Bone Tumours

Question 1

Primary tumours are more common than secondary tumours in the bone. T/F?

Answer 1

False - the opposite is true

Question 2

What is the most common type of primary bone tumour?

Answer 2

Myeloma

Question 3

The majority of patient’s with terminal cancer will have bony metastases. T/F?

Answer 3

True

Question 4

From which sites do bony metastases commonly arise?

Answer 4

Metastatic carcinoma of the bronchus, breast, prostate, kidney or thyroid

Question 5

In childhood, which cancers can commonly metastasise to the bone?

Answer 5

Neuroblastoma

Rhabdomyosarcomas

Question 6

Which bones are the most common site of metastasis?

Answer 6

Bones with a good blood supply e.g. long bones and vertebrae

Question 7

Metastasis to the bones can be asymptomatic. T/F?

Answer 7

True

Question 8

What are the potential signs and symptoms of bony metastases?

Answer 8

Bone pain
Bone destruction
Pathological frcatures
Hypercalcaemia
Spinal changes - vertebral collapses, spinal cord compression, nerve root compression, back pain

Question 9

What imaging modality is used to assess for bony metastases?

Answer 9

PET CT

Question 10

The majority of bone metastasis are lytic rather than sclerotic. T/F?

Answer 10

True

Question 11

Lytic lesions in bone due to metastasis are caused by direct action of the tumour cells. T/F?

Answer 11

False - the tumour cells release cytokines which stimulate osteoclast activity

Question 12

What drugs can be used to inhibit the destruction of bone by metastases?

Answer 12

Bisphosphonates

Question 13

Metastases from which sites commonly cause sclerotic metastases in the bone?

Answer 13

Prostatic carinoma
Breast Carcinoma
Carcinoid tumour

Question 14

Solitary bone metastases are typically metastases from which types of tumour?

Answer 14

renal and thyroid carcinomas

Question 15

Surgery is viable treatment option with solitary bone metastases. T/F?

Answer 15

True

Question 16

What is myeloma?

Answer 16

A monoclonal proliferation of the plasma cells which can be solitary (palsmacutoma) or multiple myeloma

Question 17

What are the clinical effects of myeloma?

Answer 17

Bone lesions - punched out lytic foci, generalised osteopenia
Marrow replacement resulting in anaemia, leucopenia (causing recurrent infections) and thrombocytopenia (causing haemorrhage)
ESR >100
Presence of pence jones proteins in urine

Question 18

What complications can result from renal impairment as a result of myeloma?

Answer 18

Hyperclacaemia

Amyloidosis

Question 19

Give examples of. benign primary bone tumours?

Answer 19

Osteoid osteoma
Chondroma
Giant cell tumours

Question 20

Give examples of malignant primary bone tumours?

Answer 20

Myeloma
Osteosarconma
Chondrosarcoma
Ewing’s tumour

Question 21

What is an osteoid osteomalacia?

Answer 21

A small, benign osteoblastic proliferation

Question 22

At what age are osteoid osteomas commonly seen?

Answer 22

Adolescence but can occur at any age

Question 23

Primary bone tumours are more common in men than women. T/F?

Answer 23

True

Question 24

Which bones are commonly affected by osteoid osteomas?

Answer 24

Long bones

Vertebrae

Question 25

When will pain be worst in osteoid osteoma?

Answer 25

Night time

Question 26

What will be caused by junta-articular osteoid osteomas?

Answer 26

Symapthetic synovitis

Question 27

What is an osteosarcoma?

Answer 27

A malignant tumour whose cells derived from osteoid or bone

Question 28

What is the peak age of incidence for osteosarcomas?

Answer 28

10-15 years

Question 29

At which site are osteosarcomas commonly found?

Answer 29

Knee - in metaphysis of long bones

Question 30

Osteosarcomas can result in early metastasis, particularly to which organ?

Answer 30

Lung

Question 31

What forms of osteosarcoma have the best prognosis?

Answer 31

Parosteal, periosteal or low grade central osteosarcoma

Question 32

What forms of osteosarcoma have a normal prognosis?

Answer 32

``` Osteoblastic Chondroblastic Fibroblastic Telangiectatic Small cell Sclerotic ```

Question 33

What forms of osteosarcoma have the worst prognosis?

Answer 33

Paget's disease Multifocal osteosarcoma Post-irradiation

Question 34

In which group of people is Paget's disease most common?

Answer 34

Elderly and anglo-saxon origin

Question 35

What is Paget's disease?

Answer 35

A disorder of excessive bone turnover where there is increased eosteoclast activity, increased bone formation and structurally weak bone

Question 36

Which bones are particularly affected by Paget's disease?

Answer 36

Vertebrae Pelvis Skull Femur

Question 37

What symptoms / signs can be caused by Paget's disease?

Answer 37

``` Bone pain Deformity - bowing of long bones Pathological fracture OA Deafness Spinal cord compression High cardiac output leading to cardiac failure Paget's sarcoma ```

Question 38

Paget's sarcoma is usually sclerotic. T/F?

Answer 38

False - it is usually lytic

Question 39

Give examples fo cartilaginous tumours?

Answer 39

Enchondromas Osteocartilaginous exostosis Chondrosarcomas

Question 40

What is an enchondroma?

Answer 40

Lobulated mass of cartilage within the medulla

Question 41

Enchondromas are common and can occur at any age. T/F?

Answer 41

True

Question 42

Which sites are most often affected by an enchondroma?

Answer 42

Hands Feet Long bones

Question 43

What are the features of enchondroma in the hands?

Answer 43

Swelling | Pathological fracture

Question 44

What is osteocartilaginous exostosis?

Answer 44

Benign outgrowth fo cartilage with endochonraal ossification which is probably derived from the growth plate.

Question 45

What is a chondrosarcoma?

Answer 45

A tumour of the central medullary canal or peripheral bone survive which can be a primary tumour or from a pre-existing enchondroma or exostosis.

Question 46

What age groups are particularly affected by chondrosarcomas?

Answer 46

Middle aged and elderly

Question 47

At which sites are chondrosarcomas commonly seen?

Answer 47

``` Axial skeleton Pelvis Ribs Shoulder girdle Proximal femur Humerus ```

Question 48

At what age is the peak incidence of Ewing's sarcoma?

Answer 48

5-15 years

Question 49

In Ewing's sarcoma there is early metastasis to the...?

Answer 49

Lung Bone marrow Bone