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34 Cards in this Set
- Front
- Back
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What is the most common malignant tumour in bone in a patient > 50 years of age? |
Secondary Mets from other areas |
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What is the name of a benign cartilage capped outgrowth of bone? |
Osteochondroma (most common benign tumour of bone) |
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What is the name of a malignant tumour which arrises from connective tissue? |
Sarcoma |
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What mode of transport do sarcomas typically travel via? |
Typically they have haematogenous spread (ie. via the blood stream) |
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What is the most common site of metastasis for a sarcoma to spread to? |
Typically spread to the lungs first |
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What are often the first indications there may be an underlying bone/connective tissue tumour in a patient? |
If they have an area of soft tissue which is rapidly growing (i.e weeks) + You may often see the malignant secondaries before you see the primary bone/connective tissue tumour. |
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What is the name of the two benign and one militant bone-forming tumours? |
Benign = Osteoid osteoma & Osteoblastoma Malignant = Osteosarcoma *basically if it has sarcoma in it you know its malignant* |
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What is the name of the two benign one malignant cartilage-forming tumours? |
Benign = Enchondroma & Osteochondroma Malignant = Chondrosarcoma |
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What is the name of the one benign and two malignant fibrous tissue tumours? |
Benign = Fibroma Malignant = Fibrosarcoma & malignant fibrous histiocytoma(MFH) |
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What is the name of the benign and malignant adipose tissue tumours? |
Benign = Lipoma Malignant = Liposarcoma |
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A Ewing's sarcoma, Lymphoma and Myeloma are malignant tumours of what type of tissue? |
All are malignant tumours of bone marrow tissue. |
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What is the most common type of primary bone tumour in younger patients? |
Osteosarcoma |
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What is the most common type of primary bone tumour in older patients? |
Myeloma |
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What is the most common symptom seen in a history of bone tumour? |
Increasing localised pain! Activity related at start then progress to at rest and at night = red flags for bone tumour. |
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What is the first line investigation for a suspected bone tumour? |
Plain film x-ray |
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What is the difference between how a benign and malignant tumour of the bone appears on x-ray? |
Inactive benign = Clear margins and cortical expansion. Agressive malignant = less well defined zone of transition between lesion and normal bone. Cortical destruction - i.e. disappearance of bone matrix. Periostial reactive new bone. |
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Beyond x-rays, what other imaging techniques are useful for looking at bone tumours? What are their advantages? |
MRI = GOLD STANDARD! - helps for looking at the response to neo-adjuvent chemo, however it does cannot differentiate between benign and malignant. Isotope bone scan = good for staging skeletal metastasis of the whole body. PET = good for staging and looking at response to chemo |
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What is the only test which which is accurate in determining wether a bone tumour is benign or malignant? |
Biopsy = is the only thing that can differentiate between benign and malignant. |
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Before you do a biopsy of the bone what is the list of investigations that would typically be carried out first? |
X-ray of affected limb and of chest to look for mets (lungs are the most common site of spread in bone tumours) Bloods MRI Isotope bone scan CT chest, abdomen and pelvis |
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What is the most common site in the body for an osteosarcoma to form? |
Proximal tibia and distal femur. This is because during development these areas grow the fastest. |
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What is the type of pain typical in somebody with a tumour of the bone? e.g osteosarcoma |
Increasing pain - analgesics not effective Not related to exercise Dull boring ache --> worse at night |
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Beyond the dull, worsening pain found in bone tumours, what are the other classic clinical features of an osteosarcoma? |
Loss of function - i.e. limp, reduced joint movement Swelling - often near end of long bone, warmth over swelling Occurrence of pathological fractures |
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What is the gold standard investigation for an osteosarcoma? |
MRI scan *good for pre-op as it can determine resection margins* |
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What is the treatment for a Ewing sarcoma? |
Chemo Amputation - potentially Radiotherapy |
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What type of tissue does a giant cell tumour affect, is it benign or malignant? |
Giant cell tumour is a tumour of cartilage. Majority are benign. |
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What features of a swelling on a limb should make you suspicious of a soft tissue tumour? |
Red flag if the swelling is: Rapidly growing Hard, fixed, craggy surface with indistinct margins Non-tender to palpitation but associated with ache May be painless |
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What is the most common secondary site of spread for primary lung and liver tumours? |
Bones Lung and liver tumours commonly spread to bone first. |
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The most common type of bone tumour is from secondary spread from elsewhere. True or False? |
True - 2°bone tumour 25 x commoner than 1° |
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What parts of the skeleton are most susceptible to secondary spread of tumour else where in the body? |
Most common sites for secondary spread = Vertebrae Proximal femur Pelvis Ribs Sternum Skull |
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What are the 4 commenest primary cancers that metastasise to bone? |
Lung Breast Prostate Kidney |
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What are the three main methods in place to prevent bone tumours from causing pathological fractures? |
Early chemo Prophylactic internal bone fixation Aim for early painless weight bearing *once a pathological fracture occurs they rarely re-unite* |
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What is the name of the scoring system used to determine a patient with metastatic bone disease fracture risk? |
Mirel's scoring system |
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What is the most common soft tissue tumour? |
Lipoma |
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What are the main clinical features of a soft tissue tumour? |
Painless Mass deep in swelling Fixed, hard craggy mass Persistant swelling |
