Bone Metastases - Orthopaedic Postgraduate Teaching MBBS Notes | EduRev

 Page 1


Bone Metastases 
Kenneth Rankin 
Orthopaedic Postgraduate Teaching 
22nd November 2010 
Page 2


Bone Metastases 
Kenneth Rankin 
Orthopaedic Postgraduate Teaching 
22nd November 2010 
Overview 
• Molecular mechanisms 
• Origin & distribution 
• Clinical features 
• Medical management 
• Surgical management 
• Cases 
 
Page 3


Bone Metastases 
Kenneth Rankin 
Orthopaedic Postgraduate Teaching 
22nd November 2010 
Overview 
• Molecular mechanisms 
• Origin & distribution 
• Clinical features 
• Medical management 
• Surgical management 
• Cases 
 
Molecular mechanisms of metastasis 
 
 
 
 
• Analysis of 735 autopsy records of breast 
cancer patients 
• Identified a non-random pattern of 
metastases 
• The Lancet 1889 : ‘seed and soil hypothesis’ 
Dr Stephen Paget 
Surgeon & pathologist 
1855-1926 
Page 4


Bone Metastases 
Kenneth Rankin 
Orthopaedic Postgraduate Teaching 
22nd November 2010 
Overview 
• Molecular mechanisms 
• Origin & distribution 
• Clinical features 
• Medical management 
• Surgical management 
• Cases 
 
Molecular mechanisms of metastasis 
 
 
 
 
• Analysis of 735 autopsy records of breast 
cancer patients 
• Identified a non-random pattern of 
metastases 
• The Lancet 1889 : ‘seed and soil hypothesis’ 
Dr Stephen Paget 
Surgeon & pathologist 
1855-1926 
Integrin 
Extracellular matrix 
Cadherin 
Dysregulation of these allows cancer cells to breakaway from the ECM and other cells 
Page 5


Bone Metastases 
Kenneth Rankin 
Orthopaedic Postgraduate Teaching 
22nd November 2010 
Overview 
• Molecular mechanisms 
• Origin & distribution 
• Clinical features 
• Medical management 
• Surgical management 
• Cases 
 
Molecular mechanisms of metastasis 
 
 
 
 
• Analysis of 735 autopsy records of breast 
cancer patients 
• Identified a non-random pattern of 
metastases 
• The Lancet 1889 : ‘seed and soil hypothesis’ 
Dr Stephen Paget 
Surgeon & pathologist 
1855-1926 
Integrin 
Extracellular matrix 
Cadherin 
Dysregulation of these allows cancer cells to breakaway from the ECM and other cells 
Loss of adhesion 
?E-Cadherin expression 
 
 
 
 
 
 
 
 
 
 
 
 
VEGF 
Resident blood vessel 
Primary site 
Zone of  
severe 
hypoxia 
HIF 
Intravasation  
(Interaction with  
Endothelial cells) 
HIF= Hypoxia inducible factor 
VEGF= Vascular 
            endothelial  
            growth factor