Malignant tumours of bone are shown. The most common tumours are metastases from the bronchus, breast and prostate. Metastases from kidney and thyroid are less common. Symptoms are usually related to the anatomical position of the tumour, with local bone pain over the area. Systemic symptoms including malaise and pyrexia, and aches and pains occur and are some times related to the hypercalcaemia . The diagnosis of metastases can often be made from the history and examination, particularly if the primary has already been diagnosed. Symptoms from bony metastases may, however, be the first presenting feature.
SKELETAL ISOTOPE SCANS can pick up bony metastases as ‘hot’ areas before radiological changes occur.
X – RAYS may show metastases as osteolytic areas with bony destruction. Osteosclerotic metastases are characteristic of prostatic metastases.
SERUM ALKALINE PHOSPHATASE (from the bone) is usually raised.
HYPERCALCAEMIA is seen in 10-20% of patients with malignancies. It is chiefly associated with metastases.
SERUM ACID PHOSPHATASE is raised in prostatic metastases.
PROSTATIC SPECIAL ANTIGEN (PSA) is also raised in prostatic metastases.
Treatment is usually symptomatic with analgesics and anti-inflammatory drugs like indomethacin. Local radiotherapy over bone metastases may be the best way of relieving pain. Depending on the tumour, cytotoxic chemotherapy is occasionally helpful. Some tumours are hormone-dependent and a remission can be obtained by hormonal therapy. Occasionally pathological fractures require internal fixation.
PRIMARY BONE TUMOURS are rare and usually seen in children and young adults.