Metastatic Cancer of Bone Flashcards
Which carcinomas most commonly mets to bone?
Breast, Lung, Renal, Prostate and Thyroid
What are the most common sites for mets?
1) Lung
2) Liver
3) Bone
What is the most common site for bone mets?
Thoracic spine
other common locations include: vertebral bodies, ribs, long bones
What causes osteolytic lesions and osteoblastic lesions?
Osteolysis- osteoclast activation via RANK-RANKL pathway
Osteoblastic- tumor secreted endothelin-1
Which primary malignancy carries the worst prognosis when becomes metastatic?
Lung- 6months
How do lung and renal carcinomas mets to bone?
arterial tree
What is Baxton’s venous plexus?
Valveless venous plexus of the spine that provides a route of metastasis from organs to axial structure including vertebral bodies, pelvis, skull, and proximal limb girdles
What are mechanisms of mets?
1) E-cadherin modulates release of cell into bloodstream
2) Avoidance of immune system
3) Angiogenesis via VEGF
4) genomic instability
5) decreased apoptosis
What is the workup in an older individual with suspected metastatic disease?
1) contrast CT chest/abdomen/pelvis
2) Whole body bone scan
3) CMP, CBC, ESR; UPEP/SPEP
4) Biopsy of bone if primary not found
What is the 30/60/90 rule of blastic lesions of boney mets?
30% lung, 60% breast, 90% prostate are blastic lesions
What are some stains characteristic of mets?
CK7- breast and lung
TTF1- lung
Which metastatic lesions should be embolized preoperatively?
Renal and thyroid
What role does radiation play in metastatic disease to bone?
Post operative fixation
How are spinal mets managed?
If 6 months then decompression, stabilization and post-op radiation
How are proximal femur lesions managed in mets?
If peritroch; statically locked femoral nail
femoral head/neck; hemi vs total
