Discussion Author: Miriam N Mikhail
Breast cancer remains the leading cause of death in women in the 40-44 age group. Breast metastases to bone are generally blastic, but can be lytic or mixed lytic/blastic. Patients with skeletal mets most commonly present with bone pain (70%), followed by the vague constellation of symptoms due to hypercalcemia (fatigue, depression, confusion, anorexia, nausea, constipation, renal tubule defects, polyuria, or short QT interval). Breast cancer is the second-most common neoplasm to cause release of PTHrp (following non-small cell lung cancer); hence, breast metastases do not uncommonly cause hypercalcemia, and usually NOT from local osteolysis. Of patients with metastatic disease to the skeleton and hypercalcemia, 80% of the cases of hypercalcemia are due to PTHrP but only 20% due to local osteolysis.
If a patient with skeletal metastases presents with acute neurologic impairment, a vertebral body lesion compressing the spinal cord may be found - 'spinal syndrome'; this is an indication for IMMEDIATE local irradiation (even in the middle of the night) and massive intravenous steroid therapy.
Note that 30-50% of bone has to be removed by a lytic lesion prior to becoming a conspicuous lucency on plain films!!!
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