Orthopedics and Traumatology Specialist Assoc. Dr. Merter Yalçınkaya drew attention to the importance of diseases that may cause bone pain in people over the age of 40 and said, “The number of people newly diagnosed with cancer is increasing every year, and this figure is over 1 million per year in the USA. Bone metastases develop in half of these patients. "Sudden onset of bone pain may be the first sign of metastasis, care should be taken." said.
When it comes to bone pain that occurs without any trauma in a person over the age of 40, fortunately, bone cancer or bone metastasis are not at the top of the list of disorders that should come to mind. We should review metabolic conditions such as osteopenia and osteoporosis, bone blood supply problems such as osteonecrosis, bone infections, stress fractures, rheumatic disorders such as ankylosing spondylitis and rheumatoid arthritis as possible causes, and plan their treatment as soon as we make the diagnosis. However, if we cannot detect these disorders, we should definitely take bone cancer and bone metastasis cases into the agenda and plan our examination strategies accordingly.
If You Are Over 40, Pay Attention to Multiple Myeloma and Lymphoma
The skeletal system is the third most common site of metastasis after the lung and liver. In bone metastases, which are frequently seen over the age of 40, the most common source of metastasis is breast, prostate, lung, kidney and thyroid tissues. In a person over the age of 40 who comes to the polyclinic with bone pain and has a suspicious lesion on the x-ray of the relevant bone, the first three differential diagnoses are bone metastasis, multiple myeloma and lymphoma. Other elements of the differential diagnosis following these diseases are bone cancer (such as chondrosarcoma, osteosarcoma), sacral insufficiency fractures, post-radiation or Paget's sarcoma, giant cell tumor of the bone, hyperparathyrodism and histiocytosis syndromes.
Patient's Complaints Should Be Taken into Consideration
In case of such a doubt, the first thing to do should not be to request a PET-CT. Correct treatment starts with taking a correct anamnesis, that is, one should not start without taking a good history of the patient. Character of bone pain (whether at rest or It is necessary to carefully question the existence of conditions such as weight loss, fatigue, decreased appetite, presence of a family history of cancer, blood in urine, shortness of breath. Physical examination findings should then be noted. Physical examination findings that may be important include swelling in the arm or leg, limping, decreased joint movements, neurological findings, palpable mass during breast-prostate-thyroid-abdominal examination, blood in the stool, and enlargement of regional lymph nodes.
Complete Analyzes Should Be Performed After Physical Examination Findings
A complete analysis list is needed after taking the history and physical examination. If we suspect bone metastasis in a patient, the tests the results of which may be needed are as follows: Complete blood count, serum immunoelectrophoresis, determination of Kendi Jones proteinuria in urine, thyroid function tests, urinalysis, calcium, phosphorus, alkaline phosphatase, LDH, PSA, CEA, CA125, CA19. .9 and CA15.3.
Following the analysis, radiological examinations can be carried out. In such a patient, two-way radiography of the painful bone, whole body bone scintigraphy, and computed tomography of the thorax-abdomen-pelvis regions should be primarily requested. In case of suspicion of bone metastasis, MRI examination of the painful bone may be needed, if not to investigate the origin of the organ metastasizing to the bone, then for orthopedic oncological treatment planning. Investigating the origin of the organ metastasizing to the bone with MRI can only be done by whole body MRI scanning, and this method has not yet been included in the routine examination list. Contrary to popular belief, another method that has not yet been included in the routine examination list is PET-CT. There are definitely places where PET-CT is needed in cases of suspected bone metastasis, but it should be known that it is not in the first place of the research steps.
After taking the patient's history perfectly, performing a complete physical examination, and completing all laboratory and radiological examinations, the cause of bone metastasis is determined. The origin of the organ that was formed can be determined with 85% probability. There is a 15% probability that this origin cannot be found despite detailed research. In such a case, it may be necessary to perform a bone biopsy.
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