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[Bone metastasis of breast cancer denotes progression of the disease process resulting in increased morbidity and a decrease in quality of life. Early diagnosis and treatment may help minimize pain and improve function. Metastatic lesions from the breast are commonly osteolytic but may be osteoblastic or mixed in nature and are mediated by the RANKL or endothelin1 pathway. The spine and proximal femur are the commonest sites of involvement. Patients are often in pain which is made worse by pathological fractures. Spinal cord compression may occur in vertebral fractures with the presence of neurological deficits. A complete workup is essential to delineate the metastatic lesion and determine the structural integrity of the pathological site. Bisphosphonates decrease osteoclastic activity and are administered to delay or prevent skeletal events. Indications for surgical management of metastatic bone disease include impending fractures, pathologic fractures of long bones and pelvis, untreatable bone pain, instability, and spinal cord compression. Spinal decompression and stabilization is indicated if the metastatic lesion is accompanied with weakness in the extremities. Impending or complete fractures of the long bones will necessitate internal fixation permitting early mobilization and pain relief. Surgical treatment of bone metastasis has not been reported to improve survival.]
Published: Sep 6, 2014
Keywords: Breast cancer; Bone metastasis; Spinal decompression; Internal fixation
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