2. Metastasis

Question 1

Which is the most common malignant tumor of bone?

Answer 1

Metastasis (25x more common than primary

Question 2

Where are the most common primary sites for mets to come from?

Answer 2

Breast, lung, prostate, kidney, thyroid, and bowel

Question 3

Most common target sites for mets?

Answer 3

Axial skeleton, skull, and proximal extremities

Question 4

Where does mets rarely occur?

Answer 4

Distal to the knee or elbow

Question 5

When mets occurs distally, what is it called?

Answer 5

Acral metastasis

Question 6

Skeletal mets may be as common as what?

Answer 6

Liver or lung mets

Question 7

Which primary sites are most responsible for mets?

Answer 7

Breast, prostate, lung, kidney

Question 8

Which primary site is most responsible for mets in women?

Answer 8

Breast (thyroid, kidney, and uterus also common)

Question 9

Which primary site is most responsible for mets in men?

Answer 9

Prostate (lung is also common)

Question 10

T or F: mets usually has solitary lesions

Answer 10

F (90% of mets is multiple lesions)

Question 11

Most mets patients are over what age?

Answer 11

40 years of age

Question 12

If the patient has a neoplasm under the age of 5, it is usually ___.

Answer 12

Neuroblastoma

Question 13

If the patient has a neoplasm between the ages of 10-20, it is usually ___.

Answer 13

Osteosarcoma or Ewing’s Sarcoma

Question 14

If the patient has a neoplasm between the ages of 20-35, it is usually ___.

Answer 14

Hodgkin’s Lymphoma

Question 15

T or F: Mets is not usually painful.

Answer 15

F (70% of mets patients report pain)

Question 16

What is a common reason for mets patients to present to a medical provider?

Answer 16

Pathologic Fracture

Question 17

T or F: many mets patients are asymptomatic

Answer 17

T (which is interesting considering most mets patients report pain…)

Question 18

Can you see neuro symptoms when mets is in the spine?

Answer 18

Yes, it may be present.

Question 19

How long after a primary malignancy can mets develop?

Answer 19

10-15 years after diagnosis and treatment of primary neoplasm

Question 20

Lab changes in mets?

Answer 20

ESR, CBC, chem screen, and UA (however, lab changes are inconsistent and dependent on type, extent, and fluctuations in activity of tumor…so basically, it’s not that helpful…sorry Hoyer)

Question 21

What is the most common route of mets?

Answer 21

Hematogenous (usually via veins)

Question 22

Other routes of mets?

Answer 22

• Direct invasion (like soft tissue tumors near bone, surgical implantation of tumor cells)
• Lymphatic dissemination (is unusual, especially in bone)

Question 23

1st clinical choice for imaging?

Answer 23

Plain film (requires 30-50% bone destruction to visualize)

Question 24

T or F: MRI detects changes later than bone scans

Answer 24

F (changes are detected as early or earlier than bone scans)

Question 25

Are mets lesions more commonly lytic or blastic?

Answer 25

75% Lytic (15% blastic, 10% mixed)

Question 26

If you see a "blow-out" pattern (large, solitary, expansile lesion), what does this suggest?

Answer 26

Renal or thyroid primary

Question 27

Main differences in primary malignancy vs. mets?

Answer 27

``` Primary = solitary, large, periosteal response Mets = multiple, small ```

Question 28

40% of mets occurs in the ___.

Answer 28

Spine

Question 29

Most common sites in the spine for mets?

Answer 29

Tx and Lx (atlus is infrequent due to not having a vertebral body)

Question 30

Most common spot in the vertebra for mets?

Answer 30

Vertebral body

Question 31

T or F: The IVD is commonly affected in mets.

Answer 31

F (basically never affected, though they can get infected)

Question 32

Most common cause for missing pedicle?

Answer 32

Osteolytic mets

Question 33

3 Most common causes for Ivory Vertebra?

Answer 33

- Osteoblastic Mets - Paget's Disease (cortical thickening, expansion) - Hodgkin's Lymphoma (anterior body scalloping)

Question 34

MC place for skeletal mets (other than spine)?

Answer 34

Ribs and sternum (rib mets MC cause of extrapleural sign)

Question 35

T or F: Mets in the skull is usually lytic

Answer 35

T (90% will be lytic)

Question 36

Can you adjust someone who has mets?

Answer 36

No, contraindication to adjusting

Question 37

Treatment for mets:

Answer 37

- Biphosphates to inhibit osteoclast activity | - Radiation therapy to affect bone lesions