Bony metastases

These are involved in therapy for palliation of bony metastases which are found in breast and prostate cancer. 

Severe adverse effects are unusual with tamoxifen but patients with bony metastases may experience an exacerbation of pain, sometimes associated with hypercalcaemia this reaction corn-... 

A 3-year-old boy with a neuroblastoma was given cispla-tin, adriamycin, and cyclophosphamide for five induction cycles and radiation to sites of residual bony metastases 1 month before autologous bone-marrow transplant, which resulted in an absolute neutrophil count of 500 x 10 /1 on... 

BAP is increased in metabolic bone diseases, including osteoporosis, osteomalacia and rickets, hyperparathyroidism, renal osteodystrophy, and thyrotoxicosis, and in individuals with acromegaly, bony metastases, glucocorticoid excess, Paget s disease, and other disorders with increased bone formation." ... 

Marrow disorders 40% of hypoplasia 10% of extensive bony metastases 50% of myelosclerosis... 

A complete understanding of why specific metal complexes target certain tissues has yet to be achieved, but would be extremely valuable for the rational design of new radiopharmaceuticals. Complexes of 99mTc vvilli diphosphonates, e.g. methylenediphosphonate, localize in bone and especially in areas of disturbance of bone metabolism, such as tumours thus they may be used to map the presence and location of bony metastases from various types of cancer. Chelates such as "Tc-DTPA may be used to study differential renal function in the kidneys or to monitor the function of a transplanted kidney. Attachment of chelating groups, often based on DTPA, to antibody proteins permits the formation of Tc- or in-labelled antibodies for tumour localization. 

Myeloma is characterized by bony metastases. and bone p iin is often the presenting symptom. In the face of increasing synthesis of abnonnal itiimuno-globulins, other bone marrow function is reduced, and there is a decline in red and white cell and platelet formation and decreased production of nomial inmiuno-globulins. Anaemia and susceptibility to infection are the consequences. Treatment of myeloma involves the use of bone marrow suppressive dnigs. Plasmapheresis (replacement of the patient s plasma with normal plasma, w ith retention of his or her ow n cellular components) has been used in the treatment of myeloma and macro-globulinaemia. 

Zoledronic acid (zometa) is a bisphosphonate (see Chapter 61) indicated for the treatment of patients with bony metastases and for patients with MM. A direct antitumor effect on myeloma cells has been proposed some data suggest that inhibition of bone matrix-degrading proteinases may inhibit tumor ceU invasion in breast and prostate cancers. 

Laboratory testing is likewise frequently utuevealing imtil advanced disease occnrs. Anemia and positive fecal occult blood testing may be present. Liver tests may be elevated in metastatic liver disease, while the alkahne phosphatase and calcium may be elevated with bony metastases. While certain tnmor markers may be elevated (CEA, CA... 

Compounds 1 and 2 are hypothesized to be able to deliver either high doses of radiation or a high concentration of chemotherapy agents at sites of increased osteoclastic activity in patients with bony metastases, while exhibiting minimal toxicity to normal tissues. 

Blythe JG, Cohen MH, Buchsbaum HJ, Latourette HB (1975) Bony metastases from carcinoma of cervix. Occurrence, diagnosis, and treatment. Cancer 36 475-484... 

Fig. 17.12a,b. ovarian vein thrombosis. CT scans at the level below the renal hilum (a) and lower lumbar region (b). In a patient with bony metastasizing breast cancer (m), a nonoccluding thrombus (arrow) is identified within the dilated right ovarian vein (b). At the level just below the renal hilum, the renal vein (arrowhead) is patent (a)... 

Fig. 35.4. a T1-weighted image postcontrast with fat saturation shows bilateral diffuse enhancement within the sacral wings. Since the patient preciously had a carcinoma of the uterus and because of increased uptake in the bone scan, bony metastases were suspected, b CT shows serpiginous sclerosis within the sacrum parallel to the sacroiliac joint typical for sacral insufficiency fractures. The patient had previously received radiation therapy of the pelvis, which is known to result in local osteoporosis with weakening of the bone. The patient was followed-up, and bisphosphonates were administered... 

Diclofenac is also used off-label or for investigational trials in chronic pain patients with cancer, especially when inflammation is present. Examples include patients with breast or prostate cancer with bony metastases. 

Lonsdale-Eccles AA, Carmichael AJ. Opioid antagonist for pruritus of cholestasis unmasking bony metastases. Acta Der-mato-Venereol 2009 89(1) 90. 

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