Skeletal complications of malignancy

Abstract

tumors arising from the breast, prostate, thyroid, lung, and kidney possess a special Yorkshire Cancer Research Campaign (YCRC), propensity to spread to bone. Breast carcinoma, the most prevalent malignancy, Department of Clinical Oncology, Weston Park causes the greatest morbidity. Of great clinical importance is the observation that Hospital, Sheffield, United Kingdom.metastatic bone disease may remain confined to the skeleton. In these patients, the decline in quality of life and eventual death is due almost entirely to skeletal complications and their subsequent treatment. Bone pain is the most common complication of metastatic bone disease, resulting from structural damage, periosteal irritation, and nerve entrapment. Recent evidence suggests that pain caused by bone metastasis may also be related to the rate of bone resorption. Hypercalcemia occurs in 5-10% of all patients with advanced cancer but is most common in patients with breast carcinoma, multiple myeloma, and squamous carcinomas of the lung and other primary sites. Pathologic fractures are a relatively late complication of bone involvement. The clinical courses of breast and prostate carcinoma are relatively long, with a median survival of 2-3 years. For patients with breast carcinoma, good prognostic factors for survival after the development of bone metastases are good histologic grade, positive estrogen receptor status, bone disease at initial presentation, a long disease free interval, and increasing age. In addition, patients with disease that remains confined to the skeleton have a better prognosis than those with subsequent visceral involvement. For patients with prostate carcinoma, adverse prognostic features include poor performance status, involvement of the appendicular skeleton and visceral involvement, whereas for patients with multiple myeloma, the levels of serum b 2 -microglobulin and lactate dehydrogenase and the immunologic phenotype are the most important factors. These prognostic factors may be useful in planning the rational use of bisphosphonates in the treatment of advanced cancer. T he skeleton is the most common organ to be affected by metastatic cancer. Bone metastases from carcinomas of the breast, lung, prostate, kidney, and thyroid are most frequent 1 (Table 1). The prevalence of skeletal disease is greatest in breast and prostate carcinoma, reflecting both the high incidence and the relatively long clinical courses of these tumors. These two cancers probably account for more than 80% of cases of metastatic bone disease. In breast carcinoma, the incidence of bone metastases has been found to be significantly higher in association with tumors that produce parathyroid hor- tastases are more often associated with poorly differentiated tumors. enced by molecular and cellular biologic characteristics of both the

Parathyroid hormone‐related protein measured at the time of first visit is an indicator of bone metastases and survival in lung carcinoma patients with hypercalcemia

“…These cytokines also are implicated in the pathogenesis of TIH. Furthermore, IL-1␤ 16,17 and IL-6 18 have been shown to enhance PTH-rP-induced bone resorption and hypercalcemia. Of note, these hypercalcemic patients also exhibited higher serum levels of IL-6 compared with nonhypercalcemic patients (35.5 Ϯ 7.2 pg/mL vs. 2.8 Ϯ 0.7 pg/mL [mean Ϯ SE]; P Ͻ 0.001) (Fig.…”

Prognostic factors for skeletal complications from metastatic bone disease in breast cancer

“…Although treatment options at this stage of disease are palliative, median survival is approximately 2 years, with 20% surviving beyond 5 years [2]. In this context, quality of life and survival are often diminished by the onset of debilitating skeletalrelated events (SREs) including pathologic fracture, bone pain requiring radiotherapy, spinal cord compression, and the requirement for surgery to bone [2]. Moreover, patients may suffer several SREs during their illness, with considerable costs to health services [3,4].…”

Intraosseous injection of RM1 murine prostate cancer cells promotes rapid osteolysis and periosteal bone deposition

“…Electronic supplementary material The online version of this article (doi:10.1007/s10585-008-9175-1) contains supplementary material, which is available to authorized users. skeletal compartment predominates [2] leading to substantial bone pain and mortalities. Although the nature of bone metastatic prostate cancer lesions have been described as osteoblastic, these lesions develop concomitantly with notable amounts of bone resorption [3].…”