Metastatic disease of the extremity

Question 1

Carcinomas that spread to bone

Answer 1

Breast, Lung, Thyroid, Renal, Prostate (BLT w/ Real Pickles)

Question 2

Most common sites for metastatic disease - 3

Answer 2

1. Lung 2. Liver 3. Bone

Question 3

Common bone sites for metastases - 3

Answer 3

1. Spine 2. Prox femur 3. Humerus

Question 4

Osteolytic bone lesion signaling

Answer 4

PTHrP activates osteoblastic RANKL production which activates osteoclasts

Question 5

Osteoblastic bone lesion signaling

Answer 5

Tumor secreted endothelin 1, binds endothelin A receptor to stimulate osteoblasts, also decreases WNT suppressor DKK-1 which activates WNT pathway and increases osteoblast activity.

Question 6

How to treat metastatic hyperCa

Answer 6

Hydration, loop diuretics, bisphosphonates

Question 7

Median survival in metastatic bone disease from Lung CA

Answer 7

6 mo. (very short)

Question 8

How do tumors spread (molecular)

Answer 8

E cadherin allows for tumor cell intravasation, then integrins allow for endothelial attachment and subsequent extravasation

Question 9

Metastatic hyperCa sxs

Answer 9

Confusion, muscle weakness, polyuria & polydipsia, N/V, dehydration. Imagine an old decrepit guy who’s confused, vomiting everywhere, peeing everywhere, weak, and dehydrated

Question 10

Which tumors are primarily lytic

Answer 10

Lung, thyroid, renal (anything not breast or prostate of the Big 5)

Question 11

Which tumors are primarily blastic

Answer 11

Breast (60%), Prostate (90%)

Question 12

Which tumor goes distal to elbow and knee

Answer 12

Lung or renal primary

Question 13

Characteristic histo of bone mets

Answer 13

Epithelial cells in clumps or glands in a fibrous stroma

Question 14

CK7

Answer 14

Breast and Lung CA

Question 15

TTF1

Answer 15

Lung CA

Question 16

Nonop mgmt

Answer 16

Bisphosphonates (to decrease osteoclast activity)