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MSK > Bone and Soft Tissue Tumours > Flashcards

Bone and Soft Tissue Tumours Flashcards

1
Q

Types of bone + soft tissue tumours

A

Bone

  • Benign
  • Malignant (primary + secondary)

Soft tissue

  • Benign
  • Malignant
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2
Q

What is a sarcoma

A

Malignant tumour arising from connective tissues

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3
Q

How does a sarcoma spread

A
  • Spread along fascial planes
  • Haematogenous spread to lungs
  • Rarely to lymph nodes
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4
Q

How common are benign + malignant tumours of bones

A
  • Benign = common
  • Malignant = rare
  • Bony secondaries are very common
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5
Q

When is a bone tumour in a patient likely to be metastatic

A

> 50 years old

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6
Q

Types of bone-forming tumours and cartilage forming tumours

A

Bone

  • Benign = Osteoid osteoma, Osteoblastoma
  • Malignant = Osteosarcoma

Cartilage

  • Benign = Enchondroma, Osteochondroma
  • Malignant = Chondrosarcoma
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7
Q

Types of fibrous tissue tumours

A
  • Benign = Fibroma

- Malignant = Fibrosarcoma, Malignant Fibrous Histiocytoma (MFH)

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8
Q

Types of adipose + vascular tissue tumours

A

Adipose

  • Benign = Lipoma
  • Malignant = Liposarcoma

Vascular

  • Benign = Haemangioma
  • Malignant = Angiosarcoma
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9
Q

Types of marrow tissue tumours

A

-Malignant = Ewing’s sarcoma, lymphoma, myeloma

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10
Q

How likely are benign tumours to metastasise

A
  • Unlikely

- Locally destructive

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11
Q

Commonest primary malignant bone tumour in young and older people

A
  • Young = Osteosarcoma

- Old = Myeloma (bone marrow)

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12
Q

Cardinal features of primary bone tumours

A
  • Increasing, unexplained, pain
  • Deep-seated, boring, nature
  • Night pain
  • Difficulty weigh-bearing
  • Deep swelling
  • Progressive pain at night + rest
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13
Q

Presentation of benign bone tumours

A

May present with activity related pain if large enough to weaken bone

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14
Q

Examination of suspected bone tumours

A
  • General health
  • Location
  • Shape, Consistency, Mobility (SCM)
  • Tenderness + local temperature
  • Neuro-vascular deficits
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15
Q

Investigations for suspected bone tumours

A
  • Plain X-ray
  • CT
  • Isotope bone scan
  • MRI (gold standard)
  • Biopsy
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16
Q

What would be seen on a X-ray of an inactive tumour

A
  • Clear margins

- Surrounding rim of reactive bone

17
Q

What would be seen on a X-ray of an aggressive tumour

A
  • Less well defined zone of transition + normal bone (permeative growth)
  • Cortical destruction = Malignancy
  • Periosteal reactive new bone growth occurs where the lesion destroys the cortex
  • Codman’s triangle

(onion-skinning or sunburst pattern)

18
Q

Limitation of isotope bone scanning

A
  • Frequently -ve for myeloma

- Benign tumours also demonstrate increased uptake

19
Q

What is MRI non-specific for

A

Malignant vs benign

20
Q

When could PET scanning be useful for bone cancer

A

Investigating response to chemo

21
Q

8 clinical features of bone tumours

A
  • Pain
  • Loss of function
  • Swelling
  • Pathological fracture
  • Joint effusion
  • Deformity
  • Neurovascular deficits
  • Systemic effects of neoplasia
22
Q

Describe the pain in patients with bone tumours

A
  • Increasing pain
  • Analgesics eventually ineffective
  • Not exercise related
  • DEEP BORING ACHE, WORSE AT NIGHT = !!!
23
Q

Describe the loss of function in patients with bone tumours

A
  • Limp
  • Reduced ROM
  • Stiff back (esp. child)
24
Q

Describe the swelling seen in patients with bone tumours

A
  • Generally diffuse in malignancy
  • Generally near the end of long bones
  • Warmth over swelling + venous congestion = ACTIVE!
  • Once reaching a notable size, enlargement may be rapid
25
Q

Red flag for a pathological fracture

A

Minimal trauma + Hx of pain prior to # = !!!

26
Q

3 types of treatments for bone tumours

A
  • Chemotherapy
  • Radiotherapy
  • Surgery
27
Q

Suspicious signs for soft tissue tumours

A
  • Deep tumour of any size (i.e. deep to deep fascia)
  • Subcutaneous tumours >5cm
  • Rapid growth, hard, craggy and non-tender
28
Q

What a red flags for swellings

A
  • Rapidly growing
  • Hard, fixed, craggy surface with indistinct margins
  • Non-tender to palpation but assoc. with deep ache, esp. worse at night
  • Recurred after previous excision
29
Q

Primary or secondary bone tumour more common

A

Secondary (25x)

30
Q

Most common site of primary tumour in secondary bone disease

A

Breast

31
Q

6 common sites of primary tumour in secondary bone disease

A
  • Breast
  • Lung
  • Prostate
  • Kidney
  • GI tract
  • Thyroid
32
Q

Prevention of pathological fractures

A
  • Early chemo
  • Bone cement
  • Prophylactic internal fixation
33
Q

Indications for prophylactic internal fixation

A 
-Lytic lesion + increasing pain 
&/or 
-=/> 2.5cm tumour 
&/or 
-=/> 50% cortical destruction
34
Q

How is fracture risk assessed

A

Mirel’s Scoring system

  • Site
  • Pain
  • Lesion
  • Size
35
Q

What Mirel score indicates prophylactic internal fixation

A

8 or above (prior to radiotherapy)

12 is maximum

36
Q

Most common soft tissue tumour

A

Lipoma

37
Q

Red flags for deep soft tissue tumours

A
  • Deep seated
  • > 5cm
  • Painless
  • Fixed, hard or indurated mass
  • Recurrent

MSK (28 decks)

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