![]() ![]() Radiographs are usually obtained as initial exam in the case of symptomatic patients to assess for bone lesions or a pathological fracture. Obtaining dedicated imaging studies is indicated at initial staging or when a patient presents with symptoms such as bone pain. On average patients suffer a SRE every 3 to 6 months, usually in periods of progression of their disease. More than half of these patients will suffer at least one SRE which will cause morbidity, will impair function and quality of life along with increased costs to the patient and health care system. SREs are more likely to occur after a prior SRE has taken place. Approximately 10–30% of lung cancer patients will suffer a pathological fracture, fact that worsens survival times compared to patients without a fracture ( Bone pain is present in about 80% of lung cancer patients at some point during their disease. Bone metastases are known to cause pain and several other complications such as pathologic fractures, hypercalcemia, spinal cord and nerve compressions and cause the requirement for surgery and/or radiotherapy, all of these are known as skeletal related events (SRE). Acral metastases are associated with a poor prognosis. Less than 1% of bone lesions are present below the elbow or distal to the knee, but when those, also known as acral metastases, are present 44% are originated in the lung ( The axial bones are the most frequent location of bone lesions, the vertebral bodies being the most common followed by ribs, pelvis and calvarium ( An increased number of bone lesions is a reflection of more aggressive disease and as such is associated with decreased survival and a poor prognosis. Obvious bone lesions are found in about 36% of these patients, while micro-metastasis in up to 60% of the lung cancer population. Occult primary malignancies occur in 4% of the cancer patients. Likewise, bone metastases can be the initial presentation of an occult lung cancer. Additionally, bone is the third most common site of spread for most cancers after lung and liver. Within the subtypes of lung cancer, adenocarcinoma is the subtype with the highest incidence of bone lesions. Prostate, breast and lung are the most common cancers to cause bone secondary disease. Bone seeding is more frequent in the trunk bones due to a richer bone marrow, vast in blood vessels. This event occurs via blood stream or lymphatic pathways. Bone metastases occur when the tumor has spread from its original site, the lung, to bones. ![]() This disease tends to have an asymptomatic presentation, leading to many of these patients presenting at a later stage with disease already spread to other sites. Lung cancer has different subtypes, the most frequent being Non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma those comprise 80% of the lung cancer cases. Additionally, this disease is also expected to cause more than 130.000 deaths yearly, being responsible for a fourth of the cancer fatalities in this country as well. More than 235.000 new cases are expected to occur this year in the United States only. Lung cancer is the second most common cancer, for both genders. ![]()
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