Skeletal Metastases
Original Editors - Cassie Ferrett & Rebecaa Porter from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Cancer is created in the body when abnormal cells begin to rapidly multiply. These cancer cells can end up traveling to other parts of the body if they enter into the bloodstream and/or lymph vessels. The term 'metastasis' refers to the process in which cancer cells travel to a new place and begin to grow in its new location.
A cancer is always named for the place that it first formed; this is called its primary site. For instance, if a person has breast cancer that has spread to the bone, it still is labeled as breat cancer and not bone cancer. Cancer that actually originates in the bone is called primary bone cancer and is less common than a bone metastasis.
The definition of a skeletal metastasis is a cancer of the bone that has originated from another site. Bones are a common site for certain cancers such as breast cancer and prostate cancer. The most common sites for skeletal metastases are the spine (this is the most common site), pelvis, femur, humerus, ribs, and skull.
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
The most common symptoms of skeletal metastases include pain, fractures, and anemia[1] ncbi. Pain is usually localized to the site of metastases, but can refer to areas around the site [UofM]. Pain usually increases to severe intensity. Pain in the spine usually increases as night and with rest, but pain in the long bones increase with activity [UofM]. Weakening of bones due to metastases puts patients at risk for fractures. Patients should take care with activities to avoid further risk of fracture [UofM]. Tumors in the spine can cause compression on the spinal cord resulting in numbness or tingling in the abdomen and legs, bowel and bladder problems, and difficulty walking [UofM]. Metastases in the bones producing blood cells in pelvis, ribs, spine, skull, upper arms, and long bones of legs may cause abnormalities in blood cells [1] and UofM]. Anemia is a common abnormality for patients with skeletal metastases, especially with chemotherapy and radiation therapy. Patients exhibit weakness, fatigue, and shortness of breath [UofM]. Patients with a white blood cell abnormality are prone to infections; whereas, patients with deviations in platelets counts cause abnormalities in bleeding and clotting [UofM].
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
If a person has cancer, lab tests and imaging tests may be done to see if the caner has spread to other sites. This is how skeletal metastases are discovered in their early stages. In other situations, symptoms of skeletal metastases may be the first indicator that the cancer has spread. These symptoms include bone pain, fractures, symptoms of spinal cord compression, and/or symptoms of hypercalcemia (these symptoms are explained in more detail under 'Characteristics/Clinical Presentation'). Lab tests and imaging tests are then performed to confirm whether or not a skeletal metastasis is causing these symptoms.
| Test | Description |
| X-rays | Often the first test performed if a person is having symptoms of a skeletal metastasis. Certain cancers are osteolytic and cause the bone to become less dense. Other cancers are osteoblastic and cause the bone to become more dense. X-rays help to show the bone density and can also indicate if there are any fractures in the bone that may have been caused by cancer. |
| Bone Scan | Shows the entire skeleton and so can help discover metastases that have not caused symptoms yet. Sometimes may not be able to detect osteolytic metastases. |
| Computed Tomography (CT) | Shows cross-sectional images of the body. Often used if a metastasis is thought to be osteolytic since a bone scan may not show the tumor. |
| Tumor Markers | Certain cancers release substances called 'tumor markers'. These can be detected through blood tests and higher levels of tumor markers indicate that cancer has spread in the body. However, this test does not help indicate where the cancer has spread. |
| Other Blood Tests | Cancer can cause increased levels of calcium and alkaline phosphates in the blood. Blood tests can help show if these levels are higher than normal. |
| Urine Tests | If the bone has become damaged by skeletal metastases, certain substances may be released into the urine. |
| Magnetic Resonance Imaging (MRI) | Shows cross-sectional images of the body and is useful at looking at the spine and spinal cord. It is the test most often used if a person is experiencing symptoms of spinal cord compression. |
| Positron Emission Tomography (PET) | Shows the whole body at once and is useful in detecting tumors throughout the body. The scans are not very detailed and so if cancer is thought to be seen, MRI or CT scans are used to have a more thorough scan. |
| Needle Biopsy | There are two types--fine needle biopsy and core needle biopsy. With fine needle biopsy, a thin needle is inserted and a little bit of fluid and tissue fragments are removed from the tumor. With core needle biopsy, a larger needle is used to remove a small cylinder of tissue. The samples are then looked under a microscope. |
| Surgical Bone Biopsy | With this test, the bone is cut into and a small part of the tumor is removed and inspected under a microscope. |
Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management ==(current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
McGarvey CL. A case report:breast cancer metastasis and implications of bony metastasis on activity and ambulation. Rehabilitation Oncology; 2006: 24- 1.
https://my.usa.edu/ICS/icsfs/Z0000009.004.gif?target=c53172c2-0933-436d-a9c4-b85a87464072
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 American Academy of Orthopaedic Surgeons. Orthoinfo:Metastatic Bone Disease. http://orthoinfo.aaos.org/topic.cfm?topic=a00093 (accessed 23 March 2013).
