- Discussion:
- carcinoma metastatic to bone is most common malignancy of bone;
- metastatic tumors of skeleton out number primary tumors 25:1;
- cancers may invade skeleton by contiguous extension from the primary site, but widespread dissemination occurs through the bloodstream;
- bone destruction may be extensive enough to weaken the skeleton and cause
pathologic fracture;
-
frequency: prostate >
breast > lung > thyroid > kidney
- most common tumors that frequently spread to skeleton are
breast (32%), lung (14%), prostate (36%),
kidney, and thyroid, although cancer from any
organ may ultimately involve bone;
- of note, metastatic lung carcinoma tends to have the highest short term mortality, and therefore orthopaedic management of these patients is often
limited to IM nailing of femoral shaft fractures or pending fractures;
-
sites:
- most frequent in the femur and
spine, followed by humerus,
pelvis, ribs, and
skull; (
J Surg Oncol. 2007 Oct 1;96(5):404-10)
- vertebral bodies are commonly involved, but the skull, ribs, and pelvis are also frequently involved;
- femur & humerus are usual locations of metastases to long bones, while involvement of bones distal to knee or the elbow is uncommon;
- in the report by RA Marco et al 2000, the lung was the most common site of visceral involvement (14 patients);
- other metastatic sites included the liver, the adrenal gland, the contralateral kidney, and the brain;
- the their study, patients w/ visceral metastases had a median period of survival of three months compared with twelve months for patients without visceral metastases;
-
age:
- child:
neuroblastoma,
leukemia,
ewing's;
- young adult: lymphoma
- adult: carcinoma
- elderly: carcinoma and
multiple myeloma
- References:
Functional and Oncological Outcome of Acetabular Reconstruction for the Treatment of Metastatic Disease.
RA Marco MD et al. J Bone Joint Surg [Am] 82-A: 642-51, 2000
