Bone Metastases Flashcards
what presentation indicates a high clinical suspicion of metastatic spinal cord compression?
new onset nocturnal back pain in a cancer patient
what are the symptoms of spinal metastases?
- unrelenting lumbar back pain
- any thoracic or cervical back pain
- worse with sneezing, coughing or straining
- nocturnal
- associated with tenderness
what is the first line investigation in suspected spinal metastases?
MRI spine within 24 hours
what are the features of neoplastic spinal cord compression?
- back pain - worse on lying down and coughing
- lower limb weakness
- sensory changes - loss and numbness
- neurological signs
what kind of neurological signs are present in spinal cord compression above L1?
upper motor neuron signs in the legs and a sensory level
what kind of neurological signs are present in spinal cord compression below L1?
- lower motor neuron signs in the legs
- perianal numbness
what investigation should be requested in suspected neoplastic spinal cord compression?
urgent MRI - whole MRI spine within 24 hours of presentation
what is the management of neoplastic spinal cord compression?
high-dose oral dexamethasone
do not delay treatment for investigations
what are the most common tumours to progress to bone metastases?
- prostate
- breast
- lung
what is the most common site of bone metastases?
- spine
- pelvis
- ribs
- skull
- long bones
what are the features of bone metastases?
- bone pain
- pathological fractures
- hypercalcaemia
- raised ALP
