transplantation

Question 3

What are the symptoms of Primary Bone Cancer?

Answer 3

Bone pain = dull deep ache

Swelling = around the area, or a lump or mass

Fractures = due to weakened bone

Decreased mobility = may be near a joint or de to pain

Unintended weight loss

Fatigue

Question 4

How would you investigate Primary Bone Cancer?

Answer 4

Bloods = FBC, U+Es, LFTs, alkaline phosphatase

X-ray

Biopsy = histology

CT = help stage

MRI

Question 5

How would you manage Primary Bone Cancer?

Answer 5

Surgery = remove cancerous bone, potentially graft a piece from elsewhere

Chemotherapy = not very effective for chondrosarcoma, but it’s an important part of treatment for osteosarcoma and Ewing sarcoma

Radiotherapy = helps kill cancer cells, for people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain

Question 6

What are the complications of Primary Bone Cancer?

Answer 6

Amputation

Metastasis

Question 7

How how can Primary Bone Cancer be graded?

Answer 7

T= Size
N= Lymph node involvement
M=Metastasised

Grade = How abnormal the tumour cells look under the microscope (high-grade tumours look more abnormal, grow more quickly and are more likely to spread)