Metastatic Disease of Skeleton

Question 1

Released by tumors, upregulates RANKL expression by osteoblasts

Answer 1

PTH-related protein (PTHrP)

Question 2

Common places for hematogenous spread

Answer 2

Lungs
Liver
Bone
Brain

Question 3

RANKL action

Answer 3

receptor expressed by osteoclast precursor cells, stimulate differentation

Question 4

Purpose of radiation in metastatic disease

Answer 4

Pain relief

Question 5

What is the most common mechanism of metastatic spread?

Answer 5

Lymphatic spread

Question 6

Key component of bone remodeling

Answer 6

Receptor activator of nuclear factors kB Ligand

Question 7

These cells secrete RANK-ligand

Answer 7

Osteoblasts

Question 8

Cancers that spread to bone

Answer 8

Breast
Lung
thyroid
Prostate
Kidney

Question 9

Actions of Osteoclasts

Answer 9

• resorb bone
• release calcium
• release growth factors –> stimulate cancer growth

Question 10

Side effects of zoledronic acid

Answer 10

Osteonecrosis of jaw, atypical femur fractures

Question 11

High calcium d/t bone breakdown can lead to

Answer 11

Paraneoplastic syndrome

Diffuse destruction

Question 12

Binds RANKL preventing osteoclast differentiation

Answer 12

Osteoprotegerin

Question 13

Bisphosphonate drug

Answer 13

zoledronic acid Zometa

Question 14

Purpose of chemotherapy in metastatic bone cancer

Answer 14

Palliative

Question 15

Action of zoledronic acid

Answer 15

bind to bone, taken up by osteoclasts, induce apoptosis, prevent resorption

Question 16

Tumor cells produce factors that stimulate osteoblasts to secrete

Answer 16

RANKL

Question 17

Denosumab

Answer 17

Binds RANKL, similar to OPG, blocks osteoclast maturation