Malignant Bone Tumours

How do you classify bone tumours?

Primary Bone Tumours
- osteosarcoma
- ewings Sarcoma
- chrondosarcoma
- fibrosarcoma
- myeloma
- lymphoma
- malignant fibrous hiscytoma
- chordoma
Metastatic Bone disease

What is an OSTEOSARCOMA?
Common
Young

primary cancer of bone

adults - 10 and 25 years

Rare

in later age Secondary to previous

irradiation or Pagets disease
genetic

(retinoblastoma gene)

Metaphysis
Tenderness

of a long bone (Knee)

Tenderness / pain / Mass. Malignant

mesenchymal cells that produce Irregular
lace like osteoid matrix.
May or may not be calcified.
pre-operative chemotherapy with surgical
resection.
The five-year survival ~ 60%

What is a CHONDROSARCOMA?
Next

common to Osteosarcoma.

Older

adults 30 to 60 years.

Location

- axial skeleton (pelvis & pectoral

girdles, ribs & spine)
Aggressive,

erodes & invades soft tissue,

Metastases to lungs, liver, kidney & brain

Malignant cartilage with anaplastic
chondrocytes in spaces with focal enchondral
ossification and calcification
Resistant to chemo Surgical resection
Grade I tumors have 5-year survival rates of
90%, while high grade tumors have poor
prognosis.
Clear cell chondrosarcoma is a histologic
variant that is associated with a better
prognosis.

What is a EWINGS SARCOMA?

Rare,

young, 10-20 years, Males

2:1
Diaphysis

of long bones, pelvis

Histopath

: sheets uniform round

cells cytoplasmic glycogen,
extensive necrosis; 11/22
translocation
Prognosis:

very poor, <10% 5-year

survival with surgery and
radiotherapy, 40% with adjuvant
chemotherapy

What Tumours commonly

metastasize to bone?to bon
Prostate

179,300

Breast

176,300

Lung

171,600

Kidney

30,000

Thyroid

18,100
Atlanta GA, American Cancer Society 1999

Metastatic bone disease

The skeleton is the third most common site of
metastatic disease
Lung
Liver
Skeleton

Spine
Ribs
Pelvis
Skull
Proximal femur

50 70% of patients with prostate cancer will develop

skeletal metastases
Up to 85% of patients with metastatic breast cancer may
develop bony metastases

What is the workup for suspected tumour?

Hx + Physical exam
Labs FBC,renal profile, Ca,Ph, Alk Phos
Radiographs
Staging CT thorax, CXR
- bone scan
- localised MRI +/- whole body MRI
Biopsy

What factors help to determine if lesion Benign or Malignant?

Enneking Criteria
1.Where is lesion located? Long or flat bone, cortex,
Medullary canal, epi- meta- or dia-physis
2.What is the lesion doing to bone? erosions
3.What is the bone doing to lesion? Reactive rim,
Periosteal reaction, Sclerosis
Mankins Criteria
Criterion
benign
Size
small 0
Margination present 0
Cortex
intact 0
Soft tissue mass absent 0
Benign = 0

worrisome = 2

malignant
large 1
absent 1
destroyed 1
present 1
malignant =3or 4