Lumps, Bumps, and Things that may keep you awake at night!
Transcript of Lumps, Bumps, and Things that may keep you awake at night!
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Lumps, Bumps, and Things that may keep you awake
at night!David Cheong MDOrthopaedic Oncology
Orthoapedic Associates of West Florida
Lumps
Surface Chrondrosarcoma
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Bumps
Things that May Scare you…
What is a SARCOMA?
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“The Root of Sarcoma…”
SARCOMAsarx (σάρκα)
Fleshy Tumor
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“A spindle cell neoplasm of the connective and/or support tissue of the musculoskeletal system”
Low-gradeFibroblastic
Osteoma-likeConventional
Rare
Less than 1% of all malignancies
Approximately 8000 new cases a year in the United States
Who Get’s it? Children and Adults 70% of soft tissue
sarcomas are in patients over the age of 40 GIST
Leiomyosarcoma
Ewing Sarcoma, Osteosarcoma more common in the young and adolescent population
Chondrosarcoma more common in the elderly
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Avoid Delay…
50% of patients have their diagnosis delayed by as much as 4 months after seeing a health care provider
20% of patients delayed as much as 6 months after seeing a health care provider
History and Physical Exam
An appropriate
is essential to the evaluation of a patient with a suspicious mass
Helps to answer the question… Is further workup necessary?
Physical Exam
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DiagnosisPain
History of Trauma
Rapid/slow growth
Mobile
SmallLarge
Radicular Pain
Night Pain
What relieves the
pain?
History of Cancer
Incidental Finding?
History of Present Illness…
Common Benign Soft Tissue Lesions of Youth
• Hemangioma
• Granuloma Annulare
• Lipoblastoma
• Lipoma
• GCT of Tendon Sheath
• Schwannoma
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Common Malignant Soft
Tissue Lesions of Youth
• Fibrosarcoma• Rhabdomyosarcoma
• Synovial Sarcoma• MPNST
• Epithelioid Sarcoma
Radiographs All ,
bone and soft tissue need to be at least evaluated with plain film radiographs
Do not pass , Do not collect $200
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One View is No View
Evaluation of Lumps and Bumps
MUST have Imaging
MUST have a competent Differential Diagnosis
Biopsy should be performed by treating physician/team
Blind Assumptions are never a good idea
4 Most Common Assumptions…
And you know what happens when you assume…
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Assumption #1: It’s just a lipoma…
Lipoma
High Grade Malignant Soft tissue Sarcoma
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Assumption #2: It’s just growing pains…
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1% of cancers are in children
7% of cancers are in the young adult population
20-40 years of age
AGE…
Cancer and the Young and Adolescent Adult
Among 20- to 39-year-olds, cancer causes more deaths than any other disease except depression that culminates in suicide.
2009 Bleyer Semin Onc
Assumption #3:It’s just a biopsy…so it doesn’t
matter how it’s done…
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Assumption #4:It’s a hematoma…
How about 1 take away point!?!
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Size Matters!!
Limb Preserving Surgery Limb Preserving surgery is now more frequently
an option because of advances in adjuvant therapies, imaging modalities, implant development
Computer Navigation
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Non-invasive Expandable Implants
Orthopaedic Oncologist is your Friend!!!
Lumps, Bumps, and Things that may keep you awake
at night!David Cheong MDOrthopaedic Oncology
Orthoapedic Associates of West Florida