5.7 Bone metastases Flashcards Preview

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Flashcards in 5.7 Bone metastases Deck (19):
1

What is neoangiogenesis?

When tumours recruit blood vessels through a combination of hypoxia and cytokine release

2

What is intravasation?

When tumour cells enter the blood stream either actively or passively

3

What is needed for tumour cells to extravasate?

Adhere to side of the vessel
Invade through the vessel wall
Establish new blood supply

4

What is the role of osteoclasts?

Resorb bone

5

What is the role of osteoblasts?

Form new bone

6

What is the role of cytokines in bone metastases?

Local release of cytokines by malignant cells drives activation of osteoclasts and suppression of osteoblasts allowing for destruction of adjoining bone

7

What peptide do malignant cells release which is thought to be involved in bone mets and what happens when there is too much?

Parathyroid hormone related peptide

When there is high levels there is bone demineralisation in the absence of local metastases

8

What causes hypercalcemia?

Bone mets causing localised destruction of bone and release of calcium, can be due to ectopic production of parathyroid hormone related peptide

9

What are the dangers of hypercalceamia?

Dehydration, renal failure, confusion, pain, renal calculi

potentially fatal

10

What is the treatment of hypercalcaemia?

IV fluids only is 3

11

What is the usual presetation of spinal cord compression?

Pain - radicular pain at the level of compression and weakness/sensory changes below the level

12

What is the treatment for spinal cord compression?

dexamethasone 8mg to reduce oedema and protect the cord
Radiotherapy

13

What is the typical presentation of bone mets

Typically sever pain which continually worsens and is often worse on mobilisation of the affected area
Will often not respond to simple analgesia

14

What are the typical areas of bone mets?

Spine and pelvis

15

What is teh imaging for bone mets?

Local imaging
CT if symptoms of cancer
Whole body scan for other sites of mets
MRI to examine spinal cord

16

What is the role of surgery in bone mets?

Effective and immediate relief of pain, improve strength of pain and reduce risk of pathological fracture

17

What is the most common treatment of bone mets?

Radiotherapy - less useful for widespread mets

18

How do bisphosphonates work and what are some examples?

Inhibit osteoblast function through RANKL pathwat preventing bone destruction

Zoledronic acid and Palmidronate

19

What is the monoclonal antibody against RANKL?

Denosumba