2Metastatic Disease 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 cancers after lung and liver .More than 1.2 million new cases are diagnosed each yearTypically multifocal BUT renal and thyroid carcinomas produce only a solitary lesion.
3Malignant lesions are more likely to be in axial bones. Common sites for metastasis are the vertebrae, pelvis, proximal parts of the femur, ribs, proximal part of the humerus, and the skull. 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 .
4Bone metastases to the finger 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.
5Mets (adults) lytic blastic Prostate Lung Stomach Kidney Bladder colon ThyroidblasticProstateStomachBladderBreast cancer cause both lytic and blastic
6Typical x-ray appearance of osteolytic bone metastases 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 .
7typical x-ray appearance of osteoblastic bone metastases typical x-ray appearance of osteoblastic 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
8Mets (kids) NB( neuroblastoma) Wilm’s tumor OS (osteosarcoma). Ewing’s sarcomaRhabdomyosarcoma
9(1) direct extension(2) retrograde venous flow(3) seeding with tumor emboli via the blood circulation .
10presentation: bone weakness which predispose to pathologic fractures. Pain which results in reduced mobility.Large bony lesions which causes palpable masses.neurologic impairment due to spinal epidural compression.Anemia (decreased red blood cell production) is a common blood abnormality in these patientsSome patients have history of the primary malignant tumor symptoms, BUT others did not complain of anything before.
11Pathologic fracture. Radiograph shows a displaced fracture through an osteolytic lesion in the distal femur of a 53-year-old woman with lung carcinoma.
12Spinal epidural compression in a 70-year-old man with leg weakness 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
13Approach to the patient: HistoryPhysical examinationRadiological studies e.g. Plain X-ray, MRI, CT scan, Bone scan(radionuclide bone scanning (Technetium-99m)).Laboratory studies .Biopsy.
14Radiological studiesThe 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.
15(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.
20X-rayRadioIsotopePt. 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.Zaid Samkari
21Treatment: Can be divided into: Systemic therapy, aimed at cancer cells that have spread throughout the body, includes chemotherapy, hormone therapy, and immunotherapy.Local therapy, aimed at killing cancer cells in one specific part of the body, includes radiation therapy and surgery.
22Treatment: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.
23Treatment: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 fixationresection and reconstructionSurgical intervention provide stabilization and help minimize morbidity