Diagnosis of Bone cancer
Bone cancer Diagnosis: Book Excerpts
Diagnosis of Bone cancer: medical news summaries:
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are relevant to diagnosis and misdiagnosis issues for Bone cancer:
Diagnostic Tests for Bone cancer: Online Medical Books
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BONE MASS OR SWELLING:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of trauma? Trauma, of course, may cause fractures and subperiosteal hematomas.
- Is the patient a child or an adult? Children are more likely to have Ewing's tumors, scurvy, rickets, syphilis, battered baby syndrome, osteosarcoma, osteomas, and osteochondromas. Adults are more likely to have a giant cell tumor, metastasis, osteomyelitis, osteogenic sarcoma, fibrosarcoma, multiple myeloma, generalized fibrocystic disease, Paget's disease, acromegaly, and chondromas.
- Are the lesions single or focal or are they multiple or diffuse? Multiple and diffuse lesions in children are often due to scurvy, rickets, syphilis, and battered baby syndrome. Multiple lesions or diffuse lesions in adults are often due to metastasis, multiple myeloma, generalized fibrocystic disease, Paget's disease, acromegaly, and chondroma. Single lesions in children are more likely to be fracture, osteomyelitis, hematoma, Ewing's tumor, osteosarcoma, osteomas, and osteochondromas. Single lesions in adults are often due to a giant cell tumor, osteomyelitis, fracture, hematoma, osteogenic sarcoma, and fibrosarcoma, but may be due to a metastasis.
- Are the lesions usually painful? Painful lesions in children are more likely to be due to fracture, osteomyelitis, hematoma, Ewing's tumors, scurvy, syphilis, battered baby syndrome, and rickets. Painful lesions in adults may be due to a giant cell tumor, metastasis, osteomyelitis, fracture, hematomas, osteogenic sarcoma, fibrosarcomas, and multiple myeloma.
DIAGNOSTIC WORKUP
Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, arthritis panel, serum protein electrophoresis, and plain films of the involved bones. A skeletal survey may be necessary. Bone scans are often useful. A search for a primary tumor may require chest x-ray, upper GI series, barium enema, intravenous pyelogram, mammography, prostatic examination, PSA titer, thyroid scans, lymph node biopsy, and bone marrow examinations.
CT scans of the area may help differentiate the mass or swelling. Needle biopsy or exploratory surgery and bone biopsy may be necessary before deciding what surgical approach should be undertaken.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Introduction: Malignant Neoplasms:
Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Primary malignant bone tumors:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS A biopsy (by incision or by aspiration) is essential to confirm primary malignant bone tumors. Bone X-rays and radioisotope bone and computed tomography scans show tumor size. Serum alkaline phosphatase level is usually elevated in patients with sarcoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Bone Cyst:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Pain. Is this a new patient with sudden onset of severe pain? Is there a history of trauma, mild or severe? Is this a patient with a new bone cyst picked up incidentally on x-ray study? Or is a known bone cyst being followed? Does the patient come in complaining of pain? Or does the patient wait until asked about pain? Significant pain may indicate a traumatic or spontaneous fracture. Is there tenderness elicited over the cyst area? Usually bone cysts are painless, unless they fracture or are growing rapidly. If there is pain or tenderness associated, consider referral or further imaging to differentiate from a more serious lesion.
B. Disability, weakness. Has the little-league baseball player been having trouble with his overhand throwing? Is the swimmer having difficulty with the dolphin stroke? The patient may be guarding with exercise because of pain that occurs only then. Unless the bone cyst is near the growth plate (epiphysis), it is unlikely to produce impairment of function, but if it abuts the epiphysis, growth arrest with physis damage is likely caused by the cyst itself, not trauma (4).
C. Distortion, growth, rate of growth. When examining the child, do the limbs appear different lengths? Have they been measured? If near an epiphysis a bone cyst can impair growth of the limb, causing shortening. These cases need referral early.
Physical examination
A. Focused physical examination (PE). Bone cyst is a diagnosis that should be kept in mind during routine examinations of children, even those not suspected of harboring bone cysts. However, once it appears on x-ray, remember to examine the area on every visit. This should include careful palpation of the bone and entire limb, looking for tender areas or associated soft tissue masses. Comparative measurement should be done with the other limb in any cases of deviation from normal or any protrusion of bone or soft tissue, looking for signs of progression between visits. All these should prompt referral, because they may be signs that the cyst is actually another lesion, or that it is growing, heading for impending fracture, or impinging on the epiphysis.
B. Additional PE. Routine growth charts should be maintained meticulously. Measurement of leg and arm lengths to ascertain whether growth is being interfered with is especially pertinent if the bone cyst is near the epiphysial growth plate.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Bone tumors, primary malignant:
Diagnosis
(Handbook of Diseases)
A biopsy (by incision or by aspiration) is essential for confirming a primary malignant bone tumor. Bone X-rays and radioisotope bone and computed tomography (CT) scans show tumor size. Serum alkaline phosphatase levels are usually elevated in patients with sarcoma.
Clinical tip Bone X-rays, CT scans, and magnetic resonance imaging are all useful in assessing tumor size. Bone scans and CT scans of the lungs are important in checking for metastatic disease.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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