It should not be assumed that theįemoral lesion is a metastasis from the breast, even though breast cancerĬommonly spreads to the bone. Treatment, even if there is a prior diagnosis of a cancer (see Figure 3).įor example, a woman with known breast cancer who presents with a lytic lesion However, the first time a lesion is detected in bone,Ī tissue diagnosis of the lesion must be made by biopsy prior to definitive To assume that a newly detected bone lesion is yet another a manifestation of To treating a pathologic lesion in bone, it is essential to fully understand theĪ patient with numerous pre-existing bony metastases, it may be very reasonable Surgery first.” (This principle also applies to treating fragility fractures in Surgery for tumor metastases is guided by the axiom: “do the last More extensive surgery as the initial procedure to minimize the risk of That is, it might be reasonable to consider a Usually beneficial to offer a patient with metastatic cancer a procedure with Patient’s prognosis may influence treatment decisions. Both factors point to a needįor liberal use of bone cement at the time of surgery to fill in the gaps. Interposed between the ends of the fractured bone. With medical and radiation oncologists, among other providers.īone healing processes are largely absent. Timing of surgery, and the care needed before and after it, must be coordinated Healing is often compromised and requires special attention by surgeons regardingĬlosure techniques and the obliteration of dead space. With metastases may be immunosuppressed – either by the cancer or its With pathologic fractures from cancer metastasesĪre suffering from a progressive systemic disease. There are, however, several important differences that must be Techniques that have been developed for the treatment of ordinary fractures in Of an impending or established pathologic fracture draws on many of the If there is a focal lesion that is at high riskįor fracture, or worse, has fractured already, orthopaedic surgical intervention will be needed. Though the risk of fracture is greatest with an osteolytic lesion, theīone architecture in osteoblastic or mixed lesions is also abnormal and thus Metastatic lesions canĪlso be mixed (i.e., osteoblastic and osteolytic), as may be seen with breastĬancer. Osteoblastic metastases are common in prostate cancer. Increase the risk of fracture, and produce hypercalcemia as calcium is releasedĬan also be osteoblastic, that is, characterized by increased bone formation. Increase osteoclast activity, eroding the bone. Skeletal metastases are osteolytic (Figure 1) the tumor cells in the bone Redundant, refers to fracture in a bone that is itself not normal, as discussed (The term “pathological fracture,” seemingly Metastatic lesions are of course not made of normalīone tissue and therefore are at risk for a so-called pathological fracture. Lymphoma and multiple myeloma are also commonly detected in the skeleton. Of the breast, lung, thyroid, kidney, and prostate. Solid organ cancers most likely to spread to bone include cancers Metastases from carcinomas are the most common malignant tumors involving bone,įar more common than primary bone tumors. Stream or lymphatics to reach distal sites Tumor cells escape from the primary tumor and travel in the blood Process by which cancer spreads from its primary site of origin to other places
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