Bone and soft tissue tumour Flashcards
What are the salient clinical features of benign bone tumour?
(e.g. osteoid osteoma); Pain – activity related (if tumour is large enough to weaken the bone) , progressive pain at rest and at night
What are the clinical features of malignant bone tumour?
Pain (cardinal, increasing), loss of function (reduced movement), swelling (diffuse, deep, at ends, enlarging), pathological fracture, joint effusion, deformity, neurovascular effects, systemic effects of dysplasia
(e.g. osteosarcoma)
What are the salient clinical features of soft tissue tumours?
Painless mass deep to deep fascia any mass > 5cm any fixed, hard or indurated mass any recurrent mass rapid growth. (e.g. Liposarcoma, lipoma more common <5cm) all patients with soft tissue tumour of being malignant (above signs) should be referred to a specialist tumour centre
What are the cardinal signs of a malignant bone tumour?
Increasing pain and unexplained pain Deep-seated boring nature Night pain Difficulty weight-bearing Deep swelling
What features of a swelling would be particularly alarming?
Rapidly growing
Hard, fixed, craggy surface, indistinct margins
Non-tender to palpation, but associated with deep ache, especially worse at night
Beware may be painless
Recurred after previous incision
NASTY – suspicion of malignant tumour (primary or secondary) until proven otherwise
Describe use of X-rays in detection of bone and soft tissue tumours
Inactive tumours – clear margins, surrounding rim or reactive bone, cortical expansion can occur with aggressive benign lesions
Aggressive tumours – less well-defined zone of transition between lesion and normal bone (permeative into bone); cortical destruction = malignancy; Periosteal reactive new bone growth occurs when the lesion destroys the cortex; Codman’s triangle, onion-skinning or sunburst pattern
Describe the use of CT scan for bone and soft tissue tumours
assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
staging – primarily of lungs (metastasis)
Describe use of isotope bone scan
Staging for skeletal metastasis (shows areas of increased bone uptake)
Multiple lesions – osteochondroma, enchondorma, fibrous dysplasia + histiocytosis
Negative in myeloma
Benign also show increased uptake
Describe use of MRI scan
Study of choice for bone and soft tissue tumours
Demonstrates size, extent (intra + extraosseous), anatomical relationships (inc vessels, nerves etc)
Accurate for limits of disease both within and outside bone
Specific for lipoma, haemangioma, haematoma or PVNS
Non-specific for benign vs malignant
Helps determine resection margins
When would biopsy be used?
Complete work up prior to biopsy: bloods, x-rays of affected limb +chest, MRI of lesion, bone scan, CT chest, abdo + pelvis
Can be needle core vs open
Describe the treatment of tumours
Goal is to make free of disease
Chemotherapy (Shrink)
Surgery (excision) - limb salvageable in most cases, conside invpolvement of neurovascular structures, Usually wont work for pathological fractures and after poorly performed biopsies
Team/MDT effort
Begin discussing metastatic bone disease and its commonality
Secondary bone tumour more common than primary bone tumour (25x). Bone is the most common site for metastatic spread after lung and liver
What are the commonest primary cancers that metastasise to bone
Lung, breast, prostate, kidney, thyroid, GI tract, melanoma
How would you investigate the different sources of metastases
lung – smoking history, CXR, sputum cytology
Breast – commonest, examine
Prostate – osteosclerotic secondary; prothrombin ratio, PSA
Kidney – solitary, vascular; intravenous pyelogram (IVP) + USS, angiography + embolise (before surgery, so don’t bleed out as vascular)
Thyroid – especially follicular cancee, examine
GI tract – faecal occult blood test (FOB), endoscopy, barium studies, tumour markers
Melanoma – examine
What are the commonest sites for metastatic bone cancer to arise?
Vertebrae > proximal femur > pelvis > ribs > sternum > skull
