| Abstrakt: |
Metastases rather than primary tumors are responsible for the lion's share of the morbidity and mortality arising from malignant disease. Patients with advanced breast or prostate cancers usually develop bone metastases and usually harbor the bulk of their tumor burden in the bone at the time of death. Although it is difficult to quantify the prevalence of bone metastases, natural history and autopsy studies give an indication of the scope of the problem. In breast cancer, the skeleton is the most common site for metastasis and first distant relapse, and median survival following detection is more than 20 mo (1). At their presentation with prostate cancer, 8% of white American males and 14% of African-American males have bone metastases (2), whereas the mean incidence of bone metastasis in an analysis of autopsy studies of prostate cancer is 70% (3). It is clear, therefore, that bone metastases are both a common manifestation in patients with breast and prostate cancer and often a prolonged one. Given these considerations and the fact that bone metastases are not usually clinically silent, their importance in the context of the overall suffering and management associated with these malignancies is evident. Clinically, the lesions behave somewhat differently in the two cancers, with pathological fractures being relatively more common in breast cancer and severe, often intractable pain a classic feature of metastases in patients with advanced prostate cancer (4). Spinal cord compression as a result of vertebral metastasis is perhaps the most devastating complication of skeletal involvement with hypercalcemia and leukoerythroblastic anemia being the commonest systemic sequelae. [ABSTRACT FROM AUTHOR] |
