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Incorrect - Although most common in childhood, there is a second peak of incidence in late adulthood.
Correct - With modern chemotherapy and surgery the majority of patients presenting with an osteosarcoma can be cured of the disease. There is a lot of research and work to try and improve this number further.
Incorrect - Although there are several subtypes of osteosarcoma, they all have the potential to metastasize.
Incorrect - Although, unfortunately, amputation is occasionally required, most of the time modern techniques can result in limb salvage.
Referring to the causation of sarcomas:
Correct - Most sarcomas are apparently random events that can affect anyone of any age.
Incorrect - Although some conditions such as Li Fraumeni syndrome can predispose to sarcoma occurence, these are uncommon.
Incorrect - A small percentage (approximately 1 in 1000) of patients receiving Radiation Therapy will go on to develop a radiation-induced sarcoma.
Incorrect - Although many patients will recall a history of trauma to the affected area, and often attribute their mass to that event, there is no evidence that acute trauma will cause a sarcoma. This is a good example of recall bias.
A patient undergoes treatment including 5000cGy of external beam radiation and wide resection surgery for a large, deep high grade soft tissue sarcoma in the thigh. There is no evidence of metastases. How will you counsel the patient?
Incorrect - While this is serious, and more follow up is needed, it is not inevitable that this patient will die from this disease.
Correct - Survival rates for this scenario are between 50 and 60% in most studies.
Incorrect - In some circumstances resection of metastases while they are small can be associated with prolonged disease free intervals, so it is reasonable to screen patients for disease.
Incorrect - Potential long term effects include swelling, joint stiffness and second malignancy
Correct - Multiple Hereditary Exostoses, also known as Diaphyseal Aclasia, is an autosomal dominant condition predisposing to the development of ostoechondromas.
Incorrect - The surface of the lesion is covered with growth plate cartilage. Once the patient reaches skeletal maturity, usually in the early twenties, the normal growth plates shut down, as do the growth plates on the osteochondromas. Growth in a skeletally mature patient is concerning for malignant transformation.
Incorrect - The risk is hard to predict, but malignant transformation to low grade chondrosarcoma certainly does occur. The risk seems to be about 1 in 1000 in sporadic tumours, and about 1-25% for patients with MHE.
Incorrect - The best primary investigation is a plain X-Ray. In some areas like the pelvis a CT scan may be required due to the complexity of the anatomy. If there is concern for malignant change, an MRI may be required to assess the cartilage cap.
A patient presents to his family doctor with a 4 cm mass that has been stable. How would you first try to determine if it was superficial?
Incorrect - Even deep lesions can still be soft.
Incorrect - Tensing up the muscle will make a deep lesion feel fixed.
Correct - Tensing up the muscle will make a deep lesion feel fixed.
Incorrect - You can do this if you are unsure, but a careful examination should come first.
Giant Cell Tumour of Bone:
Incorrect - Although 1% of Giant Cell Tumours of Bone can metastasize, the vast majority behave in a benign fashion.
Incorrect - Giant Cell Tumours of Bone typically occur at the ends of the long bones.
Correct - They are one of the more common benign bone tumours.
Incorrect - Giant Cell Tumours of Bone almost never occur prior to skeletal maturity.
Soft Tissue Sarcomas:
Incorrect - Soft Tissue Sarcomas can occur almost anywhere, although they are most common in the limbs, especially the thigh.
Correct - There are multiple subtypes of soft tissue sarcoma, each with its own demands. A mutlidisciplinary approach to management has repeatedly been shown to produce better results.
Incorrect - Ultrasound Scans are quite non-specific, but can tell if the lesion is deep and its size. If the history and examination are very suspicious for a soft tissue sarcoma then a MRI scan is the investigation of choice.
Incorrect - Fine Needle Aspiration is rarely adequate for the diagnosis of a soft tissue sarcoma. Either a core needle biopsy or an open biopsy is recommended.
In the treatment of malignant primary bone tumours (bone sarcomas), Radiation Therapy has an important role in the primary treatment of:
Correct - In fact, there are some instances where radiation may be given without surgery being required.
Incorrect - Radiation Therapy is generally only used in palliative care settings.
Incorrect - Radiation Therapy is not particularly effective against chondroid tumours and is generally only used in palliative care settings.
An MRI scan can definitively diagnose a soft tissue sarcoma:
Incorrect - A definitive diagnosis almost always requires a biopsy.
Correct - While an MRI can often suggest the diagnosis, a tissue diagnosis is sensible before undertaking major interventions.
A 14 year old boy has a swollen tibia and pain for 6 months. You suspect a bone tumour. What would be the best first radiological investigation?
Incorrect - This would almost certainly be required but is not the best diagnostic modality.
Correct - A Plain film X-ray is cheap, effective and readily available. It remains the diagnostic tool of choice for bone tumours.
Incorrect - This will almost certainly be required as well, but is not the best first investigation.
Incorrect - This sounds like a bony lesion, which would not be well imaged with an ultrasound.