Management of Metastatic Disease to the Musculoskeletal System

TABLE OF CONTENTS:
I. INTRODUCTION

Incidence and Effect on Society 
Molecular Mechanisms of Metastatic Disease 
Pathology of Metastatic Disease

II. CLINICAL PRESENTATION
Symptoms and Serologic Findings 
Conventional Techniques in Radiologic Evaluation 
Role of Bone Scanning and PET Scanning 
Computer Tomography and Magnetic Resonance Imaging in Radiologic
Evaluation
Interventional Radiology: Biopsy and Embolization

III. NONOPERATIVE TREATMENT
Therapy Affecting Bone Resorption andDeposition
Radiation Therapy
Pharmacologic Management of Bone CancerPain 
Terminal Care and Psychological Consequences of Chronic Bone
Cancer Pain

IV. MANAGEMENT OF SPECIFIC TUMORS METASTATIC TO BONE

Breast Cancer 
Endocrine Cancer 
Gastrointestinal Cancer 
Gynecologic Cancer 
Hematologic Cancer 
Lung Cancer 
Malignant Melanoma and Other Skin Lesions 
Neural Tumors 
Prostate Cancer 
Metastatic Sarcomas 
Urinary Tract Cancer

V. METASTATIC DISEASE TO THE AXIAL SKELETON AND PELVIS

Metastatic Disease of the Jaw and Skull 
Classification of Spinal Metastases 
Nonoperative vs. Operative Treatment of the Spine 
Metastatic Disease of the Cervical Spine 
Metastatic Disease of the Thoracic Spine and Ribs 
Metastatic Disease of the Lumbar Spine and Sacrum 
Metastatic Disease of the Pelvis and Acetabulum

VI. METASTATIC DISEASE TO THE EXTREMITIES

Nonoperative vs. Operative Treatment of Extremity Metastatic
Disease 
Biomechanics of Extremity Fixation in Metastatic Disease 
Metastatic Disease of the Femoral Neck and Shaft 
Metastatic Disease of the Distal Femur 
Metastatic Disease of Tibia and Foot 
Metastatic Disease of the Humerus and Shoulder Girdle 
Metastatic Disease of the Distal Humerus, Elbow, Forearm, and
Hand 
Soft Tissue Metastases

VII. COMPLICATIONS OF TREATMENT

The Effect of Radiation on Tissue and Wound Healing 
Reconstructions in Delayed Wound Healing 
Paraneoplastic Syndromes 
Failure of Fixation in Metastatic Disease to the Pelvis and
Extremities