Malignant Bone Tumors
If see maliganncy in a shoulder chances are = Chondrosarcoma!
50 yo healthy male presents to sports medicine clinic c/o right shoulder pain Golf game is lagging He has tried resting it and NSAIDs with little improvement He has an upcoming trip to Hilton Head planned and needs HELP
Metastatic carcinoma These are blastic lesions
55 yo woman presents with back pain Pain is diffuse over the thoracic and lumbar areas She has a history of breast cancer diagnosed 3 years ago She has been lost to f/u and is no longer taking tamoxifen Bone scan is performed
Paget's disease
Case: 78 yo M w/ progressive hearing loss. Associated disease?
Osteomyleltis- Brodies abscess
Dx
Osteosarcoma- Codman's triangle= Osteosarcoma
Dx
Surgery, does not respond to radiation or chemotherapy
How to treat Chondrosarcoma?
Radiation or chemotherapy
How to treat Ewing's sarcoma?
Osteosarcoma- most commonly found at the metaphysis
Potential cancer?
Midshaft of bones
Primary location of Ewings?
Ends of long bones (ex. end of femur)
Primary location of osteosarcomas?
Osteosarcoma
Prior chemotherapy/radiation, retinoblastoma, Li-fraumeni syndrome, Rothmund-Thomsom syndrome, and radium are all risk factors for what?
Multiple myelomas Calcium elveated Renal failure Anemia Bone lesions CRAB
Pt's with plasmacytomas are at risk for what? What are signs for it?
The more aggressive the cancer is
The more elevated Alkaline phosphatase is, signifies what?
Race (Caucasians)
The only proven risk factor for Ewings is what?
Focal radiotherapy not systemic therapy
Therapy for plasmacytomas
If asymptomatic: no tx If nerve impingment/pain: IV Bisphophonates
Tx for Paget's disease:
Kids
What age group is Chondrosarcoma the most serious?
Peak for miid-teens
What age range is the higest incidence for bone cancers?
Prostate and breast cancer
What are hte two most common metastatic carcinomas?
Biophosphinates or Ab to rank ligand
What are the two tx's for metastatic carcinomas?
The tumor grade
What determines the survial of people with Chondrosarcoma
Magnetic resonance
What is the gold standard for cancer workup?
Chondrosarcoma
What is the most common malignancy of the shoulder an dstrnum?
White
What race is Ewing's cancer most commonly found in?
Af. Americans
What race is osteosarcoma mostly found in?
CT angiogram
What test can be used to look at vasculature to see if resecetion is possible?
Bone scan
What test helps a doctor determine the margins of cancer?
Use chemotherapy, NOT radiation
What tx should you and should not you use for osteosarcoma?
In the metaphysis
Where does osteosarcoma mostly occur?
1) Pelvis 2) Femur 3) Shoulder
Where in your body is Chondrosarcoma mostly found?
Ewing's sarcoma
Which cancer grows quickly and spreads quickly?
Osteoscarcoma (primary)
Which cancer is assoc with: 1) painful swelling 2) No joint effusion or ROM issues 3) Night pain/limping 4) High alkaline phosphatase
Paget's diease AKA Osteitis deformans hence bone looks so messed up
Which disease is associated with: 1) Disorder of bone metabolism 2) Pain/nerve impingment 3) High alkaline phosphate
Males
Which sex is more effected by bone cancers?
B/c of Chemotherapy
Why are hte survival rates for Ewings and Osteosarcoma increasing over the years?
Secondary osteosarcoma
_____ is usually found in people >40 yo w/ a history of paget's disease or radiotherapy
Multiple myeloma
______ is a sarcoma imitator that begins in teh bone marrow, no sign of distinct tumor, and affects older adults.
Plasmacytomas
_______ are primary bone tumros made of malignant monoclonal plasma cells
