Diagnosis

Metastatic bone tumors

Any cancer metastasized to the bone.

Also known as: Bone metastasis, Bone tumor

Etiology

Common origin for metastatic tumors: [yvp][smb]

Pathophysiology [ihb]

  1. The rich arterial supply of the bone --> hematogenous spread

  2. The skeleton is the 3rd most common site of metastatic disease after lung and liver

  3. Classification of bone lesions:

    • Osteoblastic (prostate cancer)

    • Osteolytic (breast, lung, renal cancers)

    • Mixed (breast cancer)

Complications: [ihb]

Epidemiology

Incidence per 100.000 [sqh][zmq][qq9][rvb][yvp][smb][3r7]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Ataxia, Fasciculations, Hepatomegaly, Muscle weakness, Paresis, Paresthesia, Splenomegaly, Weakness, Weight loss

Clinical findings

Anemia, Elevated ALP, Elevated Sedimentation Rate, Hypercalcemia, Lytic bone lesion, Osteoblastic bone lesion, Pathologic fracture

Anamneses

None listed.

Localized findings

Pain
Radiates
JointsArmBackLower body
Onset
Acute (minutes)Subacute (hours)Gradual (days)
Pattern
Constant
Provoked by
Activity
Severity
Mild (1-3)Moderate (4-7)

Approach

Treatment

  1. Primary cancer treatment: Radiation therapy + chemotherapeutic + hormonal drugs [smb][3fp]

  2. Slow bone destruction: bisphosphonates + RANKL inhibitors (denosumab)

  3. Painful or progressive lesions: Radiation therapy and Radiofrequency Thermal Ablation

  4. Control bleeding and relieve pain: Embolization

  5. Risk of pathologic fracture --> Surgery: Stabilize, resect and joint reconstruction

Differential diagnoses

Chondrosarcoma, Ewing sarcoma, Hyperparathyroidism, Leukemia, Lymphoma, Multiple myeloma, Osteomyelitis, Osteoporosis, Osteosarcoma, Paget's disease, Polyneuropathy

References

[1] Piccioli A, Maccauro G, Spinelli MS, Biagini R, Rossi B. Bone metastases of unknown origin: epidemiology and principles of management. J Orthop Traumatol. 2015 Jun;16(2):81-6.

[2] Tsukamoto S, Kido A, Tanaka Y, Facchini G, Peta G, Rossi G, Mavrogenis AF. Current Overview of Treatment for Metastatic Bone Disease. Curr Oncol. 2021 Aug 29;28(5):3347-3372.

[3] Jayarangaiah A, Kemp AK, Theetha Kariyanna P. Bone Metastasis. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507911/

[4] Hauben, E. I., Hogendoorn, P. C., & Heymann, D. (2015). Epidemiology of primary bone tumors and economical aspects of bone metastases. In BONE CANCER: PRIMARY BONE CANCER AND BONE METASTASES, 2ND EDITION (pp. 5–10). ACADEMIC PRESS LTD-ELSEVIER SCIENCE LTD.

[5] Franchi A. Epidemiology and classification of bone tumors. Clin Cases Miner Bone Metab. 2012 May;9(2):92-5. Epub 2012 Sep 30.

[6] Lai J, Li X, Liu W, Liufu Q, Zhong C. Global, regional, and national burden and trends analysis of malignant neoplasm of bone and articular cartilage from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021. Bone. 2024 Nov;188:117212.

[7] Hu B, Zhang Y, Zhang G, Li Z, Jing Y, Yao J, Sun S. Research progress of bone-targeted drug delivery system on metastatic bone tumors. J Control Release. 2022 Oct;350:377-388.

[8] Jiang W, Rixiati Y, Zhao B, Li Y, Tang C, Liu J. Incidence, prevalence, and outcomes of systemic malignancy with bone metastases. Journal of Orthopaedic Surgery. 2020;28(2).

[9] Bădilă AE, Rădulescu DM, Niculescu AG, Grumezescu AM, Rădulescu M, Rădulescu AR. Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review. Cancers (Basel). 2021 Aug 23;13(16):4229.

[10] Huang JF, Shen J, Li X, Rengan R, Silvestris N, Wang M, Derosa L, Zheng X, Belli A, Zhang XL, Li YM, Wu A. Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study. Ann Transl Med. 2020 Apr;8(7):482.

[11] http://emedicine.medscape.com/article/1253331 (2014-01-02); [Medscape]

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