Metastatic bone tumor Maher swaileh. Metastatic Disease Most common malignant lesion of bone. approximately 50 percent of tumors can spread or metastasize.

Metastatic bone tumor

Maher swaileh

Metastatic DiseaseMetastatic Disease

Most common malignant lesion of bone.Most common malignant lesion of bone.approximately 50 percent of tumors can spread or

metastasize to the skeleton.Bone is the third favorite place for metastatic Bone is the third favorite place for metastatic

cancers after lung and liver .cancers after lung and liver .More than 1.2 million new cases are diagnosed each

yearTypically Typically multifocalmultifocal BUT BUT renal and thyroid renal and thyroid

carcinomas carcinomas produce only a produce only a solitary lesion.solitary lesion.

Malignant lesions Malignant lesions are more likely to be in are more likely to be in axial axial bonesbones..

Common sites for metastasis are the vertebraevertebrae, , pelvispelvis, proximal parts of the femurfemur, , ribsribs, proximal part of the humerus,humerus, and the skullskull.. More than 90% of metastases are found in this distribution.

metastases to the bones of the hands and feet are rare , but 50% metastases to hand and feet originate from lung neoplasms .

Bone metastases to the finger.

Radiograph shows a destructive expanded

osteolytic lesion in the metacarpal of the thumb in a 55-year-old man with

lung carcinoma.

Mets (adults)lytic

Lung Kidney colon Thyroid

• blastic Prostate Stomach Bladder

Breast cancer cause both lytic and blastic

Typical x-ray appearance of osteolytic bone metastases. This plain pelvic x-ray film of a 75-year-old patient with breast carcinoma shows multiple osteolytic bone lesions. =>decrease in bone density .decrease in bone density .

typical x-ray appearance of osteoblastic bone metastasesosteoblastic bone metastases. This plain pelvic x-ray film of a patient with prostate cancer shows multiple osteoblastic metastases to the pelvis and lumbar (L4) and sacral (S1) vertebral bodies.=>increase in bone density

Mets (kids)

– NB( neuroblastoma)– Wilm’s tumor– OS (osteosarcoma).– Ewing’s sarcoma– Rhabdomyosarcoma

• (1) direct extension• (2) retrograde venous flow• (3) seeding with tumor emboli via the blood

circulation .

presentation:1. bone weakness which predispose to pathologic

fractures.2. Pain which results in reduced mobility.3. Large bony lesions which causes palpable

masses.4. neurologic impairment due to spinal epidural

compression.5. Anemia (decreased red blood cell production) is

a common blood abnormality in these patients6. Some patients have history of the primary

malignant tumor symptoms, BUT others did not complain of anything before.

• Pathologic fracture. Radiograph shows a displaced fracture through an osteolytic lesion in the distal femur of a 53-year-old woman with lung carcinoma.

• Spinal epidural compression in a 70-year-old man with leg weakness. Lateral lumbar myelogram shows a complete epidural block due to a destructive osteolytic lesion of the L3 vertebral body. Lumbar puncture was performed at the L2-3 level

• Approach to the patient:– History– Physical examination– Radiological studies e.g. Plain X-ray, MRI, CT scan,

Bone scan(radionuclide bone scanning (Technetium-99m)).

– Laboratory studies .– Biopsy.

Radiological studies

• The presenting radiologic finding on X-ray is often destruction of bone and/or lucent Lesions of Bone.

• Bone scan(radionuclide bone scanning (Technetium-99m)) most cost-effective and available whole-body screening test for the assessment of bone metastases.

• (CT) and (MRI) are useful in evaluating suspicious bone scintiscan findings that appear equivocal on radiographs.

• MRI can also help in detecting metastatic lesions before changes in bone metabolism make the lesions detectable on bone scintiscans.

• CT scanning is useful in guiding needle biopsy, particularly in vertebral lesions.

• MRI is helpful in determining the extent of local disease in planning surgery or radiation therapy.

Zaid Samkari20

RadioIsotope

Pt. presented with pain in the right upper thigh, xray showing METS in upper 1/3 of the femur, however radioisotope scan revealed many deposits in other parts of the skeleton.

X-ray

TreatmentTreatment::

• Can be divided into:a)a) Systemic therapySystemic therapy, aimed at cancer cells that have

spread throughout the body, includes chemotherapychemotherapy, hormone therapy, and immunotherapy. hormone therapy, and immunotherapy.

b)b) Local therapyLocal therapy, , aimed at killing cancer cells in one specific part of the body, includes radiation therapy radiation therapy and surgerysurgery.

TreatmentTreatment::

Treatment depends on the type of tissue involved (which organ tissue type)

Radiation therapy, combined with selected chemotherapeutic or hormonal agents, is the most common treatment modality.

Early use of radiation and bisphosphonates (eg, zoledronic acid, pamidronate) slows bone destruction.

Some tumors are more likely to heal after radiation therapy, such as blastic lesions of prostate and breast, as compared to lytic destructive lesions of lung and renal cell.

TreatmentTreatment::

Surgery is indicated mainly in case of fractures or large metastatic mass.

If bone destruction is extensive, resulting in imminent or actual pathologic fracture we may need: surgical fixation resection and reconstruction

Surgical intervention provide stabilization and help minimize morbidity

Thank YouGood Luck