Oncology considerations

Question 1

Which adult and pediatric cancers may present as bone or joint pain?

Answer 1

Bone Mets: Breast, prostate, Lung, kidney thyroid (BLT w/ Kosher Pickle)

Spinal cord radiculopathy Mets? Lung, Breast, Colon, Sarcoma

Primary bone cancers: MM, lymphoma, leukemia, osteosarcoma, chondrosarcoma, Ewing sarcoma

• seen in young people

Metastatic process 
Primary tumor
Paraneoplastic syndromes (intrathoracic tumors)

Question 2

What are the “red flags” to look for in a patient with bone or joint pain?

Answer 2

Unexplained musculoskeletal pain

Pain in spine or proximal extremities (hips, thighs, shoulders) that doesn’t correlate with a known injury

Night or rest pain

Question 3

Which patients are most at risk for bone metastases?

Answer 3

Bone Mets: Breast, prostate, Lung, kidney thyroid (BLT w/ Kosher Pickle)

Spinal cord radiculopathy Mets? Lung, Breast, Colon, Sarcoma

Question 4

Explain the indications and contraindications for osteopathic manipulative treatment of the patient with cancer.

Answer 4

why do it? provides comfort, emotional support, pain reduction, helps functionality of viscera
- if have SD, surgical pain, tx of immobility related complications (atelectasis/constipation)

Contraindications? stay away from HVLA

• tx in vicinity may cause hematogenous spread
• HVLA may hurt fractured bones
• lymphatic pumps, do they risk lymphogenous spread?

Question 5

adult mm. and skin involvment?

Answer 5

Tumors can metastasize to muscles and cause pain and decreased function due to muscle or nerve compression

These masses may be small and deep-seated

Dermatomyositis and polymyositis have a progressive proximal muscular weakness and is associated with lung and gastric cancer 50% of the time

Acanthosis nigricans is associated with gastric or abdominal malignancies

Question 6

pediatric cancers causing bone pain?

Answer 6

Leukemias, Bone tumors, neuroblastomas

Most common pediatric cancers- present w/ pain

1. osteosarcoma: during puberty, around knee
2. Ewing’s sarcoma
3. Rhabdomyosarcoma

Bone mets? 
Neuroblastoma
Wilms tumor
Osteosarcoma
Ewing sarcoma
Rhabdomyosarcoma

Question 7

what can cause pediatric bone and mm. pain?

Answer 7

and account for more than 60% of childhood cancers

Leukemia, bone tumors, neuroblastomas

Question 8

pain due to mets?

Answer 8

Pain is the most common presenting symptom

Localized, constant bone pain is the hallmark- Often begins as dull and intermittent but worsens steadily, often over several days or weeks

Pain at night and at rest is common

Common sites are the vertebral column (esp thorax), skull, humerus, ribs, pelvis, and femur

Question 9

where does pain refer?

1. High cervical spine mets
   C7 - T1?
   T12-L1?
   sacral destruction?

Answer 9

High cervical spine mets – posterior headache

C7-T1 – interscapular pain

T12-L1 – flank, iliac crest, or sacroiliac joint

Sacral destruction – saddle distribution

Question 10

where do mets often occur?

Answer 10

axial skeleton (vertebral column, pelvis, ribs, skull, sternum), proximal femur, and humerus, in descending order of frequency. The red marrow in these areas with its rich capillary network, slow blood flow, and nutrient environment facilitates implantation and growth of the tumor cells. Metastases to the small bones of the hands and feet are uncommon and usually originate in cancers of the lung, kidney, or colon.

Question 11

LABS TO DO?

Answer 11

plain film radiograph (detects 70%)- most specific

Obtain radiograph of the entire long bone for all painful sites

Multiple lesions are characteristic of metastatic disease

Lytic: lung, thyroid, kidney
Blastic: prostate
Mixed: breast, cervical, testicular, ovarian

Bone scan should be done if there is lesion on xray or on a pt with a known primary cancer and negative xray

CT scan of the chest, abdomen, and pelvis to look for primary cancer