Neoplasms

Neoplasm

Any swelling or mass

New or abnormal proliferation of cells

Tumor

Benign

No metastatic potential

Malignant

Ability to metastasize or invade

Primary tumors

Develop from or within tissue in a localized area

Secondary tumors

Lesions that originate in other organs of the body

Occur in muscle, bone, cartilage, nerves, fibrous tissue, adipose tissue

Primary tumors

Occur mostly in prostate, breast, kidney, thyroid, lung

Secondary tumor

T/F: primary tumors are always benign

False

Can be benign or malignant

T/F: secondary tumors are always benign

False

They are malignant

Key symptoms of neoplasms

Constant, unrelenting, non-mechanical pain

Night pain

Demographic of neoplasms

Age > 50

history of cancer

Onset of neoplasms

Insidious

A neoplasm may be present if symptoms of pain, fever, swelling, etc. do not improve after _____

1 month

Diagnosis of neoplasms

Radiograph/bone scans

CT, MRI, ultrasonography, angiography

biopsy

Lab tests

Common location for development of bone tumor and why?

Ends of long bones

Undergo greatest growth and remodeling

Periosteal reaction examples

Solid

Lamellated or onion skin

Codman's triangle

In neoplasms, serum calcium (increases/decreases)

Increases

In neoplasms, alkaline phosphatase (increases/decreases)

Increases

T/F: staging a neoplasm does not impact prognosis and survival

False

Staging is correlated with prognosis and survival

Staging of a neoplasm: considerations

Tumor

Nodes

Metastasis

Treatment of neoplasms

Observation

Removal of tumor

Removal of entire segment

Limb-salvage

Radiation

Chemotherapy

Benign bone tumors

Resemble normal tissue

May be locally invasive

Benign bone tumors have (high/low) potential for growth

Low

T/F: because benign tumors are less dangerous than malignant, they are not a concern to health

False

Bone island frequency

Common

Bone island

Small, sclerotic, benign bone lesion

Treatment for bone islands

No treatment needed

Patients always asymptomatic

Osteoid osteoma vs osteoblastoma size

Osteoid osteoma - <1/5 cm

Osteoblastoma - > 1/5 cm

Osteoid osteoma

Benign bone tumor

Typically in long bones

Osteoid osteomas do not occur in

The skull

Osteoblastoma

Benign bone tumor

In spine, sacrum, flat bones

Osteoid osteoma and osteoblastoma demographic

Male

Under 25

Osteoid osteoma and osteoblastoma symptoms

Pain at night - relieved with aspirin

How are Osteoid osteoma and osteoblastoma different from lesions?

Tendency to expand

Endochondroma

Benign, intramedullary, hyaline cartilage tumor

Endochondroma location

Tubular bones of hands, feet

Can also be in long tubular bones

Endochondroma demographic

Age 20-50

Osteochondroma

Continuous outgrowth of bone with cartilage cap

Most common benign primary bone neoplasm

Osteochondroma

Osteochondroma demographic

Male

<20 years

Osteochondroma location

Metaphysis of long bones

Ex: distal femur, proximal humerus, tibia

Osteochondromas usually stop growing when

The skeleton has reached maturity

Most to least common benign bone tumor

Bone islands

Osteochondroma

Osteoid osteoma

Endochondroma

Osteoblastoma

Osteoid osteoma treatment

Maybe surgical removal, bone graft

Recurrence of osteoid osteoma is (common/rare)

Rare

Osteoblastoma treatment

Maybe surgical removal, reconstructive surgery

T/F: Osteoblastomas have a moderate recurrence rate

True

15%

Endochondroma treatment

Curettage - tissue removal/scraping

With or without bone grafting

Osteochondroma treatment

No intervention needed unless symptomatic or limb function is altered

Metastatic bone tumors origin

Other organs of body

Most common malignancy of bone

Metastatic tumors

75% of all bone metastases originated in

Prostate, breast, kidney, thyroid, lung

PbKTL (lead kettle)

Areas most affected by metastatic bone tumors

Spine - lumbar and thoracic

Important red flag in a patient's history for metastic bone tumors

Cancers in - prostate, breast, kidney, thyroid, lung

How do metastatic bone tumors spread?

Bloodstream, lymphatics, direct extension

Batson's venous plexus

Network of veins that connect pelvic and thoracic veins

No valves

Why is the spine common for metastatic bone tumors?

Batson venous plexus

(Malignant/benign) tumors are more common

Benign

Malignant

Can spread to other sites of body by invading locally and destroying adjacent tissue

Osteosarcoma demographic

Male

Children, adolescents, young adults

Osteosarcoma region

Knee most common

Long bones (femur, tibia, humerus)

Common sites of spread for osteosarcoma

Lungs

T/F: onset of an osteosarcoma is usually associated with some type of trauma

False

Osteosarcoma treatment

Resistant to radiation

Complete removal or primary tumor and metastases

Codman triangle

the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone.

Chondrosarcoma

malignant tumor of cartilage

Chondrosarcoma demographic

Males

30-60 years old

Chondrosarcoma locations

Pelvis

Shoulder girdle

Chondrosarcoma treatment

surgical resection

Radiation and chemo do not work well

Ewing Sarcoma demographic

Children

Males

Ewing sarcoma location

Long bones (femur, tibia, fibula, humerus, pelvis)

Ewing sarcoma prognosis

Poor

Ewing sarcoma treatment

Resection

Chemotherapy

Ewing sarcoma periosteal reaction

"Onion skin"

Osteosarcoma periosteal reaction

Codman triangle

Giant Cell Tumor malignant or benign?

Low-grade malignant sarcoma because high rate of recurrence

Giant cell tumor location

Epiphysis of long tubular bones

Giant cell tumor demographic

Males = females

Age 20-40

Giant cell tumor radiology finding

Lytic lesion

Locally destructive

Soft tissue tumors locations

Adipose

Smooth muscle

Skeletal muscle

Malignant and benign example of adipose tumor

Liposarcoma - malignant

Lipoma - benign

Example of benign and malignant smooth muscle tumor

Leiomyoma - benign

Leiomyosarcoma - malignant

Example of benign and malignant skeletal muscle tumor

Rhabdomyoma - benign

Rhabdomyosarcoma - malignant

Main PT intervention for neoplasms

Restore, maintain, and promote function

Provide support for patient and family

Someone with a PMH of cancer (especially PBKTL) with insidious onset of pain in ____ or ____ - think cancer until ruled out

Low back

Thoracic spine

When is pain a red flag for neoplasms?

Not biomechanical

No improvements

What population with what symptom is a very suspicious combination?

Young males with leg pain

Osteosarcoma and Ewing's Sarcoma can have similar symptoms to

Leg-Calve-Perthes and SCFE

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