(MSK) (Neurology) (Respiratory)

Overview

• Bone Metastases

  • Most common causes → breast cancer, lung cancer and prostate cancer

  • Most common sites → spine (most common) > pelvis > ribs > skull > long bones

    <aside> 💡 Spine = most common site of bone metastases. Back pain worse when sneezing/coughing, worse at night, associated with tenderness.

    </aside>

  • Features → bone pain, pathological fractures, hypercalcaemia, raised ALP

    • Important to exclude Cauda Equina Syndrome due to bone metastases

    <aside> 💡 Hypercalcaemia + Raised ALP ⇒ Bone Metastases

    </aside>

  • Treatment → pain management (radiotherpay), chemotherapy, bisphosphonates for pain (inhibit bone resorption), surgery (if pathological fractures or spinal cord compression)

    • Neoplastic spinal cord compression = high-dose oral dexamethasone whilst waiting imaging
• Brain Metastases
  • Most common causes → lung cancer (most common), breast cancer, bowel cancer, melanoma, renal cell carcinoma
  • Features → seizures, focal neurological deficits, cognitive deficits, headaches
  • Treatment → surgical resection or stereotactic radiosurgery. Patients with poor functional status may be treated palliatively.
• Lung Metastases
  • Most common causes → breast cancer, colorectal cancer, renal cell carcinoma, prostate cancer, bladder cancer, melanoma
  • CXR → multiple rounded lesions (’cannonball metastases’) which are most commonly due to renal cell cancer (CT CAP to investigate this)

Making Diagnosis

Management Plan