Abstract
Metastasis is the commonest bone tumors. The commonest primary metastasis to the bone are the breast, lung, prostate, kidney, and thyroid. The bone is the third common site of metastatic disease, only the lung and the liver have higher metastatic rate than skeleton. We have no epidemiological studies conducted to evaluate the various aspects of skeletal metastasis like age, sex distribution, presentation, common sites of primary and associated secondary metastases, and investigation from Indian subcontinent. Here we are presenting the first epidemiological study of skeletal metastasis from our region. We have conducted a prospective descriptive study in the Departments of Orthopedics and Radiotherapy, Government Medical College, Kozhikode, during the period of 2007 to 2009. One hundred eleven patients were included in the study above the age of 30 years. Clinical examination and investigation were done on these patients. Skeletal metastasis commonly occurs in the fifth decade of life with modest male preponderance. In most of the cases, the primary site of malignancy was undetected at the time of presentation. Pain was the commonest presented complaint of the patient. The spine is the commonest site affected and the lung was the common site of primary metastasis. Most of the cases were detected by radiogram and confirmation was obtained by minimally invasive technique like FNAC or CNB.
Similar content being viewed by others
References
Shimada H, Setoguchi T, Nakamura S, Yokouchi M, Ishidou Y, Tominaga H, Kawamura I, Nagano S, Komiya S (2015) Evaluation of prognostic scoring systems for bone metastases using single-center data. Mol Clin Oncol 3(6):1361–1370
Mundy GR (2002) Metastasis to bone: causes, consequences and therapeutic opportunities. Nat RevCancer 2:584
Buckwalter JA, Brandser EA (1997) Metastatic disease of the skeleton. Am Fam Physician 55(5):1761–1768
Davies AM, Sundaram M, Steven JJ (eds) Imaging of bone tumors and tumor-like lesions: techniques and applications. Medical radiology and diagnostic imaging. Springer, Berlin Heidelberg
Piccioli A, Maccauro G, Spinelli MS, Biagini R, Rossi B (2015) Bone metastases of unknown origin: epidemiology and principles of management. J Orthop Traumatol 16(2):81–86. https://doi.org/10.1007/s10195-015-0344-0PMCID
Devita, Hellman, and Rosenberg: Cancer, principles and practice of oncology ... Lawrence, Theodore S;Rosenberg, Steven A. Philadelphia:Wolters Kluwer, [2016]....Principles and practice of oncology review: Govindan, Ramaswamy. 3rd ed
Ugras N, Yalcinkaya U, Akesen B, Kanat O (2014) Solitary bone metastases of unknown origin. Acta Orthop Belg 80(1):139–143
Khan MN, Sharfuzzaman A, Mostafa MG (2014) Spinal cord compression as initial presentation of metastaticoccult follicular thyroid carcinoma. J Neurosci Rural Pract 5(2):155–159. https://doi.org/10.4103/0976-3147.131661
Healey JH, Turnbull AD, Miedema B, Lane JM (1986) Acrometastases: a study of twenty-nine patients with osseous involvement of the hands and feet. J Bone Joint Surg Am 68(5):743–746
Libson E, Bloom RA, Husband JE (1987) Husband: metastatic tumors of bones of the hand and foot: a comparative review and report of 43 additional cases affiliated with ….Department of Radiology, Royal Marsden Hospital, Dennis J. Stoker Skeletal Radiology 16(5):387–392
Hage WD, Aboulafia AJ, Aboulafia DM (2000) Aboulafia: incidence, location and diagonostic evaluation of metastatic bone disease. Orthop Clin North Am 31(4):515–528
Wagner G (1984) Frequency of pain in patients with cancer. Recent Results Cancer Res 89:64–71
Weinstein JN (1992) Differential diagnosis and surgical treatment of pathologic spine fractures. Instr Course Lect 41:301–315
Springfield DS (1982) Mechanism of metastasis. Clin Orthop 169:15
Ali IU et al (1987) Reduction to homozygosity of genes on chromosomes 11 in human breast neoplasia. Science 238(4824):185–188
Arguello F, Baggs RB, Frantz CN (1988) A murine model of experimental metastasis to bone and bone marrow. Cancer Res 48(23):6876–6881
Cher ML, Bova GS, Moore DH, Small EJ, Carroll PR, Pin SS, Epstein JI, Isaacs WB, Jensen RH (1996) Genetic alterations in untreated metastases and androgen-independent prostate cancer detected by comparative genomic hybridization and allelotyping. Cancer Res 56(13):3091–3102
Harris M, Howell A, Chrissohou M, Swindell RI, Hudson M, Sellwood RA (1984) A comparison of the metastatic pattern of infiltrating lobular carcinoma and infiltrating ductcarcinoma of the breast. Br J Cancer 50(1):23–30
Mundy GR (1997) Mechanisms of bone metastasis. Cancer 80(8 Suppl):1546–1545
Bates SE (1991) Clinical applications of serum tumor markers. Ann Intern Med 115(8):623–638
Rosenthal D (1997) Radiologic diagnosis of bone metastases. Cancer 80(8 Suppl):1595–1607
Ortiz A, Lin SH (2012) Osteolytic and osteoblastic bone metastases: two extremes of the same spectrum? Recent Results Cancer Res 192:225–233. https://doi.org/10.1007/978-3-642-21892-7_11
Roodman GD (2004) Mechanisms of bone metastasis. N Engl J Med 350:1655–1664
Roudier MP, Vesselle H, True LD et al (2003) Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results. Clin Exp Metastasis 20:171–180
Hanna SL, Fletcher BD, Fairclough DL et al (1991) Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy. Skelet Radiol 20:79
Yang HL, Liu T, Wang XM, Xu Y, Deng SM (2011) Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol 21(12):2604–2617. https://doi.org/10.1007/s00330-011-2221-4
Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT (2004) Bone imaging in metastatic breast cancer. J Clin Oncol 22(14):2942–2953
Traina F et al (2015) Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. J Bone Joint Surg Am 97(2):e7. https://doi.org/10.2106/JBJS.N.00661
Blum RH, Shasha D, Fleishman SB The multidisciplinary approach to bone metastases Review Article | May 31, 2003 | Bone Metastases, Cancer Complications, Palliative and Supportive Care, Oncology Journal
Rougraff BT, Kneisl JS, Simon MA (1993) Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. J Bone Joint Surg Am 75(9):1276–1281
Fidler M (1986) Anterior decompression and stabilization of metastatic spinal fracture. J Bone J Surg[Br] (68):83–90
Alan M, Levine AJA (ed) Pathologic fractures. Browner skeletal trauma, 4th ed
Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12(20 Pt 2):6243s–6249s
Saifuddin DJSA, chapter 48, Bone tumors(2): Malignant lesion in Adam: Grainger and Allison’s diagnostic radiology,5th ed
Ottolenghi CE (1969) Aspiration biopsy of the spine. J Bone Joint Surg Am 51:1531–1544
Kilpatrick SE, Ward WG, Cappellari JO, Bos GD (1999) Fine-needle aspiration biopsy of soft tissue sarcomas: a cytomorphologic analysis with emphasis on histologic subtyping, grading, and therapeutic significance. Am J ClinPathol 112:179–188
Schweitzer ME, Gannon FH, Deely DM, O’Hara BJ, Juneja V (1996) Percutaneous skeletal aspiration and core biopsy: complementary techniques. AJR Am J Roentgenol 166(2):415–418
Bommer KK, Ramzy I, Mody D (1997) Fine-needle aspiration biopsy in the diagnosis and management of bone lesions: a study of 450 cases. Cancer 81(3):148–156
Author information
Authors and Affiliations
Contributions
All authors help in collecting data, analysis, statistics, writing, and editing the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Zacharia, B., Subramaniam, D. & Joy, J. Skeletal Metastasis—an Epidemiological Study. Indian J Surg Oncol 9, 46–51 (2018). https://doi.org/10.1007/s13193-017-0706-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-017-0706-6