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Year 3: Block 1: MSK system > Bone and soft tissue Tumours > Flashcards

Bone and soft tissue Tumours Flashcards

1
Q

Bone tumours can be?

A

Benign
Malignant - primary
- secondary

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2
Q

Where do sarcoma’s arise from

A

Malignant tumours arising from connective tissues

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3
Q

Where do sarcomas spread along and to?

A

fascial planes

Haematogenous spread to lungs

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4
Q

What benign tumours are common

A

skeleton

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5
Q

bone tumour in patient >50 years is likely to be?

A

metastatic

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6
Q

Name some benign bone forming tumours

A

osteoid osteoma, osteoblastoma

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7
Q

name a malignant bone forming tumour

A

osteosarcoma

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8
Q

Name some benign Cartilage-forming tumours

A

enchondroma, osteochondroma

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9
Q

Name a malignant Cartilage-forming tumour

A

chondrosarcoma

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10
Q

name a benign fibrous tissue tumour

A

fibroma

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11
Q

name some malignant fibrous tissue tumours

A

fibrosarcoma, malignant fibrous histiocytoma (MFH)

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12
Q

Name benign vascular tissue tumours

A

haemangioma, aneurysmal bone cyst

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13
Q

name a vascular malignant tissue tumour

A

angiosarcoma

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14
Q

Adipose tissue tumour - benign

A

lipoma

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15
Q

Adipose tissue tumour - malignant

A

liposarcoma

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16
Q

Marrow tissue tumours - malignant

A

Ewing’s sarcoma, lymphoma, myeloma

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17
Q

Benign tumours that rarely metastasise

A

Giant Cell tumours (GCT)

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18
Q

Tumour-like lesions - benign

A

simple bone cyst,

fibrous cortical defect

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19
Q

Most common primary bone tumour in younger patient uk

A

osteosarcoma

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20
Q

commonest primary malignant “bone” tumour in older patient?

A

Myeloma

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21
Q

A common history from patient will include

A

Pain
mass
Abnormal x-rays - incidental

Bone Tumours - PAIN

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22
Q

Bone tumour symptoms

A

pain

  • activity related
  • progressive pain at rest & night
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23
Q

What may benign tumours present with ?

A

activity related pain if large enough to weaken bone

eg , osteoid osteoma

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24
Q

Examination of a tumour will include what (lots)

A 
General health
measurements of mass
location
shape
consistency
mobility
tenderness
local temperature
neuro-vascular deficits
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25
Q

Investigations of bone tumours (4)

A

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

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26
Q

inactive x-rays have? (3)

A

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

27
Q

X-rays - aggressive - what will they show - detailed (3)

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
28
Q

Why use a CT scan? what is it good for ? (4)

A

Assessing ossification and calcification

integrity of cortex

best for assessing nidus in osteoid osteoma

Staging - primarily of lungs

29
Q

Isotope bone scans are used for what ? (4)

A

Staging for skeletal metastasis

Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis

Frequently negative in Myeloma

Benign also demonstrate increased uptake

30
Q

What is MRI accurate for?

A

limits of disease both within and outside bone

31
Q

MRI is specific for what (3-4)

A

Lipoma, haemangioma, haematoma or PVNS.

32
Q

Other investigations

A

Angiography:
superseeded by MRI
Psuedoaneurysms, A-V malformations
Embolisation of vascular tumours - Renal, ABC

PET:
may be useful for investigating response to chemo

33
Q

What tests should be completed before a bone biopsy takes place (5)

A 
Bloods
X-rays of affected Limb 
& Chest
MRI of lesion
Bone Scan
CT Chest, abdo & pelvis

biopsy - is it needle core vs open

34
Q

Malignant Primary Bone Tumours (7)

A 
Cardinal features
Increasing pain
unexplained pain
Deep-seated boring nature
Night pain
Difficulty weight-bearing
Deep swelling
35
Q

Main malignant primary bone tumours (3)

A

Osteosarcoma

Ewings sarcoma

Chondrosarcoma

36
Q

Clinical features of osteosarcoma (8)

A 
pain
loss of function 
swelling
pathological fracture
joint effusion
deformity
neurovascular effects
systemic effects of neoplasia
37
Q

Osteosarcoma - pain features (5)

A

cardinal feature
increasing pain - impending # (esp. lower limb)
analgesics eventually ineffective
not related to exercise
DEEP BORING ACHE, WORSE AT NIGHT  !!

38
Q

Clinical features OSTEOSARCOMA - loss of function is common - what do patients develop (3)?

A 
limp
reduced joint movement
stiff back (esp. child)
39
Q

Clinical features OSTEOSARCOMA - swelling - features ? (5)

A

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

40
Q

Osteosarcoma can develop from a

A

pathological fracture

41
Q

osteosarcoma - investigations - what will a VG show

A

MRI scan
investigation of choice - very sensitive

VG for showing
intraosseous (intramedullary) extent of tumour
extraosseous soft tissue extent of tumour
joint involvement
skip metastases
epiphyseal extension
determines resection margins

42
Q

Treatment of osteosarcoma and Ewing’s tumours

A

disease free goal
chemo and radio therapy
surgery

43
Q

What tumours are benign but aggressive

A

cartilage tumours

44
Q

all patients with a soft tissue tumour suspected of being malignant should be referred to?

A

a specialist Tumour Centre

45
Q

What are suspicious signs of a soft tissue tumour 3)

A

deep (i.e. deep to deep fascia) tumours of any size
subcutaneous tumours > 5 cm
rapid growth, hard, craggy, non-tender

46
Q

Beware of swelling which Is? wha may it be?

A

rapidly growing
hard, fixed, craggy surface, indistinct margins
non-tender to palpation, but assoc. with deep ache, esp. worse at night

BEWARE – may be painless
Recurred after previous excision

47
Q

Where is the most common site for

A

Metastatic Bone Disease

lung and liver then bone bone - secondary

48
Q

Breast cancer commonly metastasises to

A

bone

49
Q

melanoma commonly metastasises to

A

lung

50
Q

Breast cancer is the commonest primary cancer which metastasises to bone. Which bone does it most commonly metastasise to ?

A

vertebrae

  • femur - pelvis - ribs- sternum - skull
51
Q

7 commonest primary cancers which metastasise to bone

A 
LUNG - smoker, sputum cyto
BREAST
PROSTATE - osteosclerotic
KIDNEY - solitary, vascular 
THYROID -follicular Ca 
GI TRACT- - FOB, endoscopy, Ba studies
MELANOMA
52
Q

survival after pathological fracture depends on?

A

type of tumour -e.g. bronchial Ca.  1 y

53
Q

Pathological fracture: PREVENTION (3)

A

early chemotherapy / DXT

prophylactic internal fixation - lytic lesion + increasing pain &/or  2.5 cm diameter &/or  50% cortical destruction

 use of bone cement (not signif. affected by DXT)

54
Q

Fracture Risk Assessment - scoring system is called?

A

Mirel’s

55
Q

Pathological fracture: PREVENTION - when should you be careful

what bones do you do?

A

embolisation esp. renal, thyroid - wait 48h before surgery
only one long bone at a time
aim for early painless weight-bearing + mobilisation
# of non-WB skeleton (e.g. humerus) can be treated conservatively, but re-# freq.

56
Q

Never assume that a lytic lesion (especially solitary) is?

A

metastatic

57
Q

Prophylactic fixation of long bone mets is ?

A

generally easier for the surgeon and less traumatic for the patient.

58
Q

Fixation of pathological fractures or lytic lesions, especially around the hip/proximal femur have a high?

A

FAILURE RATE

59
Q

Cemented hip prosthesis have?

A

a low failure rate

60
Q

What is generally required for spinal metastases

A

decompression and stabilisation

61
Q

Ratios for soft tissue tumours

what are 80% of deep sarcomas

A

5cm 150:1 for sarcoma
>5cm 20:1 >10cm 6:1 Deep seated tumours 4:1

> 5cm

62
Q

Soft tissue Timur features (5)

main imaging technique

A 
painless
mass deep to deep fascia
any mass >5cm
any fixed, hard or indurated mass
any recurrent mass

MRI

63
Q

Sarcoma bone pain features (4)

A

persistency
increasing
non-mechanical
nocturnal or at rest

Year 3: Block 1: MSK system (22 decks)

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