Metastatic disease Flashcards
What are the most common tumours causing bone metastases in descending order?
Prostate, breast, lung
What are the most common sites for bone metastases in descending order?
Spine, pelvis, ribs, skull, long bones
What are the features of bone metastases other than bone pain?
Pathological fractures, hypercalcaemia, raised ALP
What are lung metastases?
Lung metastases are secondary cancer growths in the lungs originating from other cancers.
Which cancers commonly cause lung metastases?
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.
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 specific investigations does NICE recommend for patients with lytic bone lesions?
Myeloma screen
What specific investigation does NICE recommend for patients with symptoms requiring endoscopy?
Endoscopy directed towards symptoms
What specific investigation does NICE recommend for men?
PSA
What specific investigation does NICE recommend for women with peritoneal malignancy or ascites?
CA 125
What specific investigation does NICE recommend for men with germ cell tumours?
Testicular US
What specific investigation does NICE recommend for women with clinical or pathological features compatible with breast cancer?
Mammography
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 specific investigations does NICE recommend for patients with lytic bone lesions?
Myeloma screen
What specific investigation does NICE recommend for patients with symptoms requiring endoscopy?
Endoscopy directed towards symptoms
What specific investigation does NICE recommend for men?
PSA
What specific investigation does NICE recommend for women with peritoneal malignancy or ascites?
CA 125
What specific investigation does NICE recommend for men with germ cell tumours?
Testicular US
What specific investigation does NICE recommend for women with clinical or pathological features compatible with breast cancer?
Mammography
What are the types of metastatic bone tumours?
Metastatic bone tumours may be described as blastic, lytic, or mixed.
Which type of metastatic disease has the lowest risk of spontaneous fracture?
Osteoblastic metastatic disease has the lowest risk of spontaneous fracture when compared to osteolytic lesions of a similar size.
Which region is most prone to spontaneous fracture?
Lesions affecting the peritrochanteric region are most prone to spontaneous fracture due to loading forces at that site.
What system is used to stratify the risk of spontaneous fracture for bone metastasis?
The factors are incorporated into the Mirel Scoring system.
What are the scoring criteria for the Mirel Scoring system?
Score points are based on Site, Radiographic appearance, Width of bone involved, and Pain.
What is the treatment for a Mirel score of 9 or greater?
Prophylactic fixation
Risk of fracture is 33%.
What is the treatment for a Mirel score of 8?
Consider fixation
This score is borderline.
What is the treatment for a Mirel score of 7 or less?
Non operative management
Risk of fracture is 4%.
What is a key concern for patients with spinal metastases?
Patients may present with spinal metastases before developing metastatic spinal cord compression. It is important to detect these patients early before any neurological compromise develops.
What are the symptoms of spinal metastases?
Unrelenting lumbar back pain, any thoracic or cervical back pain, worse with sneezing, coughing or straining, nocturnal pain, and associated tenderness.
What should be suspected if neurological features are present?
If any neurological features are present, then spinal cord compression must be suspected and acted on promptly.
What imaging should be completed without neurological features?
Without neurological features, a whole spine MRI should be completed within one week.
Why should the whole spine be imaged?
The whole spine should be imaged as patients commonly present with multi-level disease.
