- Autopsy findings
- Up to 85% of patients with metastatic cancer have bony metastases
- 75% of all bone metastases are from:
- Breast (70% of metastatic disease in women)(15-30 months after mastectomy)
- Prostate (60% of metastatic disease in men)
- Lung: both bronchogenic and alveolar cell
- Kidney: late metastases even up to 10 years after primary tumor removal
- New cancer cases (1.2 million/yr in the USA):
- GI 227,800
- Oral 30,000
- Genital181,800
- Respiratory171,600
- Breast142,900
- Blood/lymph 79,100
- Urinary 70,200
- Skin 27,000
- Endocrine 12,600
- Bone 2,100
- Connective tissue 5,600
- Eye 1,900
- Cancer deaths
- Nearly 24% of 1991 deaths in the USA
- Improved survival has increased # of eventual patients with bone metastases
- Isolated skeletal metastases:
- Thyroid
- Renal
- Skeletal metastases in other carcinomas:
- Gastric
- (0-2.65% clinically, 2-17% by autopsy)
- spine (59.6-65.9%), ribs (8.8-58%), pelvis (10.5-42.5%), femur (30.5%), skull (1.7-21.6%), shoulder girdle (16.8%), SI joint (7.2%), humerus (6%), sternum (4.2%), tibia (3%)
- Rectum
- Pancreas
- Liver
- Urinary bladder
- Uterus
- Cervix carcinoma (12% in advanced disease)
- Neuroblastoma
- Gastric
- Less commonly reported malignancies with skeletal metastases:
- Esophagus
- Chorionepithelioma
- Ewing sarcoma
- Colon
- Melanoma
- Osteosarcoma
- Pharyngeal
- Ovary
- Hodgkin’s disease
- Seminoma
- Salivary gland carcinomas
- Lymphangiosarcoma
- Retinoblastoma
- Carcinoma of the ureter
- Pheochromocytoma/paraganglioma
- Ganglioneuroma
- Cardiac angiosarcoma
- Parathyroid (reported 19 yrs after parathyroidectomy)
- "Benign" metastases
- Benign pleomorphic adenoma (mixed tumor) of a salivary gland (up to 10% malignant transformation of the epithelial cells in a mixed tumor reported)
- GCT of bone
- Tendency of tumors to metastasize to bone (autopsy proven):
- Breast 22-74% (bone 1st site of metastasis in up to 26%)
- Lung 32-40%
- Prostate 32%
- Kidney 16-50%
- Thyroid 25-30% (much less if well-differentiated)
- Rectum 13%
- Gastric 2-17%
- Head and neck primaries reported by metastasize to bone in 1-23%
- Unusual location
- Hand/feet (most often from lung because of arterial tumor emboli) with distal phalanges most frequently involved (obtain a CxR)
- May be mistaken for a felon and rapid progression to fungating mass described after I&D
- Patella
- No matter how remote, metastatic disease must be considered in a patient with a previous malignancy (most often within the 1st 2 yrs)
- Osseous metastasis inital presentation in 23% of metastatic adenocarcinoma
- Childhood malignancies (eg Wilms’ tumor) must not be discounted as a diagnostic possibility
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