Metastatic Bone Disease as Seen in a Tertiary Care Cancer Center in Pakistan

Metastatic bone disease is the most common malignancy involving bone. The skeleton is the third most frequent organ involved by metastatic tumors and comes after lungs and liver in the list (Coleman, 2006). Most of the metastatic tumors are carcinomas and rarely sarcomas. Different studies have shown that 30-90% patients of common carcinomas have skeletal metastasis in their course of disease. The disease often affects older patients. In children, osseous metastasis is rare and occurs in cases of clear cell sarcoma of kidney, neuroblastoma, Ewing’s sarcoma/PNET and rhabdomyosarcoma. The common routes of involvement of bone include direct extension and/or lymphovascular spread. In this regard, location of the primary tumor and the local pattern of blood flow determine involvement of skeletal sites. At molecular level, it has been found that genetic evolution of metastatic cells confers tropism of metastatic deposits for specific bones. The growth of metastatic implant is regulated by its interaction with an array of