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Primary & Secondary Bone Tumours (Diagnosis (MRI - used for vertebral…
Primary & Secondary Bone Tumours
Key Facts
The MOST COMMON tumours are metastases from the bronchus, breast and prostate
Primary bone tumours are rare and usually seen only in children and young adults
Bone pain may be due to:
Primary tumour of bone (rare and only seen in young) - osteosarcomas, fibrosarcomas, chondrosarcoma, Ewing's tumour
Metastases (secondary tumour - osteolytic) - lungs, breast, prostate, thyroid, kidney
Lymphoma
The pain is typically unremitting and worse at night and there are other clinical clues such as weight loss of ill-health
Multiple myeloma
Symptoms are usually related to the anatomical position of the tumour, with local bone pain
Systemic symptoms e.g. malaise and pyrexia as well as aches and pains occur and are occasionally related to hypercalcaemia
Diagnosis
MRI - used for vertebral lesions
Serum alkaline phosphatase (from bone) is usually raised
X-rays
May show metastases as osteolytic areas (for lytic tumour to be visible it must have lost greater than 60% bone density) with bony destruction
Osteosclerotic metastases are characteristic of prostatic carcinoma
Hypercalcaemia occurs in 10-20% who have metastatic malignancies
Skeletal isotope scan - show bony metastases as 'hot' areas BEFORE radiological changes occur
PSA is raised in the presence of prostatic metastases
Treatment
Some tumours respond to chemotherapy
Some tumours are hormone dependent and respond to hormonal therapy
Local radiotherapy to bone metastases relives pain and reduces the risk of pathological fracture
Bisphosphonates can help symptomatically
Analgesics and anti-inflammatory drugs
Primary Bone Tumours
Ewing's sarcoma
Average age of onset is 15yrs
Presents with a mass/swelling, most commonly in the long bones of the:
Arms, legs, pelvis and chest
Occasionally in the skull and flat bones of the trunk
Very rare
Painful swelling, redness in the area surrounding the tumour, malaise, anorexia, weight loss, fever, paralysis and/or incontinence if affecting spine, numbness in affected limb
Thought to arise from mesenchymal stem cells
Osteosarcoma
Common sites are knee (75%) or proximal humerus
Often presents as a relatively painless tumour
Occurs in metaphases of long bones
Destroys bone and spread into the surrounding tissue
Associated with Paget's disease in adult life
Rapidly metastasises to the lung
Usual peak onset 15-19 years
X-ray
Bone destruction and formation
Soft tissue calcification produces a sunburst appearance
Most common primary bone malignancy in children
Chondrosarcoma
Most common adult non sarcoma
Associated with dull, deep pain and affected area is swollen & tender
Cancer of the cartilage
Common sites affected; pelvis, femur, humerus, scapula and ribs