2. Metastasis Flashcards
Which is the most common malignant tumor of bone?
Metastasis (25x more common than primary
Where are the most common primary sites for mets to come from?
Breast, lung, prostate, kidney, thyroid, and bowel
Most common target sites for mets?
Axial skeleton, skull, and proximal extremities
Where does mets rarely occur?
Distal to the knee or elbow
When mets occurs distally, what is it called?
Acral metastasis
Skeletal mets may be as common as what?
Liver or lung mets
Which primary sites are most responsible for mets?
Breast, prostate, lung, kidney
Which primary site is most responsible for mets in women?
Breast (thyroid, kidney, and uterus also common)
Which primary site is most responsible for mets in men?
Prostate (lung is also common)
T or F: mets usually has solitary lesions
F (90% of mets is multiple lesions)
Most mets patients are over what age?
40 years of age
If the patient has a neoplasm under the age of 5, it is usually ___.
Neuroblastoma
If the patient has a neoplasm between the ages of 10-20, it is usually ___.
Osteosarcoma or Ewing’s Sarcoma
If the patient has a neoplasm between the ages of 20-35, it is usually ___.
Hodgkin’s Lymphoma
T or F: Mets is not usually painful.
F (70% of mets patients report pain)
What is a common reason for mets patients to present to a medical provider?
Pathologic Fracture
T or F: many mets patients are asymptomatic
T (which is interesting considering most mets patients report pain…)
Can you see neuro symptoms when mets is in the spine?
Yes, it may be present.
How long after a primary malignancy can mets develop?
10-15 years after diagnosis and treatment of primary neoplasm
Lab changes in mets?
ESR, CBC, chem screen, and UA (however, lab changes are inconsistent and dependent on type, extent, and fluctuations in activity of tumor…so basically, it’s not that helpful…sorry Hoyer)
What is the most common route of mets?
Hematogenous (usually via veins)
Other routes of mets?
- Direct invasion (like soft tissue tumors near bone, surgical implantation of tumor cells)
- Lymphatic dissemination (is unusual, especially in bone)
1st clinical choice for imaging?
Plain film (requires 30-50% bone destruction to visualize)
T or F: MRI detects changes later than bone scans
F (changes are detected as early or earlier than bone scans)
Are mets lesions more commonly lytic or blastic?
75% Lytic (15% blastic, 10% mixed)
If you see a “blow-out” pattern (large, solitary, expansile lesion), what does this suggest?
Renal or thyroid primary
Main differences in primary malignancy vs. mets?
Primary = solitary, large, periosteal response Mets = multiple, small
40% of mets occurs in the ___.
Spine
Most common sites in the spine for mets?
Tx and Lx (atlus is infrequent due to not having a vertebral body)
Most common spot in the vertebra for mets?
Vertebral body
T or F: The IVD is commonly affected in mets.
F (basically never affected, though they can get infected)
Most common cause for missing pedicle?
Osteolytic mets
3 Most common causes for Ivory Vertebra?
- Osteoblastic Mets
- Paget’s Disease (cortical thickening, expansion)
- Hodgkin’s Lymphoma (anterior body scalloping)
MC place for skeletal mets (other than spine)?
Ribs and sternum (rib mets MC cause of extrapleural sign)
T or F: Mets in the skull is usually lytic
T (90% will be lytic)
Can you adjust someone who has mets?
No, contraindication to adjusting
Treatment for mets:
- Biphosphates to inhibit osteoclast activity
- Radiation therapy to affect bone lesions
