Evaluation of Tumours

Western Health Orthopaedic Registrar presentation – Workup: Musculoskeletal Malignancy by Dr Peter Moore

Clinical History

• pain
• mass
• deformity
• fracture

Examination

• lump
  • size, shape, surface consistency, tenderness
  • inflammation, mobility, anatomic relations
  • transilluminance, bruit, atrophy
• neurovascular status
• breast
• prostate
• splenomegally
• skin lesions

Laboratory Investigations

• FBE
• ELFT
• CA
• PSA
• EPP
• Urine

Xrays

Questions to Ask

1. Where is the lesion?
2. What is lesion doing to bone?
   • wide zone of transmission
     • -> malignant or aggressive
   • well demarcated with narrow zone of transition
     • -> benign
3. What is the bone doing?
   • periosteal reaction
   • smooth with benign process
   • onion skin or sunburst
4. What is in the lesion?
   • calcification suggests cartilage lesion
5. Age of patient
6. More than one lesion