Metastatic disease Flashcards
Most common tumour causing bone metastases (in descending order)
- Prostate
- Breast
- Lung
Most common site for bone metastases (in descending order)
- Spine
- Pelvis
- Ribs
- Skull
- Long bones
Other than bone pain, features of bone metastases may include:
- Pathological fractures
- Hypercalcaemia
- Raised ALP
Isotope bone scan (using technetium-99m labelled diphosphonates which accumulate in the bones) from a patient with metastatic prostate cancer. The scan demonstrates multiple, irregular, randomly distributed foci of high grade activity involving the spine, ribs, sternum, pelvic and femoral bones. The findings are in keeping with multiple osteoblastic metastasis.
What are lung metastases associated with?
Lung metastases are seen with a wide variety of cancers including breast cancer, colorectal cancer, renal cell cancer, bladder cancer, and prostate cancer.
What are ‘cannonball metastases’?
Multiple, round well-defined lung secondaries are often referred to as ‘cannonball metastases’.
They are most commonly seen with renal cell cancer but may also occur secondary to choriocarcinoma and prostate cancer.
Is calcification common in lung metastases?
Calcification in lung metastases is uncommon except in the case of chondrosarcoma or osteosarcoma.
Chest x-ray showing cannonball metastases secondary to renal cell cancer. Multiple well defined nodules are noted distributed in both lung fields
What investigations does NICE recommend for all patients with metastatic disease of unknown primary?
FBC, U&E, LFT, calcium, urinalysis, LDH, Chest X-ray, CT of chest, abdomen and pelvis, AFP and hCG
What additional investigations does NICE recommend for patients with lytic bone lesions?
Myeloma screen
What investigation does NICE recommend if a patient has specific symptoms?
Endoscopy directed towards symptoms
What investigation is recommended for men in the context of metastatic disease?
PSA
What investigation is recommended for women with peritoneal malignancy or ascites?
CA 125
What investigation is recommended for men with germ cell tumours?
Testicular US
What investigation is recommended for women with clinical or pathological features compatible with breast cancer?
Mammography
Mirel Scoring System
Treatment based on Mirel Scoring System
What are spinal metastases?
Spinal metastases are cancerous growths that spread to the spine from other parts of the body.
Why is early detection of spinal metastases important?
Early detection is crucial to prevent neurological compromise before developing metastatic spinal cord compression.
What are common symptoms of spinal metastases?
Common symptoms include unrelenting lumbar back pain, thoracic or cervical back pain, pain worsened by sneezing, coughing, or straining, nocturnal pain, and tenderness.
What should be suspected if neurological features are present?
If neurological features are present, spinal cord compression must be suspected and acted on promptly.
What imaging should be completed if no neurological features are present?
A whole spine MRI should be completed within one week.
Why should the whole spine be imaged?
The whole spine should be imaged because patients commonly present with multi-level disease.
