Tumors and Tumor-Like Processes, Chapter 11 Flashcards
What is the most common bone tumor ?
Metastatic bone tumor
Compare primary bone tumor with metastatic bone tumor how much are these account for (%) ?
30% : 70%
Majority of metastasis bone tumors are from ?
A) Extraskeletal origin
B) Skeletal origin
Extraskeletal origin, mostly are epithelial tumor
For Extraskeletal metastasis to bone what are the organ origin that metastasis come from ?
For Skeletal origin what primary bone tumor do have metastasis ?
Extraskeletal metastasis:
Breast, lung , prostate, kidney, thyroid and bowel
Bone to Bone metastasis:
Ewing sarcoma
What tumors rare or no report to have bony metastasis ?
CNS tumor and basal cell carcinoma of skin
What is the usual route of bone metastasis ?
Vascular (hematogenous)
Between the axial skeletal, skull, proximal extremities and distal to the knee and elbow
Which sites are rare to have metastasis ?
Distal to the knee and elbow.. are rare.
In organ of metastasis
the bone meatstasis is in the 1st, 2nd or 3rd most common site of metastasis ?
3rd common site of metastasis
As known multiple bone metastasis usually occur, how much do solitary metastasis occur (%) ?
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 ?
Female:
> (70%) Breast
> (30%) thyroid, kidney and uterus
Male:
> (60%) Prostate
> (25%) Lung
Young age group, must classify by age
- s Lymphoma
- What are common symptoms of bone metastasis ?
2. What are the primary tumor that usually exhibit symptom of bone metastasis ?
1) Pain and Pathologic fracture
> Pain, classically norturnal and persistent pain, but often lacking of these characteristic symptoms
2) Thyroid, Liver and Kidney
When developed bone metastasis, how the following lab test will change ?
- ESR
- ALP
- Ca++
- PSA
- 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
About pathway of metastasis, do lymphatic spread common in bone metastasis ?
No, เชื่อว่าใน bone ไม่มี lymphatic channel จึง low incidence
About pathway of general metastasis, please give example of direct extension ?
Example of direct extension are
- Uterine carcinoma to iliac bone
- Surgical implantation
- Downstream seeding
ie UCC (TCC) or intestinal tumor
Between artery and vein which one are subjected to cause tumor emboli ?
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.
Please described about Batson’s venous plexus ..
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
When developed bony metastasis without lung or liver metastasis what route (vessels) do these cancer cells bypass ?
Batson’s venous plexus
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.
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
Cortical metastasis most frequent associated with primary tumor ?
ขอสามตัว
1st Lung
2nd Breast
3rd Kidney
Of following bony sites which are common and uncommon sites ?
- Skull
- Proximal Humerus
- Ribs
- Cervical - Thoracic - Lumbar spines
- Sacrum, Ilium, Ischial Bones
- Proximal Femur
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”)
What is the mechanism in developed osteoblastic lesion in bone metastasis ?
Reaction of osteoid tissue to tumor
