Most common cause of bone malignancy: (PGI June 2008)
Correct Answer: Secondaries
Description: Ans. A (Secondaries) "Metastatic deposits in the bone are commoner than primary bone tumours"- Maheshivari 3rd/214Matastatic Bone DiseaseSource of Primary Tumor"Any cancer can spread to bone .but in adults more than 75% of skeletal metastases originate from cancers of the prostate, breast, kidney & lung. In children, metastases to bone originate from Neuroblastoma, Wilm's tumor. Osteosarcoma, Ewing sarcoma & Rhabdomyosarcoma"- Robbins 7th/1303"The commonest source is carcinoma of breastQ; next in frequency are carcinomas of prostate, kidney, lung, thyroid, bladder & gastroin testin al tract"- Apley's Orthopaedics 8th/l 93"In children <6yr of age, metastatic lesions are most commonly from adrenal neuroblastoma"- Apley's Orthopaedics 8th/l 94Metastases are usually osteolytic & pathological fracture are common. Osteoblastic lesions are uncommon, they usually occur in prostatic carcinoma"The metastases may occur in any bone, bu t most involve the axial skeleton (vertebral column, pelvis, ribs, skull, sternum),proximal femur & humerus, in descending order of frequency". Metastases to the small bones of hand & feet are uncommonQ- Robbins7th/1303Bone metastases may be asymptomatic or may produce pain, swelling, nerve root or spinal cord compression, pathologic fracture, or myelophthisis (replacement of the marrow). Symptoms of hypercalcemia may be noted in cases of bony destruction.Pain is the most frequent symptom.Osteoblastic lesions are associated with higher serum levels of alkaline phosphatase and, if extensive, may produce hypocalcemiaRoute of SpreadSpread is usually via the blood streamoccasionally,visceral tumors spread directly to adjacent bones- Apley's Orthopaedics 8th /193The pathway of spread include- direct extension, lymphatic or hematogenous dissemination & intraspinal seeding (Batson plexus of veins)- Robbins 7th/1303Skeletal metastases are typically multifocalTreatment of metastatic bone disease depends on the underlying malignancy and the symptoms. Some metastatic bone tumors are curable (lymphoma, Hodgkin's disease), and others are treated with palliative intent. Pain may be relieved by local radiation therapy. Hormonally responsive tumors are responsive to hormone inhibition (antiandrogens for prostate cancer, antiestrogens for breast cancer).. Bisphosphonates such as pamidronate may relieve pain and inhibit bone resorption,
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