Metastatic bone tumor

1. Metastatic bone tumor Maher swaileh

2. 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.

3. 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 .

4. 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.

5. Mets (adults) lytic Lung Kidney colon Thyroid blastic Prostate Stomach Bladder

8. Mets (kids) NB( neuroblastoma) Wilm�s tumor OS (osteosarcoma). Ewing�s sarcoma Rhabdomyosarcoma

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

10. presentation: 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 patients Some patients have history of the primary malignant tumor symptoms, BUT others did not complain of anything before.

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

12. 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

13. 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.

14. 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.

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.

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