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Radiology Tumors > Metastatic disease > Flashcards

Metastatic disease Flashcards

1
Q

what is the most common sinister complication of any malignancy and often leads to progression of disease and eventually death

A

metastasis

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2
Q

what is the MC malignant tumor of the skeleton

A

metastatic bone tumors

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3
Q

__% of all malignant tumors are metastatic in origin

__% are primary malignant tumors

A

70%

30%

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4
Q

most malignant tumors of bone are metastases from primary extraskeletal areas such as

A 
breast 
lung 
prostate
kidney 
thyroid 
bowel
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5
Q

primary __ may also metastasize

A

sarcomas

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6
Q

with exception of the following tumors __ and __, almost all tumors have reported incidence of mets to the spine

A

CNS

basal cell carcinoma in the skin

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7
Q

metastatic bone tumors usually spread via what

A

hematogenous route

others include lymphatics or by direct extension

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8
Q

which bones are predisposed to developing osseous metastases

A

bones rich in red marrow aka axial skeleton, skull, and proximal extremities

involvement distal to elbow and knee are rare

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9
Q

what is drop metastases

how does it spread

A

intracranial lesions that lead to extramedullary metastasis

spread via CSF to spinal cord

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10
Q

what kind of enhancement is needed to view leptomeningeal metastasis spread by drop metastasis

A

sugar coating enhancement

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11
Q

metastasis to the skeleton is as common as to the __ and __

A

liver and lung

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12
Q

cancers of the __ __ __ __ account for 80% of all metastatic cancers to bone

A

breast
prostate
lung
kidney

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13
Q

what is responsible for 70% of all bony metastasis

what does this increase risk for

A

female breast cancer

increase risk of pathological compression fracture

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14
Q

what results in 60% of all skeletal metastases

what results in 25% of all skeletal metastases

A

prostate carcinoma

lung carcinoma

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15
Q

metastasis usually occurs when in life

A

over the age of 40

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16
Q

metastatic osseous lesions in children < 5 years old are usually due to

A

neuroblastoma

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17
Q

metastatic osseous lesions in people 10-20 years old are usually due to

A

ewings sarcoma
and
osteosarcoma

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18
Q

metastatic osseous lesions in people 20-35 years old are usually due to

A

hodgkins lymphoma

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19
Q

what are clinical features of metastatic bone tumors

A 
pain 
recent weight loss 
cachectic 
anemia and fever in advanced stages 
pathological fracture 
insidious onset of pain with bouts of remission and exacerbation 
persistent and nocturnal pain 
may not have pain or symptoms
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20
Q

its not unusual to find osseous metastases __ years after treatment of a primary tumor

A

10-15 years

common in mastectomies for breast cancer

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21
Q

what are some lab markings that may indicate metastatic bone tumors

A

increased ESR

increased serum Ca if lytic mets - otherwise normal

increased alk phos if blastic mets

PSA and acid phosphatase - increased if prostate capsule rupture

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22
Q

what do you do if patient has prostate cancer and bone pain

A

perform bone scan irrespective of PSA value

23
Q

what is an example of direct extension of metastatic bone tumors

A

uterine carcinoma spread to pelvis via direct extension via surgery

24
Q

how do metastatic bone tumors spread via hematogenous spread

A

tumor cells enter THIN WALLED VEINS

arterial walls are thick and resistant to tumor emboli entering

25
Q

what are the most common hematogenous spread metastatic tumors

A

lungs
liver
axial skeleton

26
Q

how do metastatic bone tumors spread via lymphatic spread

A

not common due to lack of lymphatic channels in bone marrow

tumor cells can be filtered and trapped to begin to grow in lymph nodes in the body

27
Q

what is implantation or seeding metastasis

A

spread through fluids in a body cavity

ex - malignant cells rupture from the primary tumor and are released into the thoracic or peritoneal cavity - drop mets is also an example

28
Q

some tumors form large quantities of fluid called

can this be taken away

A

ascites

yes but fluid rapidly returns

29
Q

does ascites always indicate cancer or tumor

A

no, there must be evidence of malignant cells

30
Q

what is the clinical presentation of ascites

where doe bowels displace

xray findings

A

central displacement of the loops of the bowl - displacement of bowels out of the pelvis

uniform grayness of the abdomen

loss of definition of the edge of the liver and spleen

31
Q

what is another term for batsons venous plexus

A

epidural venous plexus

32
Q

describe the features of batsons venous plexus

A

epidural vertebral veins
valveless

functions as venous lake or pool

sluggish, reversal, arrested blood flow

33
Q

what can change or alter the flow of blood in the batsons plexus that will lead to reflux of blood to the ____

A

changes in intra-abdominal or intra-thoracic pressure

PARAVERTEBRAL PLEXUS - cancer cells go directly to bones bypassing liver and lungs

34
Q

the prostatic venous plexus can drain directly into the ___ which provides pathological basis for early metastatsis to the pelvis, lumbar spine, and axial skeleton

A

vertebral venous plexus

35
Q

___ is the initial presentation in 10% of patients with systemic cancer

2% of symptomatic patients have no systemic disease

90% of patients present with what?

50% of patients present with what?

5-10% of patients present with what?

A

spinal metastasis

90%
bone or back pain
radicular pain

50%
sensory and motor dysfunction
bowel and bladder dysfunction

5-10%
cord compression

36
Q

what is always an ominous symptom in a patient with systemic cancer

A

bone pain at night

mc in metastatic disease to the spine

37
Q

what tumor is typically associated with metastatic cancer from the prostate gland

A

osteoblastic/sclerotic tumor invading L1

malignant schmorls nodes

38
Q

lytic metastasis needs at least __% of bone destruction of the appendicular skeleton before seen on xray plain film

A

30%

39
Q

what causes the lytic lesions in lytic metastasis

A

pressure from proliferating metastatic cells creating lytic lesions in the cortex and trabeculae

destruction due to osteoclast stimulating cytokines secreted by the tumor cells

40
Q

what plays a large role in the formation of lytic lesion in metastatic disease

what does it affect first

A

osteoclasts

affects marrow first, then cortex

41
Q

what is myelography

what can be seen

A

contrast is inserted into thecal sac via subarachnoid space via fluoroscopic control

herniated disc

42
Q

blastic metastasis is due to what

A

bone reacts to tumor cells by laying down nonneoplastic bone

futile attempt at bone repair

enlargement of lesions and development of new lesions is a grave clinical sign**

43
Q

what are benign conditions that stimulate blastic metastasis

A

pagets disease
osteopoikiliosis
osteopetrosis
sarcoidosis

44
Q

bone scan can pick up alterations of __ % of metabolic activity

A

3-5%

45
Q

describe the features of techneticum

A

low radiation dose
6 hour half life
radiation material taken up by areas of high metabolic activity

46
Q

osteoblastic response to tumor cells results in __ bone scan

A

+

47
Q

what are conditions that are associated with + bone scans

A 
pagets 
fibrous dysplasia 
fractures 
osteomyelitis 
osteoid osteoma 
arthritidies 
ischemic necrosis
48
Q

you can see a positive bone scan __ months before you see the disease on xray

A

18 months

49
Q

what is the sensitivity of bone scan compared to plain film

A

> 50-80%

bone scan better than xray

50
Q

lesion may need to be __ cm before you see it on xray

A

> 1.5 cm

51
Q

what is CT useful for

A

cortical bone involvement

52
Q

what is MRI useful for

A

soft tissue mass formation or lesions

53
Q

what is STIR useful for

A

helpful to detect metastatic bone lesions up to 91%

54
Q

most metastatic bone tumors are lytic or blastic

A

lytic - 75%

Radiology Tumors (11 decks)

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