Approach for orthopaedic tumor PART 1
Teaching Mr. ariff
History and PE : Aim to
1. Differentiate between soft tissue or bone
2. Differentiate between malignancy or benign or benign to maligancy transformation
-benign usually long standing
-malignant usually is fast growing a/w night pain or pain at rest?
-benign to maligant transformation - usually lipoma
Tengok balik buku. Cuba buat table
3. Any symptoms of metastases
-can be to mets from other site (5 tumors commonly mets to bone are lung, breast, thyroid, renal n prostate). So need to rule out those as well. would be useful if we can read the characteristic of those tumor...osteoblastic, osteoclastic or mixed. For example prostate tumor is osteoclastic in nature
-it can also be primarily from bone itself but mets to bone elsewhere.. bone usually mets to lung and other bone which is highly vascularized, which is the cancellous bone. Examples of cancellous bones are proximal girdle,hip, vertebral body, proximal humerus (but can only be seen radiologically once it spread to pedicle giving owl wink sign). Rarely mets to liver, unlike carcinoma. So, ask about any pain elsewhere, hemoptysis, sob...
-note that giant cell tumor (benign) has metastatic characteristic, but only to lungs. It is bacause it gets doslidged from the primary lesion. But unlike a real mets in malignancy, it can't transfer from lung to lung.
4. Anticipate complications local or systemic
-local compression:
♧nerve - any loss of sensation, numbness
♧vascular - pulse, dilated vein, edema
♧muscle - weakness PNS
♧joint-effusion
- systemic
♧anemic sign n symptoms (ssx)
♧ssx of hypercalcemia (resorption-read more how it occurs)
5. obtain family history of malignancy. Apa tumor yg commonly ada genetic influence. X dpt kawab hari tu sbb x dtg seminar mr goh
6. Syndromic??? X dpt pick up sebab terspace out. Among important keywords : bone tumor boleh develop fibrous dysplasia...monostotic or polyostotic. and syndromes somehow related with endocrine punya features like thyroid pr pituitary. Good to know.
From mr shuk : causes of pain in malignancy
1. Compression to surrounding
2. Central necrosis
3. Stretch of pseudocapsule
