Bone and Soft Tissue Tumours Flashcards

(40 cards)

1
Q

Sarcoma

A

Malignant tumours arising from connective tissues. They tend to spread along fascial planes, haematogenous spread to lungs and regional lymph nodes.

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2
Q

Bone tumour in a patient > 50

A

Metastatic

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3
Q

Benign bone tumours

A

Osteoid Osteoma, Osteoblastoma

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4
Q

Malignant bone tumours

A

Osteosarcoma

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5
Q

Benign cartilage tumours

A

Enchondroma, osteochondroma

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6
Q

Malignant cartilage tumours

A

Chondrosarcoma

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7
Q

Benign fibrous tissue tumours

A

Fibroma

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8
Q

Malignant fibrous tissue tumours

A

Fibrosarcoma, malignant fibrous histiocytoma

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9
Q

Marrow Tissue tumours

A

Ewings sarcoma, lymphoma, myeloma

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10
Q

Incidence of Osteosarcoma

A

3/million/year

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11
Q

Incidence of Chondrosarcoma

A

2/million/year

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12
Q

Incidence of Ewings Tumours

A

1.5/million/year

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13
Q

Incidence of malignant fibrous histiocytoma

A

<1/million/year

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14
Q

Commonest primary malignant bone tumour in young patient

A

Osteosarcoma

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15
Q

Commonest primary malignant bone tumour in older patient

A

Myeloma

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16
Q

Benign Tumours presentation

A

Benign tumours may present with activity related pain if large enough to weaken bone

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17
Q

Examination of Tumours

A
General health
measurements of mass
location
shape
consistency
mobility
tenderness
local temperature
neuro-vascular deficits
18
Q

Investigations of leg pain

A

Plain x-rays - most useful for bone lesions
Calcification - synovial sarcoma
Myositis ossificans
Phleboliths in haemangioma

19
Q

Inactive X-ray

A

clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive benign lesions

20
Q

X-ray of aggressive bone tumours

A

less well defined zone of transition between lesion and normal bone (permeative growth)
cortical destruction = malignancy
Periosteal reactive new bone growth occurs when the lesion destroys the cortex.
- Codman’s triangle, onion-skinning or sunburst pattern

21
Q

CT of bone tumours

A

Assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs

22
Q

Isotope Bone Scan of bone tumours

A

Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis
Frequently negative in Myeloma
Benign also demonstrate increased uptake

23
Q

MRI bone tumours

A

Study of choice
size, extent, anatomical relationships
Accurate for limits of disease both within and outside bone
Specific for Lipoma, haemangioma, haematoma or PVNS.
Non-specific for benign vs. malignant

24
Q

Angiography tumours

A

Psuedoaneurysms, A-V malformations

Embolisation of vascular tumours - Renal, ABC

25
PET of Tumours
Monitor the response to chemotherapy
26
Biopsy of Tumours
Complete workup prior with bloods, X-ray, MRI of lesion, bone scan, CT chest, abdo and pelvis
27
Cardinal features of malignant primary bone tumours
``` Increasing pain unexplained pain Deep-seated boring nature Night pain Difficulty weight-bearing Deep swelling ```
28
Clinical features of Bone Tumours
``` pain loss of function swelling pathological fracture joint effusion deformity neurovascular effects systemic effects of neoplasia ```
29
Pain bone tumours
This is a cardinal feature Increasing pain (impending fracture) Analgesic ineffective Deep boring ache which is worse at night
30
Loss of function
Limp Reduced joint movement Back stiffness
31
Swelling
generally diffuse in malignancy generally near end of long bone once reaching noticeable size, enlargement may be rapid warmth over swelling + venous congestion = active! pressure effects e.g. intrapelvic
32
Pathological Fracture
n.b. many causes, of which primary bone tumour (benign or malignant) is one of rarest, c.f. osteoporosis commonest minimal trauma + h/o pain prior to # !!
33
Treatment of bone tumours
Goal is to make free of disease Chemotherapy Surgery Radiotherapy
34
Surgical treatment of bone tumours
Limb salvage possible for most cases Consider involvement of neurovascular structures pathological #s
35
Suspicious signs of Soft Tissue Tumours
deep (i.e. deep to deep fascia) tumours of any size subcutaneous tumours > 5 cm rapid growth, hard, craggy, non-tender
36
Beware of a swelling which is
rapidly growing hard, fixed, craggy surface, indistinct margins non-tender to palpation, but assoc. with deep ache, esp. worse at night
37
Which cancer commonly spreads to bone
Lung, breast, prostate, kidney, thyroids, GI tract, melanoma
38
Site of boney mets in order of frequency
vertebrae > proximal femur > pelvis > ribs > sternum > skull
39
Prevention of pathological fractures
Early chemotherapy Internal fixation Use of bone cement
40
Clinical features of soft-tissue tumours
``` painless mass deep to deep fascia any mass >5cm any fixed, hard or indurated mass any recurrent mass ``` MRI