Malignant bone tumours Flashcards
Primary vs Secondaries in bone
Mets to bone are much more common than bone primaries. Commonest to spread to bone are breast, lung, thyroid, prostate, kidney
Features of bone metastasis
Tend to erode producing a lytic lesion which can present as vertebral collapse and pathological fracture. If extensive they can cause hypercalcaemia (due to PTH production or bone breakdown)
Myeloma
Ca of plasma cells leading to bone pain and pathological fractures. can also present as pancytopenia. Will have High ESR, calcium and ALP. Diagnosis is by protein electrophoresis and biopsy. Treat with chemotherapy.
Osteosarcoma (AKA osteoid sarcoma or osteogenic sarcoma)
most cases between 10-25yrs (M>F) Typically present with pain and swelling but pathological fractures are rare. Most arise from metaphysis of the long bones (knee, prox humerus or femur and distal radius). Treatment is chemo or surgery. Commonest primary tumour of bone (20%)
Chrondosarcoma
Affects adults over 40yr. Insensitive to adjuvant treatment and management is surgical
Ewing’s Sarcoma
2nd commonest primary tumour of bone. Effects children (10-20yrs) (M>F)and presents with systemic illness and warm, erythematous swellings (usually at the femoral diaphysis) - treat with chemo, radio and surgery.
Small round tumor histologically and mets common
Radiographic appearance of Myeloma
Punched out lesions unless the disease is widespread when diffuse osteoporosis can occur.
Bone scans are cold and inconclusive.
Osteosclerotic metastases
Prostate and occasionally breast bone mets can induce reactive bone formation leading to a high ALP
Night bony pain
A classic red flag for bone cancer
Osteoid osteomas
10-12% of all benign bone tumours, more common in young male patients and long bones. Causes severe dull non-radiating pain continually which increases at night. Relieved by NSAIDs. can self resolve or be removed.
