Bone and soft tissue Tumours Flashcards
(63 cards)
1
Q
Bone tumours can be?
A
Benign
Malignant - primary
- secondary
2
Q
Where do sarcoma’s arise from
A
Malignant tumours arising from connective tissues
3
Q
Where do sarcomas spread along and to?
A
fascial planes
Haematogenous spread to lungs
4
Q
What benign tumours are common
A
skeleton
5
Q
bone tumour in patient >50 years is likely to be?
A
metastatic
6
Q
Name some benign bone forming tumours
A
osteoid osteoma, osteoblastoma
7
Q
name a malignant bone forming tumour
A
osteosarcoma
8
Q
Name some benign Cartilage-forming tumours
A
enchondroma, osteochondroma
9
Q
Name a malignant Cartilage-forming tumour
A
chondrosarcoma
10
Q
name a benign fibrous tissue tumour
A
fibroma
11
Q
name some malignant fibrous tissue tumours
A
fibrosarcoma, malignant fibrous histiocytoma (MFH)
12
Q
Name benign vascular tissue tumours
A
haemangioma, aneurysmal bone cyst
13
Q
name a vascular malignant tissue tumour
A
angiosarcoma
14
Q
Adipose tissue tumour - benign
A
lipoma
15
Q
Adipose tissue tumour - malignant
A
liposarcoma
16
Q
Marrow tissue tumours - malignant
A
Ewing’s sarcoma, lymphoma, myeloma
17
Q
Benign tumours that rarely metastasise
A
Giant Cell tumours (GCT)
18
Q
Tumour-like lesions - benign
A
simple bone cyst,
fibrous cortical defect
19
Q
Most common primary bone tumour in younger patient uk
A
osteosarcoma
20
Q
commonest primary malignant “bone” tumour in older patient?
A
Myeloma
21
Q
A common history from patient will include
A
Pain
mass
Abnormal x-rays - incidental
Bone Tumours - PAIN
22
Q
Bone tumour symptoms
A
pain
- activity related
- progressive pain at rest & night
23
Q
What may benign tumours present with ?
A
activity related pain if large enough to weaken bone
eg , osteoid osteoma
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
25
Investigations of bone tumours (4)
Plain x-rays - most useful for bone lesions
Calcification - synovial sarcoma
Myositis ossificans
Phleboliths in haemangioma
26
inactive x-rays have? (3)
clear margins
surrounding rim of reactive bone
cortical expansion can occur with aggressive benign lesions
27
X-rays - aggressive - what will they show - detailed (3)
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
Why use a CT scan? what is it good for ? (4)
Assessing ossification and calcification
integrity of cortex
best for assessing nidus in osteoid osteoma
Staging - primarily of lungs
29
Isotope bone scans are used for what ? (4)
Staging for skeletal metastasis
Multiple lesions - osteochondroma, enchondroma, fibrous dysplasia & histiocytosis
Frequently negative in Myeloma
Benign also demonstrate increased uptake
30
What is MRI accurate for?
limits of disease both within and outside bone
31
MRI is specific for what (3-4)
Lipoma, haemangioma, haematoma or PVNS.
32
Other investigations
Angiography:
superseeded by MRI
Psuedoaneurysms, A-V malformations
Embolisation of vascular tumours - Renal, ABC
PET:
may be useful for investigating response to chemo
33
What tests should be completed before a bone biopsy takes place (5)
```
Bloods
X-rays of affected Limb
& Chest
MRI of lesion
Bone Scan
CT Chest, abdo & pelvis
```
biopsy - is it needle core vs open
34
Malignant Primary Bone Tumours (7)
```
Cardinal features
Increasing pain
unexplained pain
Deep-seated boring nature
Night pain
Difficulty weight-bearing
Deep swelling
```
35
Main malignant primary bone tumours (3)
Osteosarcoma
Ewings sarcoma
Chondrosarcoma
36
Clinical features of osteosarcoma (8)
```
pain
loss of function
swelling
pathological fracture
joint effusion
deformity
neurovascular effects
systemic effects of neoplasia
```
37
Osteosarcoma - pain features (5)
cardinal feature
increasing pain - impending # (esp. lower limb)
analgesics eventually ineffective
not related to exercise
DEEP BORING ACHE, WORSE AT NIGHT !!
38
Clinical features OSTEOSARCOMA - loss of function is common - what do patients develop (3)?
```
limp
reduced joint movement
stiff back (esp. child)
```
39
Clinical features OSTEOSARCOMA - swelling - features ? (5)
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
Osteosarcoma can develop from a
pathological fracture
41
osteosarcoma - investigations - what will a VG show
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
Treatment of osteosarcoma and Ewing's tumours
disease free goal
chemo and radio therapy
surgery
43
What tumours are benign but aggressive
cartilage tumours
44
all patients with a soft tissue tumour suspected of being malignant should be referred to?
a specialist Tumour Centre
45
What are suspicious signs of a soft tissue tumour 3)
deep (i.e. deep to deep fascia) tumours of any size
subcutaneous tumours > 5 cm
rapid growth, hard, craggy, non-tender
46
Beware of swelling which Is? wha may it be?
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
Where is the most common site for
Metastatic Bone Disease
| lung and liver then bone bone - secondary
48
Breast cancer commonly metastasises to
bone
49
melanoma commonly metastasises to
lung
50
Breast cancer is the commonest primary cancer which metastasises to bone. Which bone does it most commonly metastasise to ?
vertebrae
- femur - pelvis - ribs- sternum - skull
51
7 commonest primary cancers which metastasise to bone
```
LUNG - smoker, sputum cyto
BREAST
PROSTATE - osteosclerotic
KIDNEY - solitary, vascular
THYROID -follicular Ca
GI TRACT- - FOB, endoscopy, Ba studies
MELANOMA
```
52
survival after pathological fracture depends on?
type of tumour -e.g. bronchial Ca. 1 y
53
Pathological fracture: PREVENTION (3)
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
Fracture Risk Assessment - scoring system is called?
Mirel's
55
Pathological fracture: PREVENTION - when should you be careful
what bones do you do?
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
Never assume that a lytic lesion (especially solitary) is?
metastatic
57
Prophylactic fixation of long bone mets is ?
generally easier for the surgeon and less traumatic for the patient.
58
Fixation of pathological fractures or lytic lesions, especially around the hip/proximal femur have a high?
FAILURE RATE
59
Cemented hip prosthesis have?
a low failure rate
60
What is generally required for spinal metastases
decompression and stabilisation
61
Ratios for soft tissue tumours
| what are 80% of deep sarcomas
5cm 150:1 for sarcoma
>5cm 20:1 >10cm 6:1 Deep seated tumours 4:1
> 5cm
62
Soft tissue Timur features (5)
| main imaging technique
```
painless
mass deep to deep fascia
any mass >5cm
any fixed, hard or indurated mass
any recurrent mass
```
MRI
63
Sarcoma bone pain features (4)
persistency
increasing
non-mechanical
nocturnal or at rest
