Bone tumours
Bone tumours include benign lesions, rare primary bone sarcomas, myeloma and secondary deposits; the high-yield task is to recognise persistent or unexplained bone pain, swelling, a pathological fracture or an aggressive radiograph, investigate promptly and ensure that suspected primary bone tumour is referred before biopsy to an expert sarcoma centre.
Definition
Bone tumours are neoplastic lesions arising in bone. They include benign lesions, rare primary malignant bone tumours or sarcomas, plasma-cell disease such as myeloma, and secondary malignant deposits. A persistent symptom or aggressive imaging finding requires investigation; a suspected primary bone tumour should be referred to a specialist sarcoma centre before biopsy.
First principles
Separate primary bone sarcoma from secondary or benign disease
Primary malignant bone tumours are rare. In an adult with a destructive lesion, consider metastasis, myeloma, lymphoma, infection and a primary sarcoma together; the age, number of lesions, known cancer, symptoms, radiograph and blood results change the probability. Many benign lesions are incidental, but a lesion is not safely labelled benign from a single reassuring feature when symptoms or imaging are discordant.
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