Osteosarcoma

Question 1

Osteosarcoma is a type of ___ _____

Answer 1

bone cancer

Question 2

What age does osteosarcoma typically present?

Answer 2

In adolescents and young adults aged 10-20 years.

Question 3

What are common sites for osteosarcoma to develop?

Answer 3

Femur
Tibia
Humerus

Question 4

How does osteosarcoma present?

Answer 4

Persistent bone pain, particularly at night.
May wake them up from sleep.
May have bone swelling, a palpable mass and restricted joint movements.

Question 5

What should be done if a child presents with unexplained bone pain or swelling?

Answer 5

Very urgent direct access X-ray within 48 hours

Question 6

If an x-ray suggests a possible sarcoma, what then needs to happen?

Answer 6

A very urgent specialist assessment within 48 hours

Question 7

What is periosteal reaction?

Answer 7

Irritation of the lining of the bone

Question 8

What would be seen on the bone X-ray in a patient with sarcoma?

Answer 8

Poorly defined bone lesion
Destruction of normal bone with “fluffy” appearance
Periosteal reaction
May be soft tissue mass

Question 9

On an x-ray, how is periosteal reaction described?

Answer 9

Sun-burst appearance

Question 10

In osteosarcoma, blood tests may show raised a______ p______

Answer 10

alkaline phosphatase (enzyme released by osteoblasts during bone formation)

Question 11

Osteosarcoma not only builds a____ b___ but also causes l___ d______

Answer 11

abnormal bone
local destruction

Question 12

Tumour cells produce immature bone matrix, also called…

Answer 12

osteoid

Question 13

What investigations may be used to better define an osteosarcoma lesion and stage the cancer?

Answer 13

CT
MRI
Bone scan
PET scan
Bone biopsy

Question 14

What are the complications of taking a bone biopsy?

Answer 14

Tumour contamination
haemorrhage
Wound breakdown
Infection
Pathological fracture

Question 15

What must be done before taking a bone biopsy in the case of malignant tumours?

Answer 15

Detailed imaging of the lesion as the biopsy may alter the appearance of the lesion on imaging.

Question 16

How is osteosarcoma managed?

Answer 16

Surgical resection of lesion, often with limb amputation.
Adjuvant chemotherapy

Question 17

What are the 2 main complications of osteosarcoma?

Answer 17

Pathological bone fractures
Metastasis

Question 18

Primary bone tumours refer to bone tumours originating in _____ tissue

Answer 18

mesenchymal

Question 19

What does the non-organic component of bones consist of which makes them hard?

Answer 19

Calcium hydroxyapatite crystals

Question 20

What are osteoblasts and what happens to them?

Answer 20

Cells that lay bone matrix around themselves until they become trapped and become osteocytes.

Question 21

What are osteocytes?

Answer 21

Mature osteoblasts that maintain the integrity of bone tissue

Question 22

Osteoclasts are derived from _____ and resorb bone in response to hormonal signalling

Answer 22

monocytes

Question 23

What are osteogenic cells and where are they found?

Answer 23

Bone stem cells located in the periosteum and endosteum. These cells differentiate into osteoblasts.

Question 24

What is a benign osteogenic (bone-forming) tumour called

Answer 24

Osteoid osteoma (or osteoma or osteoblastoma)

Question 25

What is a malignant osteogenic (bone-forming) tumour called?

Answer 25

Osteosarcoma

Question 26

What does sarcoma refer to?

Answer 26

A broad group of cancers that start in the bones and soft tissues (eg fat, muscle, blood vessels, nerves, connective tissue). They are rare and malignant.

Question 27

Osteosarcoma can occur in older adults over 60 as a complication of P_____ d_____

Answer 27

Paget's disease

Question 28

What is Paget's disease?

Answer 28

A condition involving cellular remodelling and deformity of one or more bones. Typically, excessive bone breakdown with disorganised new bone formation. The pelvis, skull, spine and legs are the most commonly affected.

Question 29

What is Ewing's sarcoma?

Answer 29

Paediatric malignancy from poorly differentiate neuroectodermal cells, affecting the diaphysis of long bones.

Question 30

Does Ewing's sarcoma affect more boys or girls?

Answer 30

Boys

Question 31

What do plain film radiographs show for Ewing's sarcoma?

Answer 31

Lytic lesions with periosteal reactions - layers of reactive bone leading to characteristic "onion skin" appearance.