Bone Tumours

Question 1

What are the most common types of benign bone tumours? Where are they generally located?

Answer 1

• Osteochondroma - common, normally in the metaphysis of long bones
• Enchondroma - generally in medullary cavity of bone
• Solitary bone cyst - commonly in proximal humerus and femur

Question 2

What are the most common types of malignant bone tumours? Where are they generally located?

Answer 2

• Osteosarcoma - generally distal femur, proximal tibia/humerus
• Chondrosarcoma
• Multiple myeloma

Question 3

Where are the common sites of metastasis to bone?

Answer 3

• Breast
• Prostate
• Also thyroid/lung/kidney

Question 4

What are the red flags for bone tumours?

Answer 4

• Bone pain increasing
• Swelling
• Spontaneous fracture
• Localised bone tenderness

Question 5

In a patient with a bone tumour, what investigations are important to order?

Answer 5

• X-ray
• CT chest (rule out lung mets)
• CT/MRI bone
• Bone biopsy

Question 6

How are bone tumours generally managed?

Answer 6

• Benign lesions - monitoring. Surgical resection if troublesome
• Malignant lesions
  
  • Neoadjuvant chemotherapy and surgical resection

Question 7

What are the main differences between benign and maignant bone tumours on xray?

Answer 7

• Benign
  
  • No periosteal reaction
  • Thick endosteal reaction
  • Intraosseous and even calcification
• Malignant
  
  • Codman’s triangle/onion skin/sunburst
  • Broad border between lesion and normal bone
  • Extraosseous and irregular calcification