Bony and Spinal Metastasis
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- The skeleton is one of the most common sites for metastatic cancer.
- Bone metastasis can cause significant morbidity including pain, pathologic fractures, spinal cord compression, and hypercalcemia.
- 80% of bony metastasis are due to breast, prostate, and lung cancers (1).
- Breast cancer—73% bony metastasis
- Melanoma—35% (2)
Not well understood
- Approximately 1.2 million new cancer diagnoses in the United States each year
- Approximately 300,000 total cases of metastatic bone disease in the U.S. population in 2008 (3,4)
Etiology and Pathophysiology
- Types of bone metastasis
- Osteolytic—thyroid, non–small cell lung, kidney, multiple myeloma
- Osteoblastic—prostate, small cell lung
- Mixed—breast, cervical, ovarian, testicular
- Bone—specifically the axial skeleton—is a common site for metastasis due to high blood flow in the red marrow.
- Tumor cells exhibit adhesive molecules that allow them to bind stromal cells in the bone marrow.
- Tumor cells produce factors that stimulate osteoblastic and/or osteoclastic activity leading to disruption in bone remodeling (2)[A].
- Studies are ongoing to identify specific genes involved in bony metastasis.
- 5–10% of all cancers are hereditary.
- Most common type is hereditary breast and ovarian cancer syndrome caused by mutations in BRCA1 or BRCA2 (4).
- Advanced disease
- Late presentation to care
- Large tumor size
- Poorly differentiated tumor
- Breast cancer is the most likely culprit for bony metastasis in the United States.
- Prevention of primary tumor/early detection
- Timely mammogram evaluations
- Cervical Pap smears
- Prostate-specific antigen (PSA) per guidelines—strong family history
Commonly Associated Conditions
- Bone pain
- Pathologic fractures
- Nerve compression
- Spinal cord compression
- Cauda equina syndrome