Bone and Soft Tissue Tumours

Question 1

what is a sarcoma

Answer 1

malignant tumour of connective tissue

Question 2

most common spread of a sarcoma

Answer 2

lungs

Question 3

what is a malignant tumour of bone called

Answer 3

osteosarcoma

Question 4

malignant tumour of vascular tissue

Answer 4

angiosarcoma

Question 5

malignant tumour of fat

Answer 5

liposarcoma

Question 6

what is Ewing’s sarcoma a tumour of

Answer 6

bone marrow

Question 7

what is chondrosarcoma a tumour of

Answer 7

malingnat cartilage

Question 8

what a giant cell tumour

Answer 8

tumour, benign or malignant of uncertain origin

Question 9

red flags symptoms of a soft tissue mass

Answer 9

deep
>5cm
rapid growth
hard, craggy and non-tender
fxed
deep ache that is worse at night

Question 10

what is the commonest soft tissue tumour

Answer 10

lipoma - benign fat

Question 11

commonest primary malignant bone tumour in younger patients

Answer 11

osteosarcoma

Question 12

age peak of osteosarcoma

Answer 12

15-19 years

Question 13

presentation of osteosarcoma

Answer 13

deep boring pain not related to activity and worse and night
not responsive to analgesia
limp or reduced movement
swelling
pathological fracture
joint effusion
deformity
neurovascular deficit

Question 14

where is osteosarcoma commonest

Answer 14

knee (75%) then proximal humerus

Question 15

what is the best imaging modality for osteosarcoma

Answer 15

MRI - will show extent within and outwith bone and any skip metastases

Question 16

what investigations would you order when someone present with bone pain

Answer 16

x-ray
alkaline phosphatase
lactate dehydrogenase
serum Ca2+

Question 17

investigation to look for bony metastases to lungs

Answer 17

CT or x-ray

Question 18

features of haemangioma on x-ray

Answer 18

phleboliths in blood vessles (calcifications)

Question 19

features of a malignant bone tumour on x-ray

Answer 19

undefined margins
cortical destruction
reactive bone growth - sunburst, codman’s triangle or onion skin

Question 20

necessary test to do before a biopsy

Answer 20

bloods
x-ray of limb and chest
MRI
bone scane
CT chest, abdo and pelvis

Question 21

name 3 primary malignant bone tumour

Answer 21

osteosarcoma, Ewing’s sarcoma and chondrosarcoma

Question 22

treatment for osteosarcoma

Answer 22

surgery AND chemotherapy

Question 23

what does Ewing’s sarcoma arise from

Answer 23

mesenchymal stem cells

Question 24

what type of reactive bone formation is seen on x-ray of Ewing’s sarcoma

Answer 24

onion skin

Question 25

general treatment option in bone tumours

Answer 25

Surgery Chemotherapy Radiotherapy MDT

Question 26

5 common primaries that metastasise to bone

Answer 26

``` breast lung prostate kidney thyroid ```

Question 27

5 common site for bone metastases to appear (in order)

Answer 27

vertebrae > proximal femur > pelvic > ribs > sternum > skull

Question 28

what scoring system is used to assess whether or not prophylactic internal fixation is necessary

Answer 28

Mirel's scoring system

Question 29

range of scores in Mirel's and what they mean

Answer 29

min = 4 max = 12 recommended prophylaxis = 8

Question 30

features used to determine a Mirel score

Answer 30

site, lesion type, size and degree of pain

Question 31

other factors used to decide on prophylactic fixation than mirel's score

Answer 31

if the lesion is >2.5cm, increasing pain or >50% cortical destruction

Question 32

treatment of a pathological fracture

Answer 32

splint and/or traction while you investigate it fixation unlikely to fully heal

Question 33

what do you do with renal metastases from bone

Answer 33

radically excise

Question 34

what is the commonest primary of bone metastases

Answer 34

breast

Question 35

true/false - the prognosis of breast cancer is better if the metastases are in soft tissue than in bone

Answer 35

false - better prognosis when to bone than soft tissue

Question 36

in bone disease, alkaline phosphatase is raised/lowered

Answer 36

raised

Question 37

what part of the liver does alkaline phosphatase come from

Answer 37

bile ducts

Question 38

sources of alkaline phosphatase

Answer 38

bile ducts, placenta, bone and intestines