"Osseous metastasis accounts for one of the 'M's in the popular mnemonic for lucent bone lesions FEGNOMASHIC."
"solitary lucent bone lesion: FOG MACHINES is a good place to start"
"The major route of spread of tumour to bone is haematogenous, although lymphatic spread is also seen (e.g. pelvic tumours spreading to para-aortic nodes, and then directly into bone cf. the more common haematogenous spread from the same tumours) 3. Although direct extension of tumours in bone is also not infrequently seen (e.g. oral cavity tumours into mandible, Pancoast tumours into first rib) this is not usually what is considered metastatic disease ref."
"Harrington criteria"
Expected headings
"Bone scintigraphy"
"direct compression of adjacent structures by extraosseous soft tissue mass (e.g. spinal cord compression)"
"In most cases, the diagnosis of metastatic disease is already known. If no known primary exists, or there is uncertainty regarding the diagnosis (e.g. no known metastases; unusual imaging appearances) then a bone biopsy can usually allow a definitive diagnosis."
"Regardless of the route of spread, metastases lead to both bone loss and bone formation, in varying amounts. The former is most likely due to direct enzymatic destruction and osteoclast activation. The latter can be due to stromal bone formation (formation of bone within tumour substrate; the case in prostate cancer metastases) or reactive new bone formation which represents the normal adjacent bone's response to the presence of tumour and is similar to callus formation 3."
"Plain radiographs have low sensitivity (~50%) compared to bone scintigraphy (~80%, range 62-100%), CT (~85%, range 71-100%), and MRI (~90%, range 82-100%) 6,9. Bone scintigraphy is the preferred first-line imaging modality as a much smaller change in abnormal-to-normal bone is needed than for detection on plain radiographs 9."
"It is important to note that, unlike primary bone tumours, in general metastases incite no or only limited periosteal reaction. The occasional exception to this general rule includes prostate cancer, some gastrointestinal malignancies, retinoblastoma and neuroblastoma 3."
"A rule of thumb is that there is a high risk of pathological fracture if the lesion is painful, >2.5 cm in size and involves >50% of the bone. There are more formal classification systems, although increasing cortical involvement is probably the most important factor 4,5:"
"There are, unfortunately, no specific features of metastases, although often the diagnosis is straightforward in the setting of known advanced malignancy and multiple lesions."