This is an extract of our Bone Tumours document, which we sell as part of our Orthopaedics Notes collection written by the top tier of University Of Leicester students.
The following is a more accessble plain text extract of the PDF sample above, taken from our Orthopaedics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
Bone Tumours Malignant tumours Presentation
- Non-specific pain often worse at night
- Limb swelling
- Restricted movement
- Pathological fractures Hx:
- Mechanical pain (weakened bone)
- Pain preceding a fracture
- Weight loss
- PMH malignancy/infection (ask about type, treatment, remission follow-up)
- Anaemia Red flags
- Systemic features inc o Weight loss o Tiredness o Change in bowel habit o Coughing o Smoking history
Night pain Previous cancer Age of patient
- General and focussed
- Lymph nodes
- Affected limb
- Potential sites of primary e.g breast, thyroid, prostate Investigations Bloods:
- FBC - Hb for anaemia (microcytic is common in malignancy - low Fe count) Low level bleeding or infiltration of bone marrow
- Calcium - Raised = medical emergency = nerve conduction problems (treat with bisphosphonates)
- Alk. Phos sometimes raised. LFTs deranged due to mets in liver
- Platelets - thrombocytopaenia
- U+E - check renal function (hypercalcaemia can cause dehydration) Xrays:
- Bone destruction
- New bone formation
- Soft tissue swelling
- Periosteal elevation-
Compare with previous films Cystic/lytic or sclerotic Single or multiple lesions?
- Bone scan (nuclear med) to identify other lesions (show silent secondary deposits)
- CT + MRI assess extent of tumour and infiltration of surrounding structures
If doubt still persists - biopsy and send for microbiology and histology (biopsy track considered contaminated) Staging = radioisotope scan and CT chest/abdo/pelvis Differential diagnosis
- Developmental e.g bone cyst
- Trauma e.g avulsions
- Infection e.g TB, osteomyelitis
- Stress fracture Questions when assessing bone tumours
- Where is the lesion?
- Calcified centre?
- Well-defined margins
- Cortical destruction
- Periosteal reaction
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