Diagnostics used for cancer induced bone pain

diagnosis

Patients may describe the pain as annoying, gnawing, aching, and nagging.

• most commonly seen in the lower back, pelvis, long bones, and ribs
  • patients with persistent pain (with or without active cancer) in these areas should be evaluated for the possibility of bone metastases since pain in bones may be the presenting feature of the primary cancer or may be due to recurrence of previously treated cancer

Vertebral pain in the presence of sensory disturbance, generalised leg weakness, or changes in bladder or bowel function may indicate spinal cord compression

Physical examination may be non specific – there can be some tenderness over the site of metastasis or movement related pain

Early diagnosis and treatment of impending spinal cord compression is important in improving quality of life in these patients, therefore a full neurological examination (even in the absence of "red flag" signs) should be carried out with a low threshold for a spinal magnetic resonance scan.

Initial investigation may include:

• plain film radiography – has low sensitivity: requires >50% cortical destruction to be visible
• computed tomography – more sensitive than plain radiography, best for ribs and pelvic and shoulder girdles

Other investigations carried out by specialists include:

• technetium 99m bone scan - whole skeleton can be assessed
• magnetic resonance imaging - high sensitivity; detects small metastases before bone damage occurs; optimal for cord compression
• fluorodeoxyglucose positron emission tomography
• fluorine positron emission tomography - most sensitive detection of bone metastases

Reference:

• (1) Kane CM, Hoskin P, Bennett MI. Cancer induced bone pain. BMJ. 2015;350:h315