Bone Tumours Flashcards
How can bone tumours be divided?
Into primary and secondary tumours.
The primary tumours arise from cells which constitute the bone and can be divided further into benign and malignant types.
Epidemiology of bone tumours
Metastatic bone tumours make the most of the disease burden.
Primary bone tumours are relatively rare with an overall prevalence of < 1% in the UK.
In children and adolescents it is more common (5% of all cancers)
Where does metastatic bone cancer come from?
Renal
Thyroid
Lung
Prostate
Breast
Most common site for a bony metastases is the spine
How is metastatic bone disease usually treated?
Systemic therapies and often palliative.
It is rarely treated surgically.
Prophylactic nailing of certain long bones can be done if there is a high risk of pathological fractures.
Risk factors for primary bone cancer.
RB1 and p53 are associated with increased risk of osteosarcomas.
TSC1 and TSC2 mutations (tuberous sclerosis) are associated with an increased risk of chondromas during childhood.
Previous exposure to radiation or alkylating agents in chemotherapy
Benign bone conditions like Paget’s disease and fibrous dysplasia.
Clinical features
Main symptoms of a primary bone tumour is pain
It is not associated with movement
Worse at night (red flag)
Mass may be palpable
If the patient presents with a fracture without hx of trauma a bone tumour may be suspected as well.
Dx
Osteomyelitis
Multiple myeloma
Metabolic bone disease
Pathological fracture
Explain osteoid osteoma.
Arise from osteoblasts, often around the 10-20 yo.
More common in males and are typically small tumours (<2cm)
Found usually around the metaphysis of long bones like proximal femur or tibia.
Clinical presentation of osteoid osteoma.
Localised progressive pain worse at night.
NSAIDs usually makes it better
Localised swelling, tenderness or limping might occur as well.
X-ray findings of osteoid osteoma.
Show a small mass commprised of a radiolucent nidus with a rim of reactive bone.
Management of osteoid osteoma.
Conservatively through serial radiological imaging every 4-6 months.
If there is severe pain that may warrant surgical resection.
Overall there is a good prognosis and they resolve spontaneously.
Explain osteochondroma
AKA exostoses are benign bony tumours.
They form as an outgrowth from the metaphysis of long bones and have a cartilaginous cap.
Most develop in males in their 10s to 20s.
Clinical presentation of osteochondroma.
Most are detected incidentally and usually asymptomatic and slow growing.
Can cause deformities or impinge on nerves they grow large enough.
X-ray findings of osteochondroma
Pedunculated bony outgrowth from metaphysis pointing away from the joint.
How are osteochondromas managed?
Conservatively through serial radiological imaging every 4-6 months.
Those with significant deformity or neurological symptoms may warrant surgical resection.
Explain chondromas.
Arise from chondroblasts within the medullary cavity of the bones.
They present in 20-50 years olds
Most commonly affect the long bones of the hands, femur and humerus.
X-ray findings of chondromas.
Well circumscribed oval lucency with intact cortex.
X-ray findings of osteoclastomas
Eccentric lytic area
Soap bubble appearance
X-ray findings of osteosarcoma
Medullary and cortical bone destruction
Significant periosteal reactions
Codman’s triangle or sunburst pattern
X-ray findings
Lytic lesion with periosteal reactions
Produces layers of reactive bone leading to characteristic onion skin appearance
X-ray findings of chondrosarcom
Lytic lesions with calcifications
Cortical remodelling
Endosteal scalloping
Explain Enneking staging system of malignant tumours.
