Management of Skeletal Metastases in Renal Cell Carcinoma Patients

Abstract

Patients with metastatic renal cell carcinoma (RCC) to the skeleton are evaluated by the orthopedic surgeon either directly because of unknown cause of skeletal pain or by referral from primary physicians, medical oncologists, or urologists after a lesion of bone is identified. Often a cancer diagnosis is well appreciated and the patient may have already had a nephrectomy and/or ongoing adjuvant therapy. Because of bone pain or a positive bone scan, the orthopedic surgeon is requested to evaluate and assess the structural integrity of long bones and the spine. In situations where a lytic lesion is visualized and the actual diagnosis is unknown, the surgeon embarks upon the differential diagnostic workup. Although all orthopedic surgeons are trained to diagnose and surgically manage metastatic disease, metastatic tumor cases can be just as challenging as primary sarcomas of bone and are often referred to orthopedic surgical oncologists, who are well versed in the complexity and management pitfalls of these lesions.