#radonc

[teachingrounds]

Q. We interrupt this week of posts on bone metastases to ask, "Where did this lung metastasis come from?"

A. Statistically speaking it is most likely to be a carcinoma (colon, kidney, breast, testicle, thyroid), a sarcoma (bone), or melanoma. However, if it is a peripheral interstitial abnormality described as lymphangitic, it is more likely to be an adenocarcinoma (lung, breast, GI), melanoma, or lymphoma/leukemia.

Pro-Tip #1: Endobronchial mets are classically from renal cell carcinoma.

Pro-Tip #2: A miliary pattern should make you think of metastasized non-small cell carcinoma of the lung.

[radioactivelight]

I love getting random emails to the entire department. No clue what the cheese knife is or how it’s relevant to radiation oncology, but it’s definitely a euphemism for something. Love a good mystery

[teachingrounds]

We close this week on malignancies that metastasize to bone with a wry bit of medical student humour courtesy of Reddit: Cookies_72 complained, "I pay £9250 yearly for this medical education" and shared a screen shot of their lecture notes:

-All the "Bs" go to bone

-Breast, bung, bidney, byroid, brostate

[teachingrounds]

Instead of the lip-smacking, sandwich-topping mnemonic for malignancies that metastasize to bone BLTKP, if you use the more sedate "lead kettle," you can group the cancers with the kinds of mets they make in bone (mostly the spine):

Prostate--blastic lesions

Breast--mixed lesions

(Pb = lead)

Lung--lytic

Kidney--lytic

Thyroid--lytic

Source: Owen Kang and Juan Diego Soares Zambon et al., "Tumors that metastasize to bone (mnemonic)," Radiopaedia.

https://radiopaedia.org/articles/tumours-that-metastasise-to-bone-mnemonic-1

[teachingrounds]

You've probably heard that the malignancies most likely to metastasize to bone can be remembered with the mnemonic "Bacon, Lettuce, Tomato, and a Kosher Pickle," which stands for "breast, lung, thyroid, kidney, and prostate." It's catchy, because it fits an existing English phrase for yummy sandwich or burger toppings. But did you know there's another mnemonic that includes some information about what kind of mets the cancers make? Stay tuned tomorrow…

Image: Jorge Muniz, "Malignancies that metastasize to bone," Med Comics, 2013.

[cancer-researcher]

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[cancer-researcher]

[teachingrounds]

New back pain in a known cancer patient

New back pain in a known cancer patient is concerning for spinal cord compression: while you call neurosurgery and radiation oncology, give 10mg dexamethasone and order stat MRI with and without contrast of the thoracic and lumbar spine. 87% of patients who ambulate before the diagnosis of this emergent complication will ambulate afterward, but only 10% of patients unable to walk at time of diagnosis will regain this ability.

Pro-tip #1: The most likely malignancies to cause cord compression are lung cancer, breast cancer, and then prostate cancer.

Pro-tip #2: If the cancer diagnosis is new, try to hold off on steroids, as they could change the staging.