常發生骨轉移或脊椎轉移的原發性腫瘤(Primary tumors that often leads to bone or spinal metastasis)

 

脊椎、骨骼相關疼痛原因有很多可能性(例如下背痛可能的原因) 

原發性腫瘤遠端轉移是其中一種

那麼，有哪些腫瘤較容易發生骨轉移及脊椎轉移呢？

根據研究

大約有三分之二的癌症患者會發展出骨轉移 

美國每年有大約 35 萬人死於骨轉移 

有時骨轉移在臨床上不可見，只有在大體解剖時才能發現，因此無法報告骨轉移的實際發生率 

骨轉移實際上比原發性骨癌更常見，發生比率為 25比1

骨骼是癌症轉移第三常見的部位，僅次於肺部及肝臟

最常導致骨轉移的原發性腫瘤依發生率順序為：「攝護腺癌、乳癌、腎臟癌、肺癌和甲狀腺癌。」

其他常發生骨轉移的腫瘤：黑色素瘤、淋巴瘤、肉瘤(sarcoma)和胃腸道惡性腫瘤，以及子宮癌。

大約三分之二的脊椎轉移來自肺癌 (24.6%) 、前列腺癌 (20.7%)和乳癌 (16.5%)

若以平均累積發病率計算(mean cumulative incidence )則為前列腺癌 (20.04%)、肺癌 (17.68%)、和乳癌 (10.94%)

其中大約9％的脊椎轉移病例無法確定原發腫瘤來源

根據大體解剖研究

骨轉移的發生率為：

乳癌 73%（範圍為 47% 至 85%）

攝護腺癌 68%（範圍為 33% 至 85%）

甲狀腺癌 42%（範圍為 28% 至 60%）

肺癌 36%（範圍為 30% 至 55%）

腎臟癌 35%（範圍為 33% 至 40%）

食道癌 6%（範圍為 5% 至 7%）

胃腸道癌 5%（範圍為 3% 至 11%）

直腸癌 11%（範圍為 8% 至 13%）

另外根據其他研究

除了上列癌症

膀胱癌(40%)及黑色素瘤(14-45%)亦有較高的骨轉移機率

 References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265280/

https://www.sciencedirect.com/science/article/pii/S2212137422000367

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444408/

https://www.uptodate.com/contents/epidemiology-clinical-presentation-and-diagnosis-of-bone-metastasis-in-adults

Red flags of low back pain

Low back pain is a highly prevalent disease (up to 84% of adults have low back pain at some time in their lives).

There are many different versions of treatment guidelines from different countries.

Some review articles had summarized some common clinical red flag symptoms from these guidelines

 

 

Malignancy        History of malignancy (e.g., cancer, neoplasm) 

                          Unexpected weight loss 

Fracture             Significant trauma 

                         prolonged use of corticosteroid 

Infection            Fever 

                         HIV 

Cauda equina syndrome (CES)   Saddle anesthesia/perineal numbness

                                                   (Sudden onset) Bladder dysfunction (e.g. urinary retention, overflow incontinence)

                                                   Fecal incontinence

                                                   Progressive weakness in lower limbs/lower motor neuron weakness

 

Although some guidelines suggest "red flag" symptoms as an indication for earlier imaging exams, there are limited data to support the use of most of the red flags as an indication for early imaging.

However, when these symptoms occur, patients and healthcare professional should be aware of it.

 

Reference: https://pubmed.ncbi.nlm.nih.gov/29971708/

                   https://link.springer.com/article/10.1007/s00586-016-4684-0

 

 

 

下背痛的“紅旗”徵兆

下背痛是個高盛行率的疾病(約84%的成人曾有過下背痛)

因此有許多各種版本的治療指引來自各個國家

一些review articles根據這些臨床指引

整理出共通臨床應當注意的紅旗徵兆（危險徵象）

 

惡性腫瘤    腫瘤病史（癌症、腫瘤）

                    意料之外的體重減輕

骨折            重大外傷

                    長期使用類固醇

感染            發燒

                    人類免疫缺乏病毒感染

馬尾症候群  鞍部麻木/會陰部麻木

                   （突然發生的）膀胱功能障礙（尿滯留、滿溢性尿失禁）

                     大便失禁

                     嚴重下肢無力/下運動神經元無力

 

雖然有些治療指引將紅旗症狀視為早期影像學檢查的適應症

但目前支持這種作法的數據仍有限

不過

當有這些症狀時

病患及醫療人員仍要非常小心及注意

 

參考資料：https://pubmed.ncbi.nlm.nih.gov/29971708/

                   https://link.springer.com/article/10.1007/s00586-016-4684-0

背痛的危險因子 Risk factors associated with back pain complaints

吸煙 smoking

肥胖 obesity

年齡 age

女性 female sex

體力勞動的工作 physically strenuous work

久坐不動的工作 sedentary work

精神壓力大的工作 psychologically strenuous work

心理因素(身心症、焦慮、抑鬱等) psychologic factors  (somatization disorder, anxiety, and depression)

 

 

 

 

 

What are the possible causes of low back pain?

There are many causes of low back pain, which can be divided into three main categories-

 

Mechanical low back pain:

arises intrinsically from the spine, intervertebral disks, or surrounding soft tissues

Ex: Herniated disc, Degenerative disease, Spondylolisthesis, Spinal stenosis, Osteoporosis, Fractures, Congenital disease (Severe kyphosis, scoliosis, transitional vertebra)...etc.

 

Nonmechanical spine disease:

spine disease caused by other origin

Neoplasia, Infection, Inflammatory arthritis (often HLA-B27-associated), Scheuermann disease, Paget disease

 

Visceral disease: 

Renal disease, Gastrointestinal disease, Pelvic organ disease, Aortic aneurysm, Fat herniation of lumbar space

 

If you have any relevant problems, please go to a qualified medical facility for evaluation and treatment by healthcare professional.