Metastatic Bone Disease Flashcards
3 indications for surgical intervention
- intractable pain
- impending pathologic fracture
- pathologic fracture
Most common reason for bone mets in females
breast cancer
What makes up posterior spinal column
spinous process, laminae, facets, ligamentum flavum
3 main characteristics of metastatic disease that increases risk of pathologic fracture
Anaplastic, rapidly growing, osteolytic
3 most common cancers that results in metastatic bone disease
lung, breast, prostate
which bony mets have increased risk of fracture, lytic or blastic?
lytic
Majority of symptomatic lesions to the femur come from what 4 cancers?
breast, prostate, renal, multiple myeloma
Common symptoms of bone mets
bone pain severe at night
What kind of exercises are done in bone cancer rehab
isometric and non-resistive isotonic exercises
MC UE location for bony mets
humerus
Skeletal survey reveals diffuse punched out lytic lesions with black sclerotic borders
multiple myeloma
What makes up middle spinal column
PLL, posterior half of vertebral body, posterior annulus
most common bones that osteosarcomas are found in
knee and proximal humers
Most common reason for bone mets in males
prostate cancer
most common site of pathologic fractures
proximal femur
The most common primary malignant bone tumor in children
osteosarcoma
median survival rate for breast cancer with metastatic cancer
24 months
What precaution is taken if bony mets to a limb is suspected?
NWB
spine is considered stable if…
one column is involved
Surgical intervention is indicated if greater than how much of medullary cross-sectional diameter is involved
50-60%
Bone scan sensitivity and specificity
It is highly sensitive, but low specificity for bony mets
What kind of physical modalities are contraindicated in malignancy
deep heat modalities such as diathermy, microwave and ultrasound
Pharmacologic treatment for multiple myeloma
bisphosphonates and high dose steroids
specificity and sensitivity of PET scan vs bone scan
PET scan is more sensitive and more specific for bone mets
Any complaint of bone pain in cancer patient warrants what 2 images?
x-ray and bone scan
Majority of symptomatic lesions to the hip come from what 4 cancers?
prostate, breast, lung, lymphoma
what would bone scan look like for multiple myeloma
normal
what pharmacologic treatment is used for metastatic bone disease
biphosphonates or denosumab
where is primary cancer if bony mets is blastic vs lytic
blastic lesions = prostatic cancer
lytic lesions = breast, lung, kidney
If there is bone mets in the spine, what is relation of pain and position of patient
pain is worse with lying down and better with sitting
In the upper extremity, the majority of symptomatic lesions come from what three cancers?
Breast cancer, multiple myeloma, renal cancer
median survival rate for prostate cancer
40 months
what would skeletal survey look like for multiple myeloma
diffuse punched out lytic lesions
LE indication for surgical intervention (%age of cortex involved)
30-50%
UE indication for surgical intervention (%age of cortex involved)
> 50%
Osteoblastic vs osteolytic lesions in terms of strength and stiffness
osteolytic has decreased strength and stiffness
osteoblastic has decreased stiffness
median survival rate for lung and kidney cancer with metastatic disease
6 months
spine is considered unstable if…
2 columns are involved, only the middle column is involved, or there is >20 degree angulation
what makes up the anterior spinal column
ALL, anterior annulus, anterior half of vertebral body
