| Neutropenic Sepsis
| Pulmonary Embolism
| Superior vena caval obstruction syndrome
| Cerebral Metastases
| Metastatic bone disease
| Oncological emergencies
Metastatic bone disease has a major impact on both the morbidity and
mortality of patients
- Bone is the third most common site of metastasis for cancers
- It is common in
people at advanced stages of these cancers
- Improve management of bone metastases
secondary to breast and prostate cancer
- Lung cancer
- Breast cancer
- Prostate cancer
- Thyroid carcinoma
- Renal cell carcinoma
- Bladder carcinoma
- Osteolytic (e.g.Myeloma)
- Calcium more likely raised. ALP normal unless fracture.
- Lytic lesions are best detected with plain radiography.
- Breast, lung, renal cell, myeloma and melanoma
- Progression of osteolytic metastases is much faster
- Osteoblastic "Sclerotic" with bone growth (e.g.Prostate)
- Calcium may be raised. Raised ALP.
- Blastic lesions are prominent on radionuclide bone scans
- Prostate cancer, and a subset of breast and lung cancers
- Most are mixed. bone-resorbing (osteoclasts) and bone-forming (osteoblasts) cells
- Bone pain which may be worse at night
- Pathological fracture and deformity
- Osteoarthritis, Degenerative disease
- Paget's disease, osteoporosis, or disc disease
- U&E: raised Calcium, ALP high
- Where bone metastases are suspected, individuals
should be assessed with a plain X-ray followed by
radiological review and, if indicated, an orthopaedic
- Technetium diphosphonate bone scans are useful to delineate the extent of bony metastases and in following response to therapy. It can miss purely lytic lesions.
- Skeletal radiography supplemented with computed tomography and magnetic resonance imaging
- Skeletal survey is preferable for multiple myeloma
- Pain, impaired mobility, pathological fracture
- Spinal cord compression, cranial nerve palsies
- Nerve root lesions, hypercalcaemia, and suppression of bone marrow function.
- In breast cancer, prostate cancer, and multiple myeloma patients, bisphosphonate therapy increases the time to a first skeletal event.
- Bisphosphonate therapy also appears to prolong survival in patients with metastatic breast cancer.
Management: depends on the
- Analgesia, bed rest and Imaging and Orthopaedic surgery can help treat/prevent pathological fractures and spinal decompression and stabilization to relieve spinal cord compression or instability
- Antitumor treatments such as external-beam radiotherapy, endocrine therapy, cytotoxic chemotherapy, targeted biological agents, and radioisotope therapy
- Antiresorptive bisphosphonates have revolutionized
treatment and outcomes for patients with bone metastases, but pain and
other skeletal complications still occur
- Bisphosphonates may reduce hypercalcemia, relieve pain, and
limit bone resorption. Consider 4 mg zoledronic acid IV
- Denosumab is a new
bone-modifying drug that has shown much promise
in this setting. It is a fully-human
monoclonal antibody to RANKL.
- Physical activity is promoted though those with metastatic bone lesions
are at an increased risk of fracture and this needs
to be taken into account when recommending