ICC-2 [037] Orthopedics Oncology 2024-2025 PDF

 Module Abbr, Code and Orthopaedic Oncology i.e. FNM Intro to Lecturer name & title  - Neoplasm (tumour) A mass of tissue formed as a result of abnormal, excessive and inappropriate proliferation of cells, the growth of which cont...

 Module Abbr, Code and Orthopaedic Oncology i.e. FNM Intro to Lecturer name & title  - Neoplasm (tumour) A mass of tissue formed as a result of abnormal, excessive and inappropriate proliferation of cells, the growth of which continues indefinitely and regardless of the mechanisms which control normal cellular proliferation. Benign or Malignant Malignant: primary or secondary Tumors that involve bone Benign primary bone tumors Malignant primary bone tumors Secondary tumors (metastatic bone disease) Haemopoietic tumors Diagnosis History: Patient’s age: Young --- primary or haemopoetic Older --- secondary History of trauma Usually unrelated, but draws attention to lesion History of malignancy or radiotherapy Weight loss, lethargy Diagnosis Symptoms: Persisting pain Night pain Swelling Pathological fracture Paraesthesia, numbness (neural compression) Recognition by the treating doctor is the most important aspect in management Investigations itsown X-rays > - can be diagnostic on Blood tests ▪ FBC ▪ Inflammatory markers ▪ Plasma electrophoresis multiple myeloma > - ▪ U&Es and LFTs - ▪ Special tests e.g PSA, Alkaline phosphatase CT MRI Bone scan to confirm diagnosis Biopsy - most diagnostic only , way X-rays Tissue biopsy Image-guided to ensure sampling of appropriate necrotic risue part of the lesion. - nor Planned in conjunction with the specialist surgeon and pathologist if surgical excision is being considered Biopsy tract must be excised during definitive surgery (risk of seeding) Tumors that commonly metastasize to bone b 1. Lung 2. Thyroid 3. Breast 4. 5. Prostate Kidney - - g increased bone density Mets could be Lytic or Sclerotic decreased bone density · tin Prostate Gar Benign tumours Options for treatment: Observation Surgical excision: If thinning of the cortex > 50% Mass effect on adjacent structures Surgical curettage of benign cysts surgical procedure to remove diseased or reactive tissue and/or foreign material from the periradicular bone s Benign tumours Selected benign tumours: 1. Osteochondroma (Exostosis) 1. Osteoid osteoma Benign tumours Osteochondroma (Exostosis): Most common benign bone tumour Usually solitary Multiple in (Hereditary multiple exostoses) - Pedunculated lesion arising from near physis Malignant change in 1% Cartilage cap Excision if symptomatic  Benign tumours Osteoid osteoma: lages 2 ⑳ ed schrotic area-meades docted pain Classic symptoms: Localised pain + worse at night + relieved by salicylates - > - ownbe used to diagnose Femur, tibia & spine most affected CT scan If untreated, grows in size but eventually burns out over a number of years Radio-frequency ablation Malignant tumours (Primary) Options for treatment: 1. Amputation 2. Reconstruction 3. Adjuvant chemo and radiotherapy Treatment should not compromise prognosis Treatment should preserve function as best as possible Malignant tumours 1. Amputation: Tumours with vascular / neurological invasion Extensive tumours Zip normal limb tumor Prosthetics 180 degre esa pexcise ouse ankle as knee Malignant tumours 2. Reconstruction: Endoprosthetic replacement Implant replaces the segment of the excised bone with the nearby joint  butsuke Malignant tumours 2. Reconstruction: ef excision We In selected cases, reconstruction may be done with autograft (patient’s own bone) Usually the fibula in tibial tumours Malignant tumours Selected malignant tumours: 1. Osteosarcoma 2. Ewing’s sarcoma Malignant tumours Osteosarcoma The most common bone sarcoma Most commonly around the knee (50%) or shoulder (25%) Second decade of life = Metastasize early Surgery + pre and post operative chemotherapy Malignant tumours Ewing’s sarcoma Second most common malignant bone tumour 80% in first two decades Mostly affects diaphysis of long bones Chemotherapy + limb salvage resection +/- Radiotherapy Metastatic Bone Disease (MBD) Most common bone malignancy Pain, swelling, pathological fractures, spinal cord compression and hypercalcaemia - Fractures caused by MBD may not unite ↑ Whenever possible, replace rather than fix Prophylactic fixation of impending fractures is easier and less traumatic Decompression + stabilisation for spinal MBD Follow up for fixation failure Metastatic Bone Disease (MBD) Mirels’ score – For Predicting if lesion is at risk of pathological fracture - Sclerotic of medulling Cana Consider prophylactic stabilisation if >8 MDT (Multi-disciplinary Team) Management of malignant orthopaedic tumours must be delivered by MDT in a tumour center. A typical MDT comprises of: Orthopaedic oncology surgeon medical and radiation oncologist Pathologists Radiologist Palliative care specialist Rehabilitation specialist Psychologist References: Basic orthopaedic sciences, Stanmore guide. ISBN- 10 0340 885 025 British Orthopaedic Oncology Society & British Orthopaedic Association guide on Metastatic Bone Disease (2015 Revision). Osteosarcoma: review article. J Am Acad Orthop Surg 2009;17: 515-527 Thank you