Bones, Cartilage, and STS

Bones and cartilage make up the ________ system

Skeletal

What are functions of bone and cartilage

• gives shape and movement

• Protects softer tissue

• Reservoirs for fats, minerals, blood cell production

• Provides connection, support, and locomotion

What is the most common pediatric skeletal malignancy

Osteosarcoma

Osteosarcomas happen in what age group?

10-30

What is the 2nd most common bone tumor in adults?

Osteosarcoma

What is the 1st most common bone tumor in adults?

Chondrosarcoma

What age group is Ewings Sarcoma most commonly seen in?

Teens and Young Adults

What is the most common bone tumor malignancy

Bone mets

Bone/Joint cancer has ______ (good/poor) prognosis with _______ (little/large) incidence

Poor; Little

Is there an exact cause of bone cancer?

No

What are suspected risk factors for Osteosarcoma

• Genetics

• Higher birth weight/increased height

• Paget’s Disease

• Hyperparathyroidism

• Osteomyelitis

What is Paget’s Disease

Breakdown of old bone is interfered with new bone formation

What does Hyperparathyroidism cause

Loss in bone calcium

What gland regulates calcium in the blood

Parathyroid

What is Osteomyelitis

Infection of bone/bone marrow

What is this

Paget’s Disease

Previous radiation can cause what bone cancers?

• Osteo/Chondro/Fibrosarcomas

Can a chromosome defect from Ewing’s Sarcoma cause Osteosarcoma?

Yes

Osteosarcomas occur in areas of ______ (slow/rapid) growth

Rapid

What regions do Osteosarcomas usually develop?

Near growth plates

Where are growth plates located

In long bones where rapid cell proliferation takes place

What are the 2 most common sites of primary bone tumors

• Distal Femur

• Proximal Tibia

What are the 4 parts of the bone

1. Diaophysis

2. Epiphysis

3. Periosteum

4. Metaphysis

What is the main shaft of the bone

Diaphysis

Which part of the bone is knob-like at either end

Epiphysis

Which part of the bone is the hard, sense covering

Periosteum

Which part of the bone is the neck?

Metaphysis

The epiphysis contains what kind of bone?

Spongy

The Metaphysis has what kind of bone marrow

Red

The Diaphysis has what kind of bone marrow?

Yellow

What are the 7 primary bone tumors

1. Osteosarcoma

2. Chondrosarcoma

3. Fibrosarcoma

4. Ewing’s Sarcona

5. Multiple Myeloma

6. Giant Cell Tumor

7. Malignant Fibrous Histiocytoma

Most common anatomical sites of Osteosarcomas

• Proximal Tibia

• Proximal Humerus

• Distal femur

T/F: Osteosarcomas frequently occur in distal extremities

False

Chondro = _____ (adult/kid)

Adult

Osteo = _______ (adult/kid)

Kid

Average age of Chondrosarcoma incidence

60

Most common anatomical sites of Chondrosarcoma

• Femur

• Shoulder/Proximal Humerus

T/F: Chondrosarcomas rarely occur in distal extremities

True

Fibrosarcomas often occur in ________ bones

Tubular

Examples of tubular bones

• Tibia

• Femur

Fibrosarcomas can affect ________ and _______ ________

Bone; Soft tissue

Do Fibrosarcomas often occur in kids?

No

Ewing’s Sarcoma accounts for 3% of all _________ (childhood/adult) cancers

Childhood

Can Ewing’s Sarcona occur in any bone?

Yes

Which part of the body does Ewing’s Sarcoma most commonly occur?

Lower half

What part of the bone does Ewing’s Sarcoma most commonly occur in?

Diaphysis

What cell characteristics does Ewing’s Sarcoma represent

Small, blue, round

Multiple Myeloma is the malignancy of ________ cells

Plasma

What does Multiple Myeloma cause in the bone?

• Bone resorption = painful osseous lesions

Where does Multiple Myelona arise

B-Lymphocytes in Bone Marrow

As single lesion of Multiple Myeloma is called?

Plasmacytoma

T/F: Giant Cell tumors are usually malignant

False

Are giant Cell tumors aggressive

Yes

Where on the bone do giant cell tumors occur most?

• Metaphysis

• Epiphysis

What do Giant cell tumors cause

Bone destruction

Mets disease gets what kind of XRT

Palliative

What are most common sites of bone mets

• Vertebral bodies

• Pelvic bones

• Ribs

Distal lesions for bone cancer occur more in the ______ than the _______

Feet; hands

Distal bone lesions are usually due to what malignancy?

Lung cancer

What is the most common presentation of bone cancer

Pain

Pain is often correlated with tumor ______

Size

T/F: Early detection of bone cancers is easy

False

Lytic or blastic?

Lytic

What is the most important tool for bone cancer detection

Radiograph

Why is CT gradually being replaced by MRI?

MRI shows disease growth and neurovascular structure relationship

What isotope do they use for bone scans?

Technetium-99m (Tc-99m)

What is important for determining radiosensitivity of bone lesions?

Surgical bx

What is this

Ewing’s Sarcoma of Upper Right Humerus

what is this

Osteosarcoma of Distal Femur

Which organs have normal uptake of FDG

• Brain

• Bladder

• Kidneys

Lytic or blastic?

Blastic

Blastic lesions look _____ (black/white)

White

What Grading system is used for bone lesions

AJCC Grading

Describe AJCC Grading

• G1 = Low grade

• G2 = High grade

Higher grade = (better/worse) prognosis

Worse

High grade sarcomas typically spread ____________ to the peripheral lung

Hematogenously

Where do high grade sarcomas typiy spread to?

Peripheral lung

80% of Osteosarcomas spread to the _______

Lungs

Low grade sarcomas grow ________ (slow/fast) and are ________ (easy/hard) to control

Slow; Easy

Can low grade sarcomas recur and become high grade?

Yes

T/F: Sarcomas can spread via Skip Mets

True

What is Skip Mets

Cancer cells get into the LN and travel to a different region/organ of the body

What are 2 ways sarcomas can be staged?

• by Grade

• TNM

What does the staging of sarcomas depend on

Histology

What is important to do when treating sarcomas with XRT

Do skin sparing strips to prevent lymphedema

T/F: Osteosarcomas are the most common malignant bone tumor

True

Who is at increased risk of osteosarcoma

• <35 yrs old

• Tall

• Equal in children for gender

• 2:1 Male/Female >15

Osteosarcomas are chemo________ but radio________

Sensitive; Resistant

What is the tx of choice for Osteosarcomas

Chemo and Surgery

5 year survival Osteosarcoma

60-70%

When is XRT used for Osteosarcomas

• Chemoadjuvant

• Unresectable/Partially Resected tumor

• Positive margins

Dose for post-op Osteosarcoma

• 55 Gy

• Boost: 64-68 Gy

Dose for Unresectable Osteosarcoma

60-70 Gy

What is important to keep in tx field for Osteosarcomas

Scar, Spare 1-3 cm margin

What is this

Chondrosarcoma

T/F: Chondrosarcoma is the 2nd most common bone tumor overall

True

What is the most common bone tumor in adults

Chondrosarcoma

Chondrosarcomas arise from _________ elements of bone

Mesenchymal

Where can chondrosarcomas form

Any cartilage forming bone

What is important for Chondrosarcoma prognosis

• Location

• Grade