sacroma and peds onco test 3

Primary vs metastatic bone tumors

Metastatic bone cancers are more common than primary

Origin of bone tumors

Primitive mesenchymal cells

Most common site of primary bone sarcomas

Metaphysis

Function of periosteum

Keeps primary bone tumors contained

Common metastasis route for sarcomas

Hematogenous spread to lungs

Skip metastases

Secondary lesion in same bone or across joint

Lymph node involvement in bone sarcoma

Automatically stage III or higher

Most common primary bone cancer in children

Osteosarcoma

Common location of osteosarcoma

Distal femur and proximal tibia (metaphysis)

Osteosarcoma sensitivity

Chemo sensitive, radioresistant

Most important prognostic factor (osteosarcoma)

Presence of metastases at diagnosis

Common metastasis site (osteosarcoma)

Lungs

Common primary bone tumor in adults

Chondrosarcoma

Chondrosarcoma treatment

Surgery (radioresistant)

Chondrosarcoma produces

Cartilage (no osteoid)

Prognostic factor (chondrosarcoma)

Histologic grade

Fibrosarcoma occurrence

Less than 6% of primary bone cancers

Fibrosarcoma treatment

Wide/radical resection + postop radiation

Fibrosarcoma common bones

Femur and tibia

Most common bone tumor in children <5

Ewing’s sarcoma

Ewing’s location

Diaphysis of long bones

Ewing’s x-ray appearance

Onion-skin

Ewing’s sensitivity

Chemo and radiosensitive

Ewing’s symptoms

Pain, fever, swelling, fatigue

Ewing’s treatment volume

Entire bone + 2 cm margin

Multiple myeloma origin

Plasma cells in bone marrow

Radiographic appearance (myeloma)

Lytic lesions

Multiple myeloma treatment

Chemo (curative) + radiation (palliative)

Radiation dose for myeloma pain

3000 cGy

Giant cell tumor location

Epiphysis (long bones)

Giant cell tumor behavior

Usually benign

Giant cell tumor treatment

Surgery

Most common malignant bone lesions

Metastatic lesions

Common primary sites for bone metastases

Lung, prostate, kidney, thyroid

Common locations for bone metastases

Spine and pelvis

Soft tissue sarcoma origin

Mesenchymal cells

Most common soft tissue sarcoma in children

Rhabdomyosarcoma

Most common in adults

Malignant fibrous histiocytoma

Key prognostic factor (STS)

Histologic grade

Most common pediatric solid tumors

CNS tumors

Ependymoma origin

Cells lining ventricles

Ependymoma spread

CSF seeding

Most common pediatric CNS tumor

Medulloblastoma

Medulloblastoma spread

CSF

Medulloblastoma treatment

Craniospinal irradiation (CSI)

Brainstem glioma treatment

Radiation (unresectable)

Retinoblastoma age range

6 months to 4 years

Retinoblastoma sign

White retinal reflex

Most radiosensitive eye structure

Lens

Second most common pediatric solid tumor

Neuroblastoma

Neuroblastoma origin

Adrenal gland/paraspinal ganglia

Neuroblastoma treatment

Chemo ± radiation

Wilm’s tumor origin

Kidney

Wilm’s tumor presentation

Painless abdominal mass

First step in Wilm’s treatment

Nephrectomy