- 30% of patients with malignant disease will develop bone metastases
- 10% of these patients will develop a pathological fracture
- Tumours spread to bone by:
- Direct invasion
- Haematogenous spread
- Lymphatic spread
- Spread via paravertebral venous plexus
- Commonest sites lumbar vertebrae, pelvis and ribs
Primary tumours which spread to bone
- Breast (35%)
- Prostate (30%)
- Bronchus (10%)
- Kidney (5%)
- Thyroid (2%)
- Others (18%)
Clinical features
- Pain or localised bone lump
- Pathological fracture
- Hypercalcaemia
- Cord compression
Radiology
- Plain x-rays can be normal
- If abnormal will show either an osteolytic or sclerotic lesion
- Bone scan has higher sensitivity than x-rays
- May identify other asymptomatic lesions
Differential diagnosis
- Calcified enchondroma
- Hyperparathyroidism
- Chronic sclerosing osteomyelitis
- Bone infarct
- Myeloma deposit
Treatment
- The aims of treatment are to relieve pain and preserve mobility
- If pathological fracture consider internal fixation for early mobilisation and pain relief
- Consider radiotherapy for back pain
- Spinal decompression may be needed for cord compression
- Prophylactic internal fixation may be required if:
- Greater than 50% erosion of a long bone cortex
- A metastasis of more than 2.5 cm in diameter
- Metastasis in high risk area (e.g. subtrochanteric femur)
- Metastasis with persistent pain
Bibliography
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