🔑 Key Learning
- Osteochondroma is the most common benign bone tumour.
- Osteosarcoma is the most common malignant primary bone tumour, presenting with bone pain or swelling (often at night) in children and young adults.
- XR findings in osteosarcoma include sunburst appearance and Codman triangle.
- Refer via 2WW or very urgent pathway (48hr) as below.
👀 Clinical Features
Symptoms
- Bone pain (may be severe, progressive or worse at night)
- Swelling or palpable mass
- Low trauma fracture
- Limp or restricted joint movement
Red Flag Features
- Unexplained bone pain or swelling
- Lump increasing in size (soft tissue sarcoma)
- Pain at night or not responding to analgesia
🦴 Benign Bone Tumours
| Tumour | Key Features |
|---|---|
| Osteoma | Benign skull overgrowth; seen in Gardner syndrome |
| Osteochondroma | Most common; cartilage-capped bony projection |
| Giant cell tumour | Occurs at epiphyses of long bones; “double bubble” sign on X-ray |
💥 Malignant Bone Tumours
Osteosarcoma
- Most common primary bone malignancy
- Affects children/young adults (10–20 yrs)
- Common sites: proximal femur, tibia, humerus, mandible
- Red flags: unexplained pain, night pain, swelling
- 1st line investigation: X-ray - sunburst appearance, Codman triangle
- May present with low trauma fracture
Ewing's Sarcoma
- Usually in children/young adults
- Sites: pelvis, chest wall, long bones
- Presents with severe pain ± swelling
Chondrosarcoma
- Malignancy of cartilage
- Commonly affects the axial skeleton
🧵 Malignant Soft Tissue Tumours
Soft Tissue Sarcoma
- Malignant tumour of muscle, fat, tendon or ligaments
- Red flag: unexplained lump increasing in size
- Common in arms, legs, chest, abdomen
- 1st line investigation: ultrasound
🧪 Investigations
| Scenario | Initial Imaging |
|---|---|
| Suspected bone tumour (e.g. osteosarcoma) | X-ray (1st line) |
| Suspected soft tissue tumour (e.g. soft tissue sarcoma) | Ultrasound (1st line) |
| Further assessment (if suspicious) | MRI / CT + urgent referral |
- XR: May show lytic lesions, periosteal reaction, or cortical disruption
- MRI: Best for local staging and soft tissue involvement
- CT/PET: Used for staging and surgical planning
📤 Recognition & Referral (NICE)
Adults
- Lump increasing in size → urgent ultrasound within 2 weeks
- Imaging suspicious for sarcoma → 2WW referral
Children & Young People
- Lump increasing in size → ultrasound within 48 hours
- Unexplained bone pain or swelling → X-ray within 48 hours
- Suspicious imaging → specialist referral within 48 hours
📝 Exam Clues & Clinchers
-
Child with night bone pain and swelling → Osteosarcoma
- Urgent X-ray - codman triangle, sunburst pattern
- Teen with chest wall swelling and pain → Ewing's Sarcoma
- Painless lump increasing in size → Soft tissue sarcoma