Mod 4-3 Bone Mets Flashcards
Metastases are the most common what?
Malignant bone tumors.
What is the definition of bone metastases?
Secondary growth of malignancy, distant from site of origin.
What are the three ways Malignant cells reach the bone?
- hematogenously
- lymphatic channels
- direct extension
What percentage of malignant bone lesions are from other parts of the body?
60-65%
What are some common areas that are favored sites of metastases?
- Red marrow sites - spine, pelvis, ribs, skull
- Upper ends of humerus and femur
What sites are not seen as frequently as being affected with mets?
Distal to the knees and elbows, but they do occur.
Mets distal to knees and elbows happen infrequently, but they are especially known to happen with what?
Bronchogenic carcinoma
What is the most common presenting symptom of bone mets?
Pain.
*There are a number of lesions that are identified radiographicially while the patient is asymptomatic.
Metastatic lesions can be both _______ and _______.
osteolytic (dissolution of bone); osteoblastic (increased bone production)
Osteolytic mets begins where?
In the medullary canal and erode through the cortical bone.
The most common primary tumors causing osteolytic mets (medullary canal eroding through cortical bone) are tumors of the what (3)?
breast, kidney and thyroid.
Lytic mets produced by ____ ____ are usually multiple in number.
breast cancer
Lytic mets produced by _____ and ______ primaries usually produce only a single lesion.
thyroid and kidney
What do osteoblastic lesions indicate?
Slow growth of a tumor
What is the most common primary tumor in men that produces this type of mets (osteoblastic mets)?
Carcinoma of the prostate gland
What is the most common primary tumor in women to produce this type of metastases (osteoblastic mets)?
Cancer of the breast
What size are the areas of sclerosis (osteoblastic lesions of mets)?
They may be small, round areas of involvement or may involve most or all of a bone.
How will the bone appear when there is a mix of lytic and blastic lesions?
Mottled
What is the effect on radiographic technique when imaging those with bone metastases?
Depending on stage of progression. Densely sclerotic lesions are additive (increase technique) and lucent lesions are destructive (decrease technique).
Multiple myeloma is considered to be a common cancer. T/F?
How many people are affected by multiple myeloma?
False
1 in 159 people in the United States
Why does UAMS see multiple myeloma patients daily?
Because UAMS is considered a center of excellence for the treatment of multiple myeloma.
What are some risk factors for developing MM?
- Most cases are in people between 40-70 years old
- Exposure to radiation accounts for avery small numebr of cases
- Being overweight
What percentage of patients with MM are under the age of 35 years old?
Less than 1%
Multiple myeloma is a ___________ that arises from the _____ ________ and spreads and destructs the affected bone.
malignancy; bone marrow
What is seen with MM?
A single lesion or multiple lesionsin various areas of the body.
What type of bones are typically affected by MM?
- In flat bones that contain red marrow
- Skull, vertebrae, ribs, pelvis
Are lesions from MM a density or a lucency?
Lucency
Is MM cureable or treatable?
MM is a disease that is rarely cureable, but highly treatable.
MM is related to ________ because it is a hematologic malignancy.
Leukemia
Why has teh American Cancer Society categorized MM as a bone malignancy and not a blood malignancy?
Because it arises in the marrow of bone.
What is the most common bone malignancy?
Multiple myeloma
*Accounts for 1/3 of all bone cancers
What is the etiology of Multiple Myeloma?
Unknown but it is known that there is a transformation of plasma cells (form of white blood cells) from a normal state to a malignant state.
What is the definition of multiple myeloma?
Non-osseous tumor arising from bone marrow.
MM affects ______ bones that contain ____ ______. List examples.
- flat; red marrow
- i.e. skull, vertebrae, ribs, pelvis
What is an early symptom of MM?
- Pain usually felt in the lower back or ribs.
- Pain tends to go away when at rest
- Often thought to be arthritis, osteoporosis or muscle spasms
- Tylenol does relieve some pain
What are some symptoms of MM?
- Pain
- Fever
- Anemia
- Recurring infections (pneumonia or URI)
- Kidney failure
- Bone loss
- Pathologic fractures
Where is a common site for fractures with patients that have MM?
The spine
What is the classic radiographic appearance of MM?
Multiple punched out osteolygic lesions scattered throughout the skeletal system.
How are the punched out osteolytic lesions best seen readiographically?
On lateral views of hte skull
How is a radiograph of MM different compared to Paget’s disease?
There is no new bone laid down at hte sites of destruction with MM.
How do the punched out lesions in MM differ from Bone Mets?
The multiple myeloma lesions tend ot be more discrete and uniform in size than those of metastatic lesions.
What may MM simulate in it’s progresive state?
Postmenopausal osteoporosis
What is one site that MM does NOT invade and why?
The pedicles because they do not contain marrow.
*Bone mets commonly destroys the pedicles.
What modalities are used to precisely define the locations of malignancy with MM?
CT and MRI
How does MM effect radiographic technique?
MM is a destructive lesion and therefor easier to penetrate. (decrease technique)
