Secondary Bone Cancer (bone metastasis)
Secondary bone cancer is where malignant cells have spread to the bones from other parts of the body. This is different to cancer that actually started in the bones (primary bone cancer). Virtually all types of cancer can spread to bone. Bone metastases are particularly common in people with breast, lung or prostate cancer. Bone metastases are usually multiple, they cause pain and can can lead to other symptoms such as hypercalcemia (abnormally high levels of calcium in the blood).Information for Patients and the Public
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MeSH term: Bone Neoplasms
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Radium 223 for the treatment of metastatic castration-resistant prostate cancer.
Arch Esp Urol. 2019; 72(5):500-507 [PubMed] Related Publications
Intravoxel incoherent motion diffusion MR and diffusion kurtosis imaging for discriminating atypical bone metastasis from benign bone lesion.
Br J Radiol. 2019; 92(1100):20190119 [PubMed] Related Publications
METHODS: Patients with bone lesions in lower extremity suspected of metastases were enrolled in this prospective study. IVIM diffusion MR and DKI were performed before biopsy. Apparent diffusion coefficient (ADC), true diffusion (D), perfusion fraction (f) and perfusion-related pseudodiffusion (D*) were generated with IVIM, while mean kurtosis (MK) and mean diffusion (MD) generated with DKI. Two radiologists blinded to pathology results separately measured these parameters for each lesion through drawing region of interest. Intraclass correlation coefficient was used to determine the inter-reader viability in measurement. The patients with pathology-confirmed metastasis or benign lesion were analyzed. The Mann-Whitney test was used to compare IVIM and DKI parameters between metastasis group and benign lesion group. Receiver operating characteristic curves were constructed to evaluate the ability of discrimination.
RESULTS: Bone lesions from 28 patients (metastasis,
CONCLUSIONS: IVIM and DKI derived parameters distinguish between atypical bone metastasis and benign bone lesion in selected patients with tumors.
ADVANCES IN KNOWLEDGE: Bone metastasis and benign bone lesion differ in water molecular diffusion. Intravoxel incoherent motion derived true diffusion distinguishes between atypical bone metastasis and benign lesion.
Targeting cathepsin K diminishes prostate cancer establishment and growth in murine bone.
J Cancer Res Clin Oncol. 2019; 145(8):1999-2012 [PubMed] Free Access to Full Article Related Publications
METHODS: CatK mRNA expression was validated by RT-PCR, protein expression by immunoblotting in PCa LNCaP, C4-2B, and PC3 cells as well as in PCa tissues. Its protein production was measured using ELISA assay. The effect of both knockdowns via siRNA and CatK inhibitor was compared in regard to PCa cell invasion. We further studied the dose-dependent CatK inhibitor effect on conditioned media-induced bone resorption. In setting up an animal model, C4-2B cells were injected into the tibiae of SCID mice. The animals treated with either vehicle or CatK inhibitor for 8 weeks at the time of tumor cell injection (tumor establishment model; protocol I) or 4 weeks after tumor cell injection (tumor progression model; protocol II) were applied to histological and histomorphometric analyses.
RESULTS: We confirmed CatK expression in PCa LNCaP, C4-2B, and PC3 cells as well as in PCa tissues. Furthermore, we observed the inhibitory effects of a selective CatK inhibitor on PCa cell invasion. The CatK inhibitor dose-dependently inhibited PCa-conditioned media-induced bone resorption. Upon injection of C4-2B cells into the tibiae of SCID mice, the selective CatK inhibitor significantly prevented the tumor establishment in protocol I, and reduced the tumor growth in bone in protocol II. It also decreased serum PSA levels in both animal models. The inhibitory effects of the CatK inhibitor were enhanced in combination with zoledronic acid (ZA).
CONCLUSION: The selective CatK inhibitor may prevent the establishment and progression of PCa in bone, thus making it a novel therapeutic approach for advanced PCa.
Physical function and pain intensity in patients with metastatic bone disease.
J Surg Oncol. 2019; 120(3):376-381 [PubMed] Related Publications
OBJECTIVES: We aimed to assess what factors are independently associated with physical function and pain intensity in patients with bone metastasis.
METHODS: We included data from 211 patients with bone metastasis who completed a survey (2014-2016) including the PROMIS Physical Function Cancer and PROMIS Pain Intensity questionnaires.
RESULTS: Prostate (P < .001) and thyroid carcinoma (P = .007) were associated with better function and having other disabling conditions (P = 0.035) was associated with worse function. Prostate carcinoma (P = .001) and lymphoma (P = .007) were associated with less pain. There was a moderate correlation between pain and function (P < .001). Function was substantially worse as compared to a US reference population of patients with cancer (P < .001), whereas pain was slightly less compared to the US general population average (P < .001).
CONCLUSIONS: Patients with bone metastasis have a poor physical function. Physical function and pain intensity depend on tumor histology, but also on potentially modifiable factors such as other disabling conditions.
LEVEL OF EVIDENCE: Level III, prognostic study.
Management of bone health in solid tumours: From bisphosphonates to a monoclonal antibody.
Cancer Treat Rev. 2019; 76:57-67 [PubMed] Related Publications
Invasion of Adjacent Lumbar Vertebral Body from Renal Pelvis Carcinoma: Associated With Bone Metastasis But Easily Overlooked on Initial CT Scan.
In Vivo. 2019 May-Jun; 33(3):939-943 [PubMed] Free Access to Full Article Related Publications
MATERIALS AND METHODS: Criteria for the study were: (i) Metastatic renal pelvis carcinoma confirmed via pathology and computed tomographic (CT) scan, (ii) L1 and L2 invasion confirmed from retrospective CT scan review, and (iii) detection of bone metastases using radionuclide images/CT scans.
RESULTS: A total of 71 cases were enrolled in the study. Initial L1 and L2 vertebral body invasion. were detected in 45 (63%) patients. As well as L1 and L2 invasion, 32 (71%) had development of bone metastases. All bone lesions were osteolytic. Initial L1 and L2 invasion (p<0.00001) was associated with the development of bone metastasis.
CONCLUSION: CT scan can help to detect L1 and L2 vertebral body invasion in patients with renal pelvis carcinoma. Early identification and optimal management of such patients is necessary.
Neuroimaging and Stereotactic Body Radiation Therapy (SBRT) for Spine Metastasis.
Top Magn Reson Imaging. 2019; 28(2):85-96 [PubMed] Related Publications
Adjuvant bisphosphonates or RANK-ligand inhibitors for patients with breast cancer and bone metastases: A systematic review and network meta-analysis.
Crit Rev Oncol Hematol. 2019; 137:1-8 [PubMed] Related Publications
Early detection of bone metastases of hepatocellular carcinoma reduces bone fracture and paralysis.
Jpn J Clin Oncol. 2019; 49(6):529-536 [PubMed] Related Publications
METHODS: Out of 783 hepatocellular carcinoma patients treated in our institution between 2009 and 2016, 76 patients with bone metastases were enrolled. They were divided into two groups by the trigger of bone metastases detection. One was those diagnosed by surveillance (surveillance group), and the other was those based on symptom presentation (non-surveillance group). We investigated the clinical features, risk factors for fractures or paralysis and prognostic factors for survival after bone metastases.
RESULTS: Baseline characteristics and survival were not significantly different between two groups. Fractures or paralysis occurred in 10 patients (13.2%), and the frequency was significantly higher in the non-surveillance group (20.9%) than the surveillance group (3.0%) in univariate analysis (p = 0.036). The median survival after diagnosis of bone metastases was 11.7 months. Age over 75 years (p = 0.002), hepatitis C-virus etiology (p = 0.007) and Child-Pugh class B/C (p < 0.001) were significantly associated with a shorter survival in multivariate analysis, but fractures or paralysis did not affect the survival.
CONCLUSIONS: Early diagnosis through surveillance for hepatocellular carcinoma bone metastases may prevent fractures or paralysis and lead to a better quality of life for these patients.
Metastatic bone disease from an occult renal primary.
BMJ Case Rep. 2019; 12(4) [PubMed] Related Publications
Clinical analysis of patients with skeletal metastasis of lung cancer.
BMC Cancer. 2019; 19(1):303 [PubMed] Free Access to Full Article Related Publications
METHODS: We performed a medical record review of 202 patients who were diagnosed with skeletal metastasis from lung cancer. Adenocarcinoma was found in 116 patients (57.4%), squamous cell carcinoma in 29 (14.4%), small-cell lung cancer (SCLC) in 37 (18.7%), and large-cell carcinoma and other types of cancer in 20 patients (9.9%). Orthopedic surgery for skeletal metastasis was performed in 41 patients (20.3%).
RESULTS: Lung cancer survival was 12.1 months. After diagnosis of lung cancer, skeletal metastasis was found at a mean of 2.5 months, and skeletal metastasis survival was 9.8 months. Lung cancer survival in patients younger than 60 years was 13.8 months, and lung cancer survival in patients 60 years or older was 10.8 months (p = 0.009). Skeletal metastasis survival in patients younger than 60 years was 11.0 months, and skeletal metastasis survival in patients 60 years or older was 8.8 months (p = 0.002). Mean skeletal metastasis survival with surgery was 12.6 months and without surgery was 9.1 months (p < 0.000). In the multivariate analysis of lung cancer survival, age under 60 years [HR (95% CI) 1.549 (1.122-2.139), p = 0.008], non-small cell lung cancer pathology type [HR (95% CI) 1.711 (1.157-2.532), p = 0.008], chemotherapy for skeletal metastasis [HR (95% CI) 8.064 (3.981-16.332), p < 0.000], and radiation therapy for skeletal metastasis [HR (95% CI) 1.791 (1.170-2.742), p = 0.007] were significant, independent, good prognostic factors. In the multivariate analysis of skeletal metastasis survival, age under 60 years [HR (95% CI) 1.549 (1.124-2.134), p = 0.007], non-small cell lung cancer pathology type [HR (95% CI) 2.045 (1.373-3.047), p < 0.000], chemotherapy for skeletal metastasis [HR (95% CI) 7.121 (3.542-14.317), p < 0.000], and orthopedic surgical treatment for skeletal metastasis [HR (95% CI) 1.710 (1.148-2.547), p = 0.008] were significant, independent, good prognostic factors.
CONCLUSIONS: Patients who survived longer were less than 60 years old, received chemotherapy as treatment for skeletal metastasis, had NSCLC rather than SCLC, and underwent orthopedic surgery for skeletal metastasis.
Supportive mistletoe therapy in a patient with metastasised neuroblastoma.
BMJ Case Rep. 2019; 12(3) [PubMed] Free Access to Full Article Related Publications
Carcinosarcoma of the uterine cervix: a rare pathological finding originating from mesonephric remnants.
BMJ Case Rep. 2019; 12(3) [PubMed] Related Publications
Diagnosis of Bone Metastasis in Patients Without a History of Cancer.
J Nippon Med Sch. 2019; 86(1):22-26 [PubMed] Related Publications
METHODS: We reviewed patients with bone metastasis to determine the diagnostic rate at first visit, period from symptom-onset to first visit, period from first visit to diagnosis, and presence of severe skeletal-related events at diagnosis, and compared these between 27 patients without a history of cancer (Group A) and 54 patients with a history of cancer (Group B).
RESULTS: The diagnostic rate at first visit was significantly lower (11.5% vs. 52.4%, p=0.00069), the period from first visit to diagnosis was significantly longer (median, 7 weeks vs. 3 weeks, p=0.018), and the presence of severe skeletal-related events at diagnosis was significantly higher (81.4% vs. 50.0%, p=0.05) in patients without a history of cancer compared with those with a history of cancer.
CONCLUSIONS: The results of this study indicate that it is difficult to diagnose bone metastasis in patients without a history of cancer. This must be considered in the early diagnosis of bone metastasis to prevent severe skeletal-related events.
Spinal cord infarction after tumor removal surgery of the thoracic region - a case report.
Pol Merkur Lekarski. 2019; 46(273):142-145 [PubMed] Related Publications
A CASE REPORT: The authors present the case of a 62 year old woman admitted to the Neuroortopedics department due to metastasis of papillary renal carcinoma to the spine. During physical examination no neurological deficits were found. However magnetic resonance imaging revealed pathological tissue covering the left pedicle of the Th9 vertebra, penetrating the spinal canal, and compressing the spinal cord. The patient was qualified to the surgery and underwent tumor removal and transpedicular stabilization of the spine. The operation proceeded on schedule, without complications. After the operation the patient did not have any neurological deficits. In the first 24 hours post-surgery paresis of the lower limbs appeared, which rapidly deepened until the right limb was paralyzed. Due to the lack of improvement after administration of solumedrol, and suspicion of hematoma at the surgical site, the patient was qualified for reoperation. Intraoperatively there was no compression of the spinal cord, nonetheless, after being awaken from surgery, no active movements were found in the left lower limb. Magnetic resonance imaging was performed and revealed spinal cord infarction in its ventral part extending from Th9 to Th12.
CONCLUSIONS: Even in procedures where no surgical complications appeared it should be noted that the rare risk of spinal cord infarction exists.
Clinical outcomes after isolated pelvic failure in cervical cancer patients treated with definitive radiation.
Gynecol Oncol. 2019; 153(3):530-534 [PubMed] Related Publications
METHODS AND MATERIALS: Cervical cancer patients with isolated pelvic failure after definitive radiation with brachytherapy boost were identified in a tertiary academic center database from 1997 to 2016. All patients received an FDG-PET scan prior to their initial treatment and at the time of their first recurrence. Isolated failures in the cervix or pelvic nodes were biopsy-proven. Distant failure and overall survival (OS) were censored outcomes.
RESULTS: Isolated pelvic failure was detected in 67(11%) out of 607 consecutive patients treated with external beam pelvic radiation and brachytherapy boost. The median time to isolated pelvic recurrence was 9 months (range 3-198). Median follow-up time for patients alive after isolated pelvic recurrence was 40 months (range 0.6-183). Of these 67 patients, 28(42%) received salvage surgery, 17(25%) received chemotherapy alone, and 22(33%) received neither surgery nor chemotherapy. The median time to distant failure after isolated pelvic failure was 20 months (95% CI 3-37), with no significant difference between patients treated surgically vs. non-surgically. FDG-avid pelvic and para-aortic nodes at initial presentation were associated with worse distant control after isolated pelvic failure (HR = 3.4, 95% CI 1.0-12). Median OS for patients treated with surgery, chemotherapy alone, and neither surgery nor chemotherapy was 29 months (95% CI 16-41), 12 months (95% CI 3-21), and 3 months (95% CI 1-5), respectively.
CONCLUSIONS: Patients who have pelvic and para-aortic nodal disease at initial presentation are at higher risk of failing distantly after isolated pelvic failure, which should be considered when counseling patients on aggressive surgical salvage. Surgical salvage was associated with prolonged survival after isolated pelvic failure.
ALK-rearranged lung adenocarcinoma patient with development of severe sinus bradycardia after treatment with crizotinib: A case report.
Medicine (Baltimore). 2019; 98(11):e14826 [PubMed] Free Access to Full Article Related Publications
PATIENT CONCERNS: A 64-year-old woman with a no-smoking history visited hospital in November 2016 because of a persistent cough, expectoration, and progressive dysphagia for 2 months.
DIAGNOSES AND INTERVENTIONS: She was diagnosed with primary lung adenocarcinoma, accompanied by pleural and bone metastases. After receiving chemotherapy for nearly 1 year, she showed progressive disease. DNA-sequencing identified an intergenic ALK rearrangement. Surprisingly, RNA-sequencing revealed the EML4-ALK fusion transcript. Subsequently, this patient switched to crizotinib therapy.
OUTCOMES: The patient achieved partial response after 1-month treatment. However, this patient suffered a severe sinus bradycardia after 4 months of treatment. When reducing the dose of crizotinib, the side effect was alleviated and this patient showed stable disease until now.
LESSONS: Given that the severe sinus bradycardia was an unusual adverse effect, physicians should be aware of these side effects when using crizotinib. Moreover, it should be noted that this patient harbored an intergenic ALK rearrangement identified by DNA-sequencing, but EML4-ALK fusion transcript verified by RNA-sequencing. However, the mechanism remains unknown and requires further research.
Percutaneous transforaminal endoscopic decompression in the treatment of spinal metastases: A case report.
Medicine (Baltimore). 2019; 98(11):e14819 [PubMed] Free Access to Full Article Related Publications
PATIENT CONCERNS: A 71-year-old woman with colon cancer and a known L3 vertebral body metastasis presented with significant progressive pain of low back and limbs.
DIAGNOSES: Magnetic resonance imaging (MRI) showed the L3 vertebral body had been involved by osteolytic vertebral metastasis, which extended into spinal canal and compressed the dural sac and nerve root.
INTERVENTIONS: The patient was treated with percutaneous transforaminal endoscopic decompression and palliative resection of metastases was performed twice on both sides, respectively. After the minimally invasive procedure, the decompression of the dural sac and nerve root was ideal.
OUTCOMES: No complications during the procedure were reported. The minimally invasive surgery resulted in prompt and permanent pain relief until the patient died 6 months later.
LESSONS: Percutaneous transforaminal endoscopic decompression could be an appropriate treatment option for the patients who suffer neurologic deficits that result from the spinal metastases.
Ann Nucl Med. 2019; 33(5):351-361 [PubMed] Related Publications
METHODS: A systematic search was performed in PubMed/Medline and EMBASE (last Updated, September 28, 2018). Studies with histopathology confirmation and/or clinical/imaging follow-up as reference standard were eligible for inclusion.
RESULTS: A total of 14 studies were included. Twelve studies including 507 patients provided per-patient basis information. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristics curve (AUC) of
Nomogram based on homogeneous and heterogeneous associated factors for predicting bone metastases in patients with different histological types of lung cancer.
BMC Cancer. 2019; 19(1):238 [PubMed] Free Access to Full Article Related Publications
PATIENTS AND METHODS: This study was a descriptive study that basing on the invasive lung cancer patients diagnosed between 2010 and 2014 in Surveillance, Epidemiology, and End Results program. A total of 125,652 adult patients were retrieved. Logistic regression analysis was conducted to investigate homogeneous and heterogeneous factors for BM occurrence. Nomogram was constructed to predict the risk for developing BM and the performance was evaluated by the receiver operating characteristics curve (ROC) and the calibration curve. The overall survival of the patients with BM was analyzed using the Kaplan-Meier method and the survival differences were tested by the log-rank test.
RESULTS: A total of 25,645 (20.9%) were reported to have BM, and the prevalence in adenocarcinoma, squamous cell carcinoma, small cell lung cancer (SCLC), large cell lung cancer (LCLC), and non-small cell lung cancer/not otherwise specified lung cancer (NSCLC/NOS) were 24.4, 12.5, 24.7, 19.5 and 19.4%, respectively, with significant difference (P < 0.001). Male gender, more metastatic sites and lymphatic metastasis were positively associated with BM in all lung cancer subtypes. Larger tumor size was positively associated with BM in all the lung cancer subtypes except for NSCLC/NOS. Poorly differentiated histology was positively associated with adenocarcinoma, squamous cell carcinoma and NSCLC/NOS. The calibration curve and ROC curve exhibited good performance for predicting BM. The median survival of the bone metastatic lung cancer patients was 4.00 (95%CI: 3.89-4.11) months. With the increased number of the other metastatic sites (brain, lung and liver metastasis), the survival significantly decreased (p < 0.001).
CONCLUSION: Different lung cancer histological subtypes exhibited distinct prevalence and homogeneity and heterogeneity associated factors for BM. The nomogram has good calibration and discrimination for predicting BM of lung cancer.
Uncommon Presentation of Metastatic Squamous Cell Carcinoma of the Skin and Treatment Challenges.
Am J Case Rep. 2019; 20:294-299 [PubMed] Free Access to Full Article Related Publications
Cervical carcinoma leading to orbital apex syndrome and blindness.
BMJ Case Rep. 2019; 12(3) [PubMed] Related Publications
The Contribution of the Immune System in Bone Metastasis Pathogenesis.
Int J Mol Sci. 2019; 20(4) [PubMed] Free Access to Full Article Related Publications
Biomarker discordance between primary breast cancer and bone or bone marrow metastases.
Jpn J Clin Oncol. 2019; 49(5):426-430 [PubMed] Related Publications
METHODS: We retrospectively enrolled patients with breast cancer metastasis to the bone or bone marrow, excluding cases where samples from both the primary and metastatic lesions were not available. Expression patterns of the estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) and Ki67 were compared in primary tumors and bone or bone marrow lesions.
RESULTS: Forty-six patients with a median age of 52 years (range, 34-72 years) were included in the study. Discordant rates of ER, PgR and HER2 were 20%, 46% and 0%, respectively. Physicians usually determined treatment options considering the results of biomarker re-evaluation. It is unlikely that biomarker discordance was related to prior treatment.
CONCLUSIONS: Biomarker discordance in bone or bone marrow lesions is common in patients with breast cancer. An accurate and thorough analysis of biomarkers and metastatic tumor properties is important for clinical decision-making.
Therapeutic effect of RA223 in the management of breast cancer bone metastases.
Clin Ter. 2019 Jan-Feb; 170(1):e1-e3 [PubMed] Related Publications
Assessment of the radiation absorbed dose produced by
Appl Radiat Isot. 2019; 146:66-71 [PubMed] Related Publications
Levels of Circulating Fibroblast Growth Factor 23 (FGF23) and Prognosis in Cancer Patients with Bone Metastases.
Int J Mol Sci. 2019; 20(3) [PubMed] Free Access to Full Article Related Publications
Tracking Cancer Cells Colonization in Rodent Bone Using Two-Photon Microscopy.
Methods Mol Biol. 2019; 1914:631-639 [PubMed] Related Publications
Mouse Models of Melanoma Bone Metastasis.
Methods Mol Biol. 2019; 1914:343-348 [PubMed] Related Publications
Animal Models of Breast Cancer Bone Metastasis.
Methods Mol Biol. 2019; 1914:309-330 [PubMed] Related Publications