Bony and Spinal Metastasis
- 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
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.
- 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
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Domino, Frank J., et al., editors. "Bony and Spinal Metastasis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816891/all/Bony_and_Spinal_Metastasis.
Bony and Spinal Metastasis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816891/all/Bony_and_Spinal_Metastasis. Accessed June 8, 2023.
Bony and Spinal Metastasis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816891/all/Bony_and_Spinal_Metastasis
Bony and Spinal Metastasis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 08]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816891/all/Bony_and_Spinal_Metastasis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bony and Spinal Metastasis ID - 816891 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816891/all/Bony_and_Spinal_Metastasis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -