Tumors and Tumor-Like Processes, Chapter 11

Question 1

What is the most common bone tumor ?

Answer 1

Metastatic bone tumor

Question 2

Compare primary bone tumor with metastatic bone tumor how much are these account for (%) ?

Answer 2

30% : 70%

Question 3

Majority of metastasis bone tumors are from ?
A) Extraskeletal origin
B) Skeletal origin

Answer 3

Extraskeletal origin, mostly are epithelial tumor

Question 4

For Extraskeletal metastasis to bone what are the organ origin that metastasis come from ?

For Skeletal origin what primary bone tumor do have metastasis ?

Answer 4

Extraskeletal metastasis:
Breast, lung , prostate, kidney, thyroid and bowel

Bone to Bone metastasis:
Ewing sarcoma

Question 5

What tumors rare or no report to have bony metastasis ?

Answer 5

CNS tumor and basal cell carcinoma of skin

Question 6

What is the usual route of bone metastasis ?

Answer 6

Vascular (hematogenous)

Question 7

Between the axial skeletal, skull, proximal extremities and distal to the knee and elbow

Which sites are rare to have metastasis ?

Answer 7

Distal to the knee and elbow.. are rare.

Question 8

In organ of metastasis

the bone meatstasis is in the 1st, 2nd or 3rd most common site of metastasis ?

Answer 8

3rd common site of metastasis

Question 9

As known multiple bone metastasis usually occur, how much do solitary metastasis occur (%) ?

Answer 9

10%

Question 10

In female, male and young age group (<20 yr) please ranking the two most common primary tumor in each patient group that has bone metastasis ?

Answer 10

Female:
> (70%) Breast
> (30%) thyroid, kidney and uterus

Male:
> (60%) Prostate
> (25%) Lung

Young age group, must classify by age
- s Lymphoma

Question 11

1. What are common symptoms of bone metastasis ?

2. What are the primary tumor that usually exhibit symptom of bone metastasis ?

Answer 11

1) Pain and Pathologic fracture
> Pain, classically norturnal and persistent pain, but often lacking of these characteristic symptoms

2) Thyroid, Liver and Kidney

Question 12

When developed bone metastasis, how the following lab test will change ?

• ESR
• ALP
• Ca++
• PSA

Answer 12

• ESR: Often elevate, non-specific
• ALP: Often elevate in blastic metastasis, Non-specific may rise from liver dz or fx.
• Ca++: In diffuse lytic lesion may elevated but most case normal,
• PSA: when >10 ng/ml CAP usually breakthrough capsule and has bone metastasis.
  + PSA <10 ng/ml full body bone scan not recommended, except with clinical bone pain

Question 13

About pathway of metastasis, do lymphatic spread common in bone metastasis ?

Answer 13

No, เชื่อว่าใน bone ไม่มี lymphatic channel จึง low incidence

Question 14

About pathway of general metastasis, please give example of direct extension ?

Answer 14

Example of direct extension are

1. Uterine carcinoma to iliac bone
2. Surgical implantation
3. Downstream seeding
   ie UCC (TCC) or intestinal tumor

Question 15

Between artery and vein which one are subjected to cause tumor emboli ?

Answer 15

Vein.

From arteries are thick walled which resist tumor penetration, while vein are thin walled.
The cancer usually slough off in venous and form tumor emboli.

Question 16

Please described about Batson’s venous plexus ..

Answer 16

Series of epidural vertebral veins, valveless and function as venous lake or pool.

Recieve blood from pelvic, abdominal and thoracic.

Sluggish blood flow and subject to arrest or reversal flow (when change in intra-abdominal pressure).

A passage of cancer cells directly to bone โดยไม่ต้องผ่าน ตับ กับ ปอด

Question 17

When developed bony metastasis without lung or liver metastasis what route (vessels) do these cancer cells bypass ?

Answer 17

Batson’s venous plexus

Question 18

Are the following sentence is true ?

• In osteolytic lesion, the osteoclast do major role in developed lytic lesion.
• About 10% loss of bone density is necessary for detection of osteolytic lesion
• Cortical metastasis are more common than medullary metastasis.

Answer 18

All are false

• Lytic appearance are result from pressure by proliferating neoplasm to adjacent trabecular bone and cortex
• 30% loss of bone density
• Medullar metastasis is more common

Question 19

Cortical metastasis most frequent associated with primary tumor ?
ขอสามตัว

Answer 19

1st Lung
2nd Breast
3rd Kidney

Question 20

Of following bony sites which are common and uncommon sites ?

• Skull
• Proximal Humerus
• Ribs
• Cervical - Thoracic - Lumbar spines
• Sacrum, Ilium, Ischial Bones
• Proximal Femur

Answer 20

Common Sites:

• Ribs
• T-L spines
• Sacrum, Ilium, Ischial Bones

Uncommon Sites:

• Skull
• Proximal humerus
• Proximal femur

Rare sites
- Distal to knee and elbow
(“Acral metastasis”)

Question 21

What is the mechanism in developed osteoblastic lesion in bone metastasis ?

Answer 21

Reaction of osteoid tissue to tumor