Transcript Metastatic Disease - Hastaneciyiz's Blog

Metastatic bone tumor
Maher swaileh
Medical ppt
http://hastaneciyiz.blogspot.com
Metastatic 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
year
 Typically multifocal BUT renal and thyroid
carcinomas produce only a solitary lesion.
 Malignant 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 .
Bone metastases to
the finger.
Radiograph shows a
destructive
expanded osteolytic
lesion in the
metacarpal of the
thumb in a 55-yearold 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 .
typical x-ray appearance of osteoblastic bone metastases. This plain pelvic xray 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 patients
6. 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 70year-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 (Technetium99m)) 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.
X-ray
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
20
Zaid Samkari
deposits
in other parts of the skeleton.
Treatment:
• Can be divided into:
a) Systemic therapy, aimed at cancer cells that have
spread throughout the body, includes chemotherapy,
hormone therapy, and immunotherapy.
b) Local therapy, aimed at killing cancer cells in one
specific part of the body, includes radiation therapy
and surgery.
Treatment:
 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.
Treatment:
 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 You
Good Luck
Medical ppt
http://hastaneciyiz.blogspot.com