Metastatic bone tumours

Question 1

Common sites where tumours metastasise to the bone

Answer 1

Breast, Prostate, Lung, Renal carcinoma and thyroid adenocarcinoma.

Question 2

Breast cancer

Answer 2

bony metastases can be blastic (sclerotic) or lytic. Mean survival with bony metastases is around 24‐26 months

Question 3

Lung cancer

Answer 3

usually gives rise to lytic bony metastases and once bone metastases are present, mean survival is around 6 months

Question 4

Prostate cancer

Answer 4

commonly metastasizes to bone and produces sclerotic metastases. Because of the osteoblastic activity pathologic fractures are more likely to heal. Radiotherapy and hormone manipulation can reduce the fracture risk of a bone metastasis. Survival with prostatic bony metastases is around 45% at one year

Question 5

Renal cell carcinoma

Answer 5

usually gives rise to potentially large and very vascular lytic “blow out” bony metastases which can bleed tremendously with biopsy or surgery. With a single bone metastasis and a primary tumour amenable to resection (nephrectomy), surgery can potentially be curative. Mean survival with multiple bone metastases is 12‐18 months

Question 6

Bones most frequently involved in metastases

Answer 6

vertebra, pelvis, ribs, skull, humerus and long bones of the lower limb

Question 7

Why is misdiagnosis common?

Answer 7

Pain is usually misdiagnosed as muscle pain.