REFERAT

Metastatic Bone
Disease
Muhammad Riyadli

Pembimbing:
dr. Mujaddid Idulhaq, SpOT (K), M.Kes
Introduction

 MBD is the most frequent complication

carcinoma
 US :
 1,2 million new case
 600.000  tumors that often metastasized to the
bone (Ca mammae, lung, ren, prostat)
 60-80 % of all case invade the bone
 70% experience of bone pain
 Increased risk: Pathological fracture, spinal cord
compression, Hypercalcemia
 15-30% MBD  unknown primary source
Introduction
Introduction

Site of Bone
Metastasis:
• Spine
• Pelvis
• Ribs
• Skull Red areas show sites
of highest blood
• Upper Arm flow

• Long Leg Bones Yellow areas show

sites of medium
blood flow
Patogenesis

Mechanism of MBD:
 Seed & Soil Theory
 Seed : Cancer Cell
 Soil : Secondary Organ
 Circulatory Pattern between a primary tumor and
specific secondary organs
Patogenesis
Osteclastic Osteoblastic
Osteclastic Osteoblastic
 Diagnosis

History

Clinical

Laboratory

Radiologic

Histo PA
Diagnosis

 Age 50-70
 No Symptoms
 History of Cancer
 General weakness
 Pain
 Progressive
 Localized
 Night pain (+)
Diagnosis
Laboratory
Diagnosis
Radiologic

X - Ray

Radioscintigraphy

CT-Scan

MRI
Diagnosis
Radiologic

X - Ray

Radioscintigraphy

CT-Scan

MRI
Diagnosis
Radiologic

X - Ray

Radioscintigraphy

CT-Scan

MRI
Diagnosis
Radiologic

X - Ray

Radioscintigraphy

CT-Scan

MRI
Diagnosis
Histo PA

FNAB – CT
FNAB
Guided

Core Biopsy Open Biopsy

Diagnosis
Diagnosis
Treatment
Goals
1. Pain Relief
2. Treat the pathological fractures or
impending fractures
3. Treat the complications :
a. Hypercalcemia
b. Spinal Cord Compression

The Principle is Palliative Treatment

Treatment
Treatment
Treatment

 Systemic Treatment  Local Treatment

• Pain Management • Radiotherapy

• Inhibition Bone Destruction • Radionucleotide
• Chemotherapy • Surgery
• Hormonal Therapy
 Treatment
FRACTURES ???

Fracture Care : Goals :

1. Provide immediate stability
2. Fracture will not united
3. Fixation should aim to last
the lifetime of the patient
1. Relieve pain
2. Improving function and
ambulation
3. Facilitate medical and
nursing care
4. Increasing quality of life

Principle of surgery : internal fixation/ prosthetic replacement + PMMA

Treatment
Prophylactic Fixation