Evaluation and Treatment of Extremity Metastatic Disease

Abstract

Metastases can occur as part of the natural progression of a variety of malignancies and their mode of spread, manner of presentation, and prognosis are as variable as their primary sources. The ultimate goal of musculoskeletal treatment of skeletal metastases is to get the patient in question back to his or her previous level of function as soon as possible. Skeletal metastases are seldom life threatening and their treatment will rarely render someone cured of their primary disease. Nevertheless, involvement of a musculoskeletal specialist as a part of the multidisciplinary approach can and very often does provide significant improvement in patients' qualities of life. The purpose of this chapter is to discuss the evaluation of a patient with suspected metastatic disease involving the musculoskeletal system and their pre-, intra-, and post surgical management as part of a multidisciplinary team.

The need for bone biopsies in the diagnosis of new bone lesions in patients with a known primary malignancy: A comparative review of 117 biopsy cases

“…It has often previously been thought that solitary bone lesions are more likely to be irrelevant to metastases of primary tumors [5], [9], [16]. Patton et al reviewed 60 cases of isolated bone lesions unrelated to primary malignant tumors and stressed the need for bone biopsy of a single lesion [10].…”

“…Therefore, it is necessary to balance the benefits and risks of the procedure before performing biopsy. Creek et al [9] recommended that several clinical factors should be considered preoperatively, such as clinical symptoms, diagnostic interval time between the primary malignancy and bone lesions, and the number and specific sites of the bone lesions. Decision-making may depend on an assessment of the likely correlation between bone lesions and the primary malignancy.…”