Mod 4-3 Bone Mets

Question 1

Metastases are the most common what?

Answer 1

Malignant bone tumors.

Question 2

What is the definition of bone metastases?

Answer 2

Secondary growth of malignancy, distant from site of origin.

Question 3

What are the three ways Malignant cells reach the bone?

Answer 3

1. hematogenously
2. lymphatic channels
3. direct extension

Question 4

What percentage of malignant bone lesions are from other parts of the body?

Answer 4

60-65%

Question 5

What are some common areas that are favored sites of metastases?

Answer 5

• Red marrow sites - spine, pelvis, ribs, skull
• Upper ends of humerus and femur

Question 6

What sites are not seen as frequently as being affected with mets?

Answer 6

Distal to the knees and elbows, but they do occur.

Question 7

Mets distal to knees and elbows happen infrequently, but they are especially known to happen with what?

Answer 7

Bronchogenic carcinoma

Question 8

What is the most common presenting symptom of bone mets?

Answer 8

Pain.

*There are a number of lesions that are identified radiographicially while the patient is asymptomatic.

Question 9

Metastatic lesions can be both _______ and _______.

Answer 9

osteolytic (dissolution of bone); osteoblastic (increased bone production)

Question 10

Osteolytic mets begins where?

Answer 10

In the medullary canal and erode through the cortical bone.

Question 11

The most common primary tumors causing osteolytic mets (medullary canal eroding through cortical bone) are tumors of the what (3)?

Answer 11

breast, kidney and thyroid.

Question 12

Lytic mets produced by ____ ____ are usually multiple in number.

Answer 12

breast cancer

Question 13

Lytic mets produced by _____ and ______ primaries usually produce only a single lesion.

Answer 13

thyroid and kidney

Question 14

What do osteoblastic lesions indicate?

Answer 14

Slow growth of a tumor

Question 15

What is the most common primary tumor in men that produces this type of mets (osteoblastic mets)?

Answer 15

Carcinoma of the prostate gland

Question 16

What is the most common primary tumor in women to produce this type of metastases (osteoblastic mets)?

Answer 16

Cancer of the breast

Question 17

What size are the areas of sclerosis (osteoblastic lesions of mets)?

Answer 17

They may be small, round areas of involvement or may involve most or all of a bone.

Question 18

How will the bone appear when there is a mix of lytic and blastic lesions?

Answer 18

Mottled

Question 19

What is the effect on radiographic technique when imaging those with bone metastases?

Answer 19

Depending on stage of progression. Densely sclerotic lesions are additive (increase technique) and lucent lesions are destructive (decrease technique).

Question 20

Multiple myeloma is considered to be a common cancer. T/F?

How many people are affected by multiple myeloma?

Answer 20

False

1 in 159 people in the United States

Question 21

Why does UAMS see multiple myeloma patients daily?

Answer 21

Because UAMS is considered a center of excellence for the treatment of multiple myeloma.

Question 22

What are some risk factors for developing MM?

Answer 22

• Most cases are in people between 40-70 years old
• Exposure to radiation accounts for avery small numebr of cases
• Being overweight

Question 23

What percentage of patients with MM are under the age of 35 years old?

Answer 23

Less than 1%

Question 24

Multiple myeloma is a ___________ that arises from the _____ ________ and spreads and destructs the affected bone.

Answer 24

malignancy; bone marrow

Question 25

What is seen with MM?

Answer 25

A single lesion or multiple lesionsin various areas of the body.

Question 26

What type of bones are typically affected by MM?

Answer 26

* In flat bones that contain red marrow * Skull, vertebrae, ribs, pelvis

Question 27

Are lesions from MM a density or a lucency?

Answer 27

Lucency

Question 28

Is MM cureable or treatable?

Answer 28

MM is a disease that is rarely cureable, but highly treatable.

Question 29

MM is related to ________ because it is a hematologic malignancy.

Answer 29

Leukemia

Question 30

Why has teh American Cancer Society categorized MM as a bone malignancy and not a blood malignancy?

Answer 30

Because it arises in the marrow of bone.

Question 31

What is the most common bone malignancy?

Answer 31

Multiple myeloma \*Accounts for 1/3 of all bone cancers

Question 32

What is the etiology of Multiple Myeloma?

Answer 32

Unknown but it is known that there is a transformation of plasma cells (form of white blood cells) from a normal state to a malignant state.

Question 33

What is the definition of multiple myeloma?

Answer 33

Non-osseous tumor arising from bone marrow.

Question 34

MM affects ______ bones that contain ____ \_\_\_\_\_\_. List examples.

Answer 34

* flat; red marrow * i.e. skull, vertebrae, ribs, pelvis

Question 35

What is an early symptom of MM?

Answer 35

* Pain usually felt in the lower back or ribs. * Pain tends to go away when at rest * Often thought to be arthritis, osteoporosis or muscle spasms * Tylenol does relieve some pain

Question 36

What are some symptoms of MM?

Answer 36

* Pain * Fever * Anemia * Recurring infections (pneumonia or URI) * Kidney failure * Bone loss * Pathologic fractures

Question 37

Where is a common site for fractures with patients that have MM?

Answer 37

The spine

Question 38

What is the classic radiographic appearance of MM?

Answer 38

Multiple punched out osteolygic lesions scattered throughout the skeletal system.

Question 39

How are the punched out osteolytic lesions best seen readiographically?

Answer 39

On lateral views of hte skull

Question 40

How is a radiograph of MM different compared to Paget's disease?

Answer 40

There is no new bone laid down at hte sites of destruction with MM.

Question 41

How do the punched out lesions in MM differ from Bone Mets?

Answer 41

The multiple myeloma lesions tend ot be more discrete and uniform in size than those of metastatic lesions.

Question 42

What may MM simulate in it's progresive state?

Answer 42

Postmenopausal osteoporosis

Question 43

What is one site that MM does NOT invade and why?

Answer 43

The pedicles because they do not contain marrow. \*Bone mets commonly destroys the pedicles.

Question 44

What modalities are used to precisely define the locations of malignancy with MM?

Answer 44

CT and MRI

Question 45

How does MM effect radiographic technique?

Answer 45

MM is a destructive lesion and therefor easier to penetrate. (decrease technique)