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Skeletal Metastases in Malignant Tumors

Skeletal Metastases in Malignant Tumors. Prof. Dr. Nazem Shams Professor of General Surgery & Surgical Oncology Faculty of Medicine Mansoura University. Introduction.

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Skeletal Metastases in Malignant Tumors

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  1. Skeletal Metastases in Malignant Tumors Prof. Dr. Nazem Shams Professor of General Surgery & Surgical Oncology Faculty of Medicine Mansoura University

  2. Introduction • Importance of dealing with this subject originating from recent methods of management –even in late terminal cases- for better quality of life rather than aiming for cure. Post-graduate Course

  3. Metastatic Potential of Tumors • The development of metastasis is a complex and highly selective process that is dependant upon the interplay of host and intrinsic characteristics of tumor cells, adhesive capacities, cell motility, enzyme secretion and others. Post-graduate Course

  4. Routes of Metastasis • The routes by which cancer cell emboli ordinarily reach the skeleton is the blood stream (venous or arterial). • The role taken by lymphatic is not important due to apparent absence of lymph channels in bone marrow, • There is also a minute role for perineural spread. Post-graduate Course

  5. Routes of Metastasis • Venous Route. • Vertebral venous system which is a network of valveless veins around the spinal dura mater and the vertebrae. • This system has cranial and body wall connection and even connections with the veins in the wall of the vessels of extermities. • When the intrathoracic or intra-abdominal pressure rises, as in coughing or sneezing, a reversed flow in the venous vertebral system can occur. Post-graduate Course

  6. Routes of Metastasis 2. Arterial Spread: • Cancer cell emboli reaching the lungs by way of caval circulation sometimes pass through the lungs instead of being arrested in them. Post-graduate Course

  7. Routes of Metastasis 3. Perineural Spread: • Perineural space via the fifth cranial nerve have been speculated. Post-graduate Course

  8. Theories of Metastasis • Anatomical • Soil & seed • Surface properties. Post-graduate Course

  9. Incidence of Bone Metastasis • The overall incidence of skeletal metastasis rates 70% or more. • If one considers the prostate, kidney and thyroid, the incidence of skeletalmetastasis in cases which have run their full clinical course. • Sometimes the primary lesion is clinically silent and bone metastasis gives the first information about the presence of tumor as in kidney, lung and pancreas as well as lymphoma. Post-graduate Course

  10. Sites of Bone Metastasis • The vertebral column particularly in the lumbar area and the sacrum, the rib cage including the sternum, the femoral and humeral shafts, the pelvic bones and the calvarium are the general sites of predilection. Post-graduate Course

  11. Common Sources of Metastasis to Bone Post-graduate Course

  12. Sites of Bone Predilection for Metastasis in Each Tumor Post-graduate Course

  13. Sites of Bone Predilection for Metastasis in Each Tumor Post-graduate Course

  14. Clinical Presentation • Pain • Pathological Fracture • Swelling • Neurological Manifestations • General symptoms • Paraneoplastic syndrome Post-graduate Course

  15. Diagnostic Approaches • Laboratory Investigations: • Blood picture • Blood glucose • Blood electrolytes • Urine • Enzymes • Tumor markers Post-graduate Course

  16. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography • Myelography • Angiography • Tomography • Bone scanning • Computerized axial scan • MRI • PET Post-graduate Course

  17. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  18. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  19. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  20. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  21. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  22. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  23. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  24. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  25. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  26. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  27. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  28. Diagnostic Approaches • Radiological Diagnosis. • Plain radiography Post-graduate Course

  29. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  30. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  31. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  32. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  33. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  34. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  35. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  36. Diagnostic Approaches • Radiological Diagnosis. • Myelography Post-graduate Course

  37. Diagnostic Approaches • Radiological Diagnosis. • Angiography Post-graduate Course

  38. Diagnostic Approaches • Radiological Diagnosis. • Angiography Post-graduate Course

  39. Diagnostic Approaches • Radiological Diagnosis. • Angiography Post-graduate Course

  40. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  41. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  42. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  43. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  44. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  45. Diagnostic Approaches • Radiological Diagnosis. • Tomography Post-graduate Course

  46. Diagnostic Approaches • Radiological Diagnosis. • Bone scanning Post-graduate Course

  47. Diagnostic Approaches • Radiological Diagnosis. • Bone scanning Post-graduate Course

  48. Diagnostic Approaches • Radiological Diagnosis. • Bone scanning Post-graduate Course

  49. Diagnostic Approaches • Radiological Diagnosis. • Bone scanning Post-graduate Course

  50. Diagnostic Approaches • Radiological Diagnosis. • Bone scanning Post-graduate Course

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