Epidemiology
In adults, a malignant lesion of the bone is more often a metastasis from another cancer than a primary sarcoma. The first goal is to determine whether the bone can bear weight and whether there is a fracture risk, because that can change how urgent treatment is.
Basic features
It can cause pain, a pathologic fracture, neurological compression, or calcium disturbances. Seek urgent care for bone or back pain that is severe, progressive, or mechanical, an inability to bear weight, a fracture from minimal trauma, or new weakness or numbness. The appearance of a new neurological deficit, worsening of gait, or loss of bladder or bowel control can be an oncological emergency and requires immediate attention.
Usual treatment
Care coordinated with oncology: systemic treatment of the cancer, radiotherapy, bone-targeted agents when appropriate, surgical stabilization or reconstruction when there is a risk of fracture, and, in selected cases, interventional treatments. In a single bone metastasis from kidney or thyroid cancer, en-bloc resection of the segment may be considered instead of fixation alone. Before surgery on a highly vascular metastasis — mainly from kidney cancer and sometimes thyroid cancer — embolization may be performed to reduce bleeding. If there is no already-known primary cancer, a destructive bone lesion must be biopsied before any surgical treatment: treating it as a metastasis without confirmation can delay the diagnosis of an unsuspected primary bone sarcoma and worsen the prognosis.
Outcomes and prognosis
The main goal is to control pain, protect function, and prevent complications. Survival depends on the cancer of origin and varies widely (from months to several years), not on the behavior of the bone lesion itself.