What Is Metastatic Osteosarcoma?

Metastatic bone tumors refer to malignant tumors that originally originated in other parts of the body through various routes to metastasize to the bone and continue to grow in the bone. The diagnosis of the primary tumor is clear and metastases to the bone after treatment are generally easier to find. However, when the location and symptoms of the primary tumor are hidden and metastatic bone tumor is the main complaint, the diagnosis is often easily confused, and even metastatic bone tumor is diagnosed and treated as the primary tumor of bone. Bone is one of the three most common metastatic sites in tumors. The disease occurs more frequently in 51 to 60 year olds, with a male to female ratio of 2.3: 1. Bone metastases in children mainly come from neuroblastomas of the adrenal glands or sympathetic ganglia. Occurs in the spine, pelvis and femur. Bone metastases were higher in breast cancer, lung cancer and prostate cancer.

Basic Information

Also known as: Bone metastases
English name: metastatictumorofbone
Visiting department: orthopedics

Multiple groups: 51 to 60 years old
Common locations: Spine, pelvis, femur
Common symptoms: Lump, pain

Causes of metastatic bone tumors

Metastatic bone tumors are mainly produced by lymphatic or blood pathways. Malignant tumors of any organ throughout the body can be transferred to the bones through the blood circulation or lymphatic system.

Clinical manifestations of metastatic bone tumors

The patient has a history of primary malignancy and bone metastases occurred during or months to years after treatment. Different metastatic sites have different symptoms and signs. Some patients have no symptoms and signs of primary lesions, and no history in this regard. The first symptom is metastatic symptoms, and most of these bone metastases come from the kidneys, thyroid, and liver. Different tumors have their common metastatic sites and X-ray findings. The signs and symptoms of metastatic tumors are similar to those of bone metastases in malignant tumors. Tumors that metastasize to limbs and bones are mainly found first, while metastatic bone tumors in the trunk, with pain as the first symptom.

Disease site

The most common sites of metastasis are high incidences at the proximal end of the trunk and extremities, and low incidences at the distal end of the extremities. Extreme extremities are rare. Most of the early is single, but also multiple. The most common metastatic tumors in the spine were the lumbar spine, the thoracic spine and the cervical spine. Breast cancer, lung cancer and kidney cancer mostly metastasize to the thoracic spine; prostate cancer, cervical cancer and rectal cancer mostly metastasize to the lumbar spine; while nasopharyngeal cancer and thyroid cancer tend to metastasize to the cervical spine. In addition, lung cancer, liver cancer, and breast cancer also easily metastasize to the upper end of the pelvis and femur. In such cases, the primary foci can be found after examination, but 10% to 30% are still not found.

2. Symptoms and signs

The most common symptoms and signs of metastases include systemic wasting symptoms, local pain in the metastases, compression symptoms, and pathological fractures. There are many patients who come to the clinic for local pain and pathological fractures. About 40% of patients have a history and signs of primary malignant tumors, and metastatic symptoms appear during or months or years after treatment. Most patients have no history and signs of the primary tumor, and the first symptom is the symptom of metastasis, which makes diagnosis difficult. For example, liver cancer, thyroid cancer, adrenal tumors and kidney cancer often have no primary symptoms.

(1) Pain is the most common symptom. The pain is mild in the early stage, and changes from intermittent to continuous. The severe ones are easy to attract attention, and the mild ones are ignored. Those who are located on the spine can show pain in the waist, chest, back, ribs, and neck. Those in the thoracic spine often have unilateral or bilateral intercostal neuralgia. People with lumbar spine can show abdominal pain. The characteristics of the pain often change and the brakes are ineffective. The pain is getting heavier and progressing rapidly. Those in the pelvis are often accompanied by pain in the medial hip of the hip joint; those in the upper end of the femur and the upper end of the humerus are often associated with joint dysfunction.

(2) Masses Bone metastases located in the deep part are not easy to find early. The lump only reflects local pain. About 5% were seen for a lump. Rarely, tumors near the joint can cause joint dysfunction. When the tumor grows near important nerves, there may be more or less compression symptoms, numbness, muscle weakness or atrophy. The diagnosis of many cases is only when pathological fractures occur.

(3) Symptoms of compression Spinal metastasis tumors quickly show symptoms of compression of the spinal cord, cauda equina or nerve roots, root pain, loss of sensation, weakened muscles and even paralysis, often with sphincter dysfunction. Fifty percent were admitted to hospital due to paralysis. In the pelvis, it can cause compression symptoms of the rectum and bladder, and dysfunction of urine and stool. People in the limbs can also cause symptoms of compression of the blood vessels and neural stem.

(4) Pathological fractures are often one of the first symptoms. A minor trauma or no cause induces a fracture. Occurrence rate is highest in the lower limbs. Once pathological fractures increase, pain and swelling are obvious. People with spine soon became paralyzed.

(5) Systemic symptoms Those with primary cancer symptoms have poor general conditions, including anemia, weight loss, low fever, fatigue, and loss of appetite. Those without primary cancer showed better general condition, and some patients soon developed systemic symptoms.

Metastatic bone tumor examination

Laboratory examination is often used clinically as an indicator of disease progression, treatment effect and prognosis.

Routine inspection

There may be manifestations of decreased hemoglobin, decreased red blood cell count, increased white blood cell count, increased erythrocyte sedimentation, decreased plasma protein, and inverted A / G ratio, etc. Alkaline phosphatase (ALP), acid phosphatase (ACP), and lactic acid should also be performed. Dehydrogenase (LDH), blood calcium, blood phosphorus and other items. Elevated catecholamines in the urine.

2. Bone marrow examination

Tumor cells can be found on bone marrow smears during bone metastases.

3. Pathological examination

When a bone metastasis is suspected, a biopsy should be performed to confirm the diagnosis and select a treatment method.

4. Tumor marker detection

Detection of tumor markers, radioimmunoimaging of tumors, and the use of polymerase chain reaction (PCR) in bone metastases also help diagnose primary cancers and micrometastasis of tumors.

5.X-ray inspection

X-ray manifestations of metastatic bone tumors are mostly tumor-producing bones with various bone-damaging changes. Most of the lesions are localized in the bones, the edges are unclear, and sometimes they are not easy to distinguish from the primary bone tumors.

6. Nuclide scanning and gamma scintigraphy

This test is one of the commonly used tests for bone metastases. Early metastatic cancer can be found.

7.CT inspection

The presence or absence of a tumor can be determined and accurately located, and the nature of the tumor should be judged in conjunction with the clinic.

8.MRI examination

Diagnosis of bone metastases is more sensitive.

9.B-ultrasound

B ultrasound is more suitable for bone metastases with osteolytic bone destruction.

10. Angiography

Angiography can display typical malignant changes, such as rich blood flow, capillary proliferation but disorder, and the phenomenon of "vessel lake". Interventional treatment can also be performed at the same time as the angiography.

Diagnosis of metastatic bone tumors

After the diagnosis of the primary tumor, the diagnosis of metastatic bone tumors is relatively easy. Metastatic bone tumors with bone tumors as the first symptom often rely on laboratory tests for diagnosis. According to the sequence of common tumors, selective examination can help make a correct diagnosis, and pathological examination can help confirm the diagnosis.

Main points of diagnosis

(1) Anyone diagnosed with a malignant tumor should be monitored for tumor micrometastasis.

(2) X-ray examination of suspicious areas, and nuclide, CT and MRI examinations, etc., as appropriate.

(3) Viable biopsy when necessary is an effective method for diagnosing tumors and judging the nature.

(4) Patients without a history of malignant tumors should be thoroughly examined to find the primary lesion.

2. Diagnosis of primary osteosarcoma, lymphoma, and myeloma

Malignant tumors that have metastasized into or near the joint invade a single joint, showing local pain, swelling, and dysfunction; bloody exudates are often present in the joint cavity. The joint cavity effusion will relapse quickly after puncture and drainage, and tumor cells can be found in the joint cavity effusion. Synovial biopsy can detect tumor cell invasion and can be diagnosed.

Differential diagnosis of metastatic bone tumors

Metastatic bone tumors are distinguished from primary tumors. In bones and spine of the limbs, the performance of the primary tumor is clearer and easier to identify. In pelvic tumors, there are fewer special manifestations and it is difficult to identify. A single lesion is distinguished from a primary tumor of bone, such as Ewing's tumor. Biopsy is a reliable method for diagnosing tumors, and it is also the main method for differential diagnosis. Puncture biopsy is often used for bone metastases. Finding the primary tumor: If the primary tumor can be identified, the diagnosis of bone metastases is established. Even if no primary tumor is found, as long as the primary tumor is removed by biopsy, the diagnosis of metastatic tumor can be established.

Complications of metastatic bone tumors

Metastatic bone tumors can be complicated by primary osteosarcoma and lymphoma myeloma. Causes joint function disorders, muscle weakness or atrophy, pathological fractures, etc. Spinal metastases compressing the spinal cord or nerve roots can cause paraplegia or nerve root pain and sensory and motor disorders.

Metastatic bone tumor treatment

Radiation therapy, chemotherapy, biological therapy, and traditional Chinese medicine are used as the case may be. Surgical treatment can be used if necessary. After the diagnosis of metastatic bone tumor is clear, comprehensive treatment should be adopted in time. The treatment of primary tumor lesions is the main link in the entire treatment. Bone lesions can be removed by surgery, local radiotherapy and systemic chemotherapy. Cases of skeletal complications such as pathological fractures should be treated promptly. The treatment of bone metastases is a comprehensive treatment of malignant tumors. The occurrence of bone metastases is the result of early disease or delay in diagnosis and treatment, so the diagnosis and treatment of bone metastases should be extended to: screening and monitoring of middle and old age groups; prevention and monitoring of patients with malignant tumors; Micrometastasis patient monitoring and timing treatment; treatment of patients with bone metastases. Here we focus on the treatment of bone metastases.

The treatment of bone metastases is still aimed at reducing pain, preserving function, improving quality of life, and prolonging life. Its treatment includes supportive therapy, symptomatic treatment, systemic treatment and local treatment. Systemic therapy includes combined chemotherapy, radiation therapy, immunotherapy, endocrine therapy, radionuclide therapy, and Chinese herbal medicine for the primary disease. Local treatment is mainly surgery and interventional treatment. Whether to choose systemic or surgical treatment should be comprehensively formulated according to the patient's condition, the severity of the bone metastasis symptoms, the purpose and possible consequences of each treatment, and the wishes of the patient's family.

1. Treatment of bone metastases without complications

Regardless of single or multiple bone metastases, the main treatment options available are radiotherapy, hormone therapy, chemotherapy, interventional therapy, surgical treatment and postoperative chemotherapy, traditional Chinese medicine treatment, and bisphosphonate treatment.

2. Treatment of Complicated Bone Metastases

(1) Treatment of spinal metastases with paraplegia Laminectomy decompression surgery is relatively simple, reducing a part of the compression from the rear, and radiation therapy and / or chemotherapy should be continued after surgery. Radiotherapy plays an important role in the treatment of spinal metastases with paraplegia, especially for some tumors sensitive to radiotherapy. Patients with spinal metastases and paraplegia should be treated actively in early incomplete paralysis.

(2) Treatment of bone metastases with pathological fractures Different treatment methods are selected according to different parts.

(3) Treatment of bone metastases combined with other tissues and organ metastases. Such patients should be treated symptomatically according to the situation, and bone metastases should be treated at the same time. Surgical treatment is still feasible for patients with pathological fractures.

3. Treatment of pelvic metastases

(1) Non -surgical treatment Long-term pain relief and better function are obtained through comprehensive non-surgical treatment.

(2) Surgical treatment The patient's condition is good if there is no other tissue or organ metastasis, other treatment methods are ineffective or the effect is not obvious, and the survival time after surgery is expected to exceed 1 year, only consider surgical treatment.

4. Treatment of bone metastases of unknown primary focus

Bone metastases of unknown primary bone metastases are usually multiple. The processing method is the same as above.

5.Monitoring and treatment of bone marrow micrometastases

Long-term monitoring of malignant tumors that are prone to micrometastasis of the bone marrow. Once metastasis is found, it is mainly combined with chemotherapy or treated with TCM syndrome differentiation.

6. Symptomatic treatment such as pain relief

The treatment of cancerous bone pain includes anti-tumor therapy, three-step drug analgesia, radiation therapy, chemotherapy, nerve root block and neurosurgical analgesia, TCM syndrome differentiation and analgesia, microwave treatment and other methods.

Prognosis of metastatic bone tumors

Primary neuroblastoma can be treated with surgical resection, followed by radiation and chemotherapy. However, those with bone metastases have a poor prognosis and can hardly be cured. Metastatic cancers are all advanced and have a poor prognosis.

Prevention of metastatic bone tumors

Metastasis is an active process that begins early in the growth of the primary tumor. When the primary tumor begins to grow, metastatic tumor cells are likely to metastasize. Therefore, preventive treatment should be started early, especially for bone-affected people, and the metastatic link should be cut off. Studies have found that the combined use of cortisone and heparin can inhibit tumor angiogenesis, shrink the primary tumor, reduce the tumor metastasis rate, and imine has an inhibitory effect on colon cancer metastasis; the Nm-23 gene product inhibits metastasis. Plays an important role in the type.