Bone Metastases
2.3.1 Bone Metastases
Multiple myeloma and cancers of the breast, prostate, and lung account for a
large majority of bone metastasis. The most common sites of bone metastasis
include the vertebrae, pelvis, femur, and skull. Distal extremity metastasis
are uncommon (Malawer and Delaney, 1989). The most frequent symptom is pain,
although 25 percent of patients with bone metastasis have no symptoms (Wagner,
1984). Pain may result from direct tumor involvement of bone with activation of
local nociceptors, or compression of adjacent nerves, vascular structures, and
soft tissue. Because patients often have multiple-sites of bone metastasis,
multiple areas of pain are-common. Pain is usually described as dull and
aching, is usually localized to the area of metastasis, and is increased by
movement. However, spine metastasis may impinge upon nerve roots and result in
radicular pain. Patients with metastasis to the base of the skull may complain
of headache; pain on head movement; and face, neck, or shoulder pain
Greenberg, D.html#, Vikram, et al., 1981). Besides pain and immobility,
complications of bone metastasis include fractures, hypercalcemia, and spinal
cord compression. Pathologic fractures occur most commonly in cancers of the
breast, lung, kidney, and thyroid and in multiple myeloma, usually in the
proximal femur or humerus (Oda and Schurman, 1983). Hypercalcemia is most often
observed in cancers of the breast, lung, and kidney and in multiple myeloma.
The diagnosis of bone metastasis is established by radiographic confirmation
and, rarely, biopsy. Radionuclide scintigraphy and magnetic resonance imaging
are the most sensitive means of detecting bone metastasis, often demonstrating
abnormalities before those seen on plain radiographs. Plain radiographs showing
typical lyric, plastic, or mixed lesions are usually diagnostic and easily
distinguished from lesions resulting from nonmetastatic causes (Wilner, 1982).
However, plain radiographs and bone scintigraphy may be negative early in the
course of myeloma and some osseous metastasis and at sites of previously
radiated bone (Kelly and Payne, 1991). Magnetic resonance imaging may be
helpful in such cases when bone involvement is suspected.
Scope of the Problem
Initial Pain Assessment.
Assessment of Common Cancer Pain Syndromes
Epidural Metastases/Spinal Cord Compression
Common Cancer Pain Syndromes due to Peripheral Nerve Injury
PlexoPathies
Assessment of New Pain
Patients with Psychiatric Problems Associated with Cancer Pain
Index