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Metastatic bone disease from occult carcinoma: a profile

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Summary

To assess the general profile of metastatic bone disease from occult primary carcinoma, the records of 172 patients with skeletal metastases seen between 1965 and 1985 were reviewed. In 51 patients (30%), the origin of the primary could not be identified when bone metastases were first diagnosed. This group were predominantly male with a high incidence of spinal metastases, cord compression and pathological fractures, and a significantly shorter (P<0.1) survival compared with bony metastases when the primary was known. The site of the primary was established in 33 patients (65%), mostly at autopsy. Lung carcinoma was by far the most common primary tumour in 52% of the cases, while it accounted for only 7% of those with a diagnosed primary. We believe that the onset of bony metastases from an occult source must initially raise the possibility of lung carcinoma. If the primary remains undetected, it appears justifiable to assume it to be in the lung, since the probability of a missed lung tumour being responsible for the metastases is high.

Résumé

Les auteurs ont revu les observations de 172 malades porteurs de métastases osseuses, vus entre 1965 et 1985, afin d'apprécier l'aspect général des métastases provenant d'un cancer primitif méconnu. Chez 51 malades (30%) l'origine du cancer primitif n'avait pu être découverte lors du diagnostic de métastase osseuse. Ce groupe était à prédominance masculine, comportant un nombre élevé d'atteintes vertébrales, de compressions médullaires et de fractures pathologiques, et un taux de survie significativement plus court (P<0,1) comparativement à celui des métastases d'un cancer primitif connu. La localisation du cancer primitif a été découverte dans 33 cas (65%), la plupart du temps à l'autopsie. Le cancer du poumon était le plus fréquemment en cause (52%), alors qu'il n'était responsable que de 7% des cas quand le cancer primitif était connu. Il semble que l'apparition de métastases osseuses d'origine inconnue doive faire évoquer d'emblée la possibilité d'un cancer du poumon. Si le cancer primitif ne peut être découvert il est vraisemblable qu'il siège au niveau du poumon, la probabilité d'un cancer du poumon méconnu, responsable des métastases, étant élevée.

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References

  1. American Cancer Society (1983) Cancer statistics, 1983. CA Cancer J Clin 33: 2–25

    Google Scholar 

  2. Barz D (1974) Sektionsstatistische Untersuchungen der Metastasierung der malignen Geschwülste des weiblichen Genitale. Med Dipl Arbeit, Dresden

    Google Scholar 

  3. Berrettoni BA, Carter JR (1986) Mechanisms of cancer metastasis to bone. J Bone Joint Surg [Am] 68: 308–312

    Google Scholar 

  4. Cabanel G, Voog R, Phelip X, Riondel J (1969) Bone metastases of primary bronchial cancer. Rev Rhumatol Mal Osteoartic 38: 229–241

    Google Scholar 

  5. Didolkar MS, Fanous N, Elias EG, Moore RH (1977) Metastatic carcinomas from occult primary tumors. A study of 254 patients. Ann Surg 186: 625–630

    Google Scholar 

  6. Enneking WF (1983) Metastatic carcinoma. In: Enneking WF (ed) Musculoskeletal tumor surgery, Vol 2, p 1541. New York, Churchill Livingstone

    Google Scholar 

  7. Galasko CSB (1982) Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop 169: 20–27

    Google Scholar 

  8. Holmes FF, Fouts TL (1970) Metastatic cancer of unknown primary site. Cancer 26: 816–820

    Google Scholar 

  9. Johnston AD (1970) Pathology of metastatic tumors in bone. Clin Orthop 73: 8–32

    Google Scholar 

  10. Kreyberg L (1962) Histological lung cancer types. Acta Pathol Microbiol Scand Suppl 157

  11. Miller F, Whitehill R (1984) Carcinoma of the breast metastatic to the skeleton. Clin Orthop 184: 121–127

    Google Scholar 

  12. Moertel CG, Reitemeier RJ, Schutt AJ, Hahn RG (1972) Treatment of the patient with adenocarcinoma of unknown origin. Cancer 30: 1469–1472

    Google Scholar 

  13. Muggia FM, Hansen HH (1972) Osteoblastic metastases in small-cell (Oat-cell) carcinoma of the lung. Cancer 30: 801–805

    Google Scholar 

  14. Roth JA, Silverstein MJ, Morton DL (1979) Metastatic potential of metastases. Surgery 79: 669–671

    Google Scholar 

  15. Sherry HS, Levy RN, Siffert RS (1982) Metastatic disease of bone in orthopedic surgery. Clin Orthop 169: 44–52

    Google Scholar 

  16. Smith PE, Krementz ET, Chapman W (1967) Metastatic cancer without a detectable primary site. Am J Surg 113: 633–637

    Google Scholar 

  17. Springfield DS (1982) Mechanisms of metastasis. Clin Orthop 169: 15–19

    Google Scholar 

  18. Templeton AC (1973) Tumors of unknown origin. Recent Results Cancer Res 41: 302–305

    Google Scholar 

  19. Vincent TN, Satterfield JV, Ackerman LV (1965) Carcinoma of the lung in women. Cancer 18: 559–570

    Google Scholar 

  20. Shields W (1966) Neoplasms. In: Anderson WAD (ed) Textbook of Pathology, 5th ed. Mosby, St Louis, p 408

    Google Scholar 

  21. Weiss W, Boucot KR, Cooper DA (1970) The histopathology of bronchogenic carcinoma and its relation to growth rate, metastasis, and prognosis. Cancer 26: 965–970

    Google Scholar 

Download references

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Nottebaert, M., Exner, G.U., von Hochstetter, A.R. et al. Metastatic bone disease from occult carcinoma: a profile. International Orthopaedics 13, 119–123 (1989). https://doi.org/10.1007/BF00266372

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