- Bone is 3rd most common site for metastatic cancer (after lung and liver)
- ?70% overall incidence of bony metastases in pts with cancer
- Bones involved (in order of frequency) by autopsy
- Vertebrae (L>T>S>C) (38% of metastatic disease involves T-L spine)
- Pelvis
- Ribs
- Sternum
- Femur
- Humerus (esp hypernephroma)
- Skull
- Hand only 0.007% (esp lung or renal–terminal disease)
- Bones involved in specific carcinomas
- Prostate: spine, femur, pelvis, skull, ribs, sternum
- Renal: Humerus, spine, femur, pelvis, ribs, foot, skull, sternum
- Thyroid: skull, ribs, sternum, spine, humerus
- Breast: spine, pelvis, proximal femur, skull, ribs, mid-humerus
- Lung: thoracic spine, ribs
- Acrometastases rare
- Most commonly occur with bronchogenic carcinoma
- Dominant hand 2X more frequently involved
- After 40 years of age, every tumor must be considered metastatic…..until proven otherwise
- (Skeletal metastases are the most common of all bony malignancies)
- "Poorly differentiated" carcinoma indicates glandular or squamous differentiation isn’t evident
- Historical Perspective
- Paget
- "Seed and soil theory": favorable or unfavorable factors locally present to allow/not allow metastases
- Ewing
- "Circulation theory": capillary beds filter metastasizing cells with subsequent organ involvement
- Paget
References
Frytak S, McLeod RA, Gunderson LL, Pritchard DJ, Unni KK: Lung cancer. In Sim FH (ed) Diagnosis and management of metastatic bone disease: a multidisciplinary approach. Raven Press, New York 1988, pp _______.
Galasko CSB: Diagnosis of skeletal metastases and assessment of response to treatment. Clin Orthop 312:64-75,1995.
Hahn RG, Sim FH, Scott SM, : Renal cell cancer. In Sim FH (ed) Diagnosis and management of metastatic bone disease: a multidisciplinary approach. Raven Press, New York 1988, pp 285-90.
Hay ID, Rock MG, Sim FH, : Thyroid cancer. In Sim FH (ed) Diagnosis and management of metastatic bone disease: a multidisciplinary approach. Raven Press, New York 1988, pp 305-17.
Ingle JN, Sim FH, Schray MF, Wold LE, Beabout JW: Breast cancer. In Sim FH (ed) Diagnosis and management of metastatic bone disease: a multidisciplinary approach. Raven Press, New York 1988, pp 251-63.
Kitazawa S, Maeda S: Development of skeletal metastases. Clin Orthop 312:45-50,1995.
Mundy GR, Yoneda T: Facilitation and suppression of bone metastasis. Clin Orthop 312:34-44,1995.
Orr FW, Sanchez-Sweatman OH, Kostenuik P, Singh G: Tumor-bone interactions in skeletal metastasis. Clin Orthop 312:19-33,1995.
Richardson RL, Swee RB, Sim FH, Schray MF, Wold LE: Prostate cancer. In Sim FH (ed) Diagnosis and management of metastatic bone disease: a multidisciplinary approach. Raven Press, New York 1988, pp 273-81.