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Abstract
Among 1330 cancer patients consulted to and diagnosed in this University Medical School Hospital, from January of 1966 to August of 1972, 63 cases of them were confirmed to have cancers metastatic to bone. Clinical observation done on these 63 cases was as follows.
1. of 63 patients, 55 persons were all over their fourth decade of age and 27(42.8%) were at their fifth. Men were affected as twice as women.
2. Skeletal survey confirmed 94 sites of bone involvement in 63 cases and 77.5% of them were in either trunk or skull and mostly multiple.
3. Most frequent primary source in this series was lung (14 cases) and prostate cancer showed the highest metastatic rate of 57.1%.
4. Radiologically the osteolytic change was predominent in 82.5% of all metastatic foci.
5. First choice of treatment should be aimed for control of pain and walking aid rather than futile trial of radical procedure. Accordingly hormonal treatment, chemotherapy, local irradiation, and rigid fixation for pathological fracture should be applied.
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Fig. 1
Chest film of 58-year-old woman showed a large space-occupying lesion in the right mid-lung field, which was confirmed as a squamous cell ca by a needle biopsy.
Fig. 4
63-year-old man with prostate ca had an extensive osteoblastic metastasis to entire pelvis and lower lumbar spines.
Fig. 5
52-year-old man. with highly undifferentiated adenocarcinoma of stomach sustained pathologic fracture on the right trochanteric region.
Fig. 6
Massive osteolytic changes at the right ilium and sacroiliac joint were due to metastasis of hypernephroma in 23-year-old school teacher.
Table 1
Age and Sex Distribution
| sex age | male | female | total(%) |
|---|---|---|---|
| —29 | 5 | 1 | 6(9.5) |
| 30—39 | 2 | 2(3.2) | |
| 40—49 | 10 | 4 | 14(22.2) |
| 50—59 | 18 | 9 | 27(42.8) |
| 60-69 | 9 | 3 | 12(19.1) |
| 70— | 1 | 1 | 2(3.2) |
| total(%) | 43(68.3) | 20(31.7) | 63(100.0) |
Table 2
Cancers Metastatic to Bone
Table 3
Frequency of Bone Metastasis of Each Primary Cancer.
Table 4
Locations of Metastatic Bone Involvement
| 1. Bones of Trunk and Skull (73) | |
| rib | 21 |
| spine | 21 |
| pelvis | 16 |
| skull | 8 |
| scapula | 3 |
| others | 4 |
| 2. Proximal Long Bones (16) | |
| femur | 10 |
| humerus | 6 |
| 3. Acral Metastasis (5) | |
| radius | 2 |
| tibia | 1 |
| foot | 2 |
Table 5
Clinical Manifestations in 63 cases of Metastatic Bone Cancers.
| symptoms and signs | No. of patients (%) |
|---|---|
| pain | 55 (87.3) |
| tenderness | 60 (95.2) |
| swelling | 40 (63.5) |
| motor disturb. | 15 (23.8) |
| fever | 15 (23.8) |
| pathologic fracture | 8 (12.7) |
| solitary metast. | 13 (20.6) |
Table 6
Laboratory Data of Peripheral Blood.
Table 7
Radiological classification into osteolytic and osteoblastic type of the 63 metastases
| type | No. of cases | (%) |
|---|---|---|
| Osteolytic | 52 (82.5) | |
| Osteoblastic | 8 (12.5) | |
| prostate | 4 | |
| bladder | 1 | |
| stomach | 2 | |
| unknown | 1 | |
| Mixed type | 3 (5.0) | |
| skin | 2 | |
| lung | 1 |
Table 8
Palliative Treatment applied to the Metastatic Bone Disease.
| methods | No. of cases |
|---|---|
| I-M nailing | 3 |
| Hormonal therapy | 4 |
| Chemotherapy | 2 |
| Irradiation | 13 |
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