Bone Metastases

1 The Nature of Metastatic Bone Disease.- Biology of Bone Metastases.- Patterns of Bone Metastases.- Morbidity from Bone Metastases.- Assessment of Skeletal Disease.- 2 Normal Bone Remodelling and Its Disruption in Metastatic Bone Disease.- Normal Bone Structure.- Normal Bone Modelling.- Normal Bone Remodelling.- Regulation of Bone Remodelling.- Effects of Tumours on Bone.- Osteosclerosis.- Effects of Some Specific Tumour Cell Types in Bone.- Summary.- 3 The Bone Scan in Metastatic Disease.- Pathophysiology of Skeletal Uptake of Diphosphonate.- Bone Scan Imaging.- Breast Cancer.- Prostatic Cancer.- Other Genito-urinary Tract Tumours.- Lung Cancer.- Neuroblastoma.- Other Tumours.- 4 Radiology.- Skeletal Survey.- Distribution and Routes of Spread.- Radiographic Appearances.- Computed Tomography.- Radiological Appearances at Specific Sites.- Radiological Appearance of Specific Metastases.- Comparison of Skeletal Survey and Isotope BoneScans.- Response to Treatment.- Summary.- 5 Magnetic Resonance Imaging.- Principles of Magnetic Resonance Imaging.- Technical Considerations.- MRI of Normal Bone Marrow.- MRI of Pathological Bone Marrow.- Comparison of Malignant and Osteoporotic Vertebral Collapse.- Patterns of Vertebral Metastases.- Sensitivity of MRI.- Spinal Cord Compression.- Monitoring Response to Treatment.- Conclusions.- 6 Assessment of Response to Treatment.- Imaging of Bone Metastases.- Biochemical Monitoring.- Subjective Assessment.- Tumour Markers.- Suggestions for Future Study.- 7 The Systemic Treatment of Bone Metastases.- Systemic Therapy.- Direct Anti-tumour Therapy.- Inhibitors of Tumour Effects on Host Cells.- Conclusions and Prospects.- 8 Pathogenesis and Management of Cancer-Associated Hypercalcaemia.- Pathogenesis of Cancer-Associated Hypercalcaemia.- Classification.- Mediators of Hypercalcaemia.- Mechanisms of Hypercalcaemia: Summary.- Management of Cancer-Associated Hypercalcaemia.- Clinical Assessment.- Indications for Treatment.- Principles of Medical Management.- Specific Management Problems.- 9 Radiotherapy in the Management of Bone Metastases.- Principles of External Beam Irradiation.- Radiotherapy Treatment Techniques for Bone Metastases.- Biological Effects of Ionising Radiation.- Pathological Changes after Bone Irradiation.- Clinical Use of Radiotherapy for Bone Metastases.- Conclusion.- 10 Isotope Therapy for Bone Metastases.- Characteristics of Radionuclides Used for Therapy.- The Criteria for Selection.- Mechanisms for Localisation.- The Use of Radionuclides for Therapy.- Radiopharmaceuticals for Therapy.- Monoclonal Antibodies.- Radionuclide Therapy for Bone Metastases: Current Status.- The Future.- 11 The Role of the Orthopaedic Surgeon in the Treatment of Skeletal Metastases.- Impending Fractures.- Pathological Fractures.- Non-pathological Fracture in a Patient with Malignant Disease.- Spinal Instability.- Compression of the Spinal Cord or Cauda Equina.- Non-metastatic Orthopaedic Conditions in Patients with Malignant Disease.- 12 Symptomatic and Supportive Care.- The Use of Drugs to Control Pain from Bone Metastases.- Orthopaedic Surgical Treatment.- Radiotherapy.- Transcutaneous Nerve Stimulation.- Acupuncture.- Intercostal Nerve Block.- Paravertebral Block.- Dorsal Root Ganglion Rhizolysis.- Percutaneous Cervical Cordotomy.- Pituitary Alcohol Injection.- The Place of the Support Team.- Conclusion.