Paliatívna medicína a liečba bolesti 2e/2015

Skeletal metastatic disease: how to confirm and to proceed in the search for primary tumor

Metastases of many cancer in man are osseous: in 70% of patients with breast cancer, in 30-40% of patients with lung, kidney and thyreoid cancer, at least are metastases from gastrointestinal cancers (10%). In developed countries is the major cause of morbidity the low back pain, but only 1% is caused by metastases of cancer. Examination of musculoskeletal pain is based on detailed medical history (accident, symptoms of systemic inflammation, history of surgery for cancer) and on appropriate laboratory and imaging examination. Indications of summary images of skeleton, CT, radiolabelled examination and MRI are governed by the clinical picture (so called warning signals). The best way of the removing a histological specimen is its removing from the bone if it is not possible to find the primary tumor or if it is technically impossible to do it from the primary tumor.

Keywords: osseous metastases, differential diagnosis, palliative care.