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Carcinoma, metastatic — Clinical Guidelines

Overview

Metastatic carcinoma refers to cancer that has spread from its primary site to distant organs or tissues, often complicating treatment and prognosis. Metastases can occur in various locations including bone, soft tissues, and uncommon sites such as the adrenal glands, spermatic cord, and even within skeletal muscle fibers 1 4 8 9 10 12.

Diagnosis

Clinical Presentation: Varies widely depending on metastatic site; cranial nerve palsy, bone pain, and mass effects are common 2 3 6 7.

Imaging: CT, MRI, and PET scans are crucial for identifying metastatic lesions 1 3 5.

Histopathology: Essential for confirming the origin and nature of the metastatic deposits 4 10 11.

Special Imaging Signs: "Head light" sign on sonography indicative of bilateral adrenal metastases 8.

Management

Palliative Treatments:

- Oral Agents: Dichloroacetate (DCA) for symptom relief in specific cases 1. - Radionuclide Therapy: Tin-117m for palliation of painful osseous metastases 5.

Surgical Interventions:

- Palliative Amputations: Forequarter amputation for uncontrolled shoulder girdle metastases 3.

Targeted Therapies: Not specifically detailed in abstracts provided.

Special Populations

Elderly: Palliative approaches like forequarter amputation may be considered for uncontrolled shoulder girdle metastases 3.

Comorbidities: Management tailored to specific metastatic sites and patient comorbidities, with imaging and histopathology guiding treatment 1 2 3 5 8 10 12.

Key Recommendations

Utilize imaging techniques (CT, MRI, PET) for comprehensive assessment of metastatic disease 1 3 5.

Consider palliative surgical interventions like forequarter amputation for uncontrolled shoulder girdle metastases 3.

Explore palliative oral agents such as dichloroacetate for symptom management in specific metastatic scenarios 1.

(Evidence: Moderate)

References

1 Khan A. Use of oral dichloroacetate for palliation of leg pain arising from metastatic poorly differentiated carcinoma: a case report. Journal of palliative medicine 2011. link 2 Kumudhan D, Jamieson A, Sanders R. Metastatic carcinoma presenting as cranial nerve palsy. Scottish medical journal 2005. link 3 Wittig JC, Bickels J, Kollender Y, Kellar-Graney KL, Meller I, Malawer MM. Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results. Journal of surgical oncology 2001. link 4 Maheshwari V, Alam K, Khan SA, Upadhyay V, Beg MH. Metastatic adenocarcinoma rib presenting as chondrosarcoma. The Indian journal of chest diseases & allied sciences 2000. link 5 Atkins HL, Mausner LF, Srivastava SC, Meinken GE, Straub RF, Cabahug CJ et al.. Biodistribution of Sn-117m(4+)DTPA for palliative therapy of painful osseous metastases. Radiology 1993. link 6 Martin KA, Dove AF. Metastatic carcinoma of the hand. The Hand 1983. link 7 Nagendran T, Patel MN, Gaillard WE, Imm F, Walker M. Metastatic bronchogenic carcinoma to the bones of the hand. Cancer 1980. link45:4<824::aid-cncr2820450436>3.0.co;2-d) 8 Zornoza J, Bernardino ME. Bilateral adrenal metastasis: "head light" sign. Urology 1980. link90553-1) 9 Slatkin DN, Pearson J. Intramyofiber metastases in skeletal muscle. Human pathology 1976. link80044-5) 10 Gyori E. Metastatic carcinoma in meningioma. Southern medical journal 1976. link 11 Hockley AD. Metastatic carcinoma in a spinal meningioma. Journal of neurology, neurosurgery, and psychiatry 1975. link 12 Monn L, Poticha SM. Metastatic tumors of spermatic cord. Urology 1975. link90366-0)

Carcinoma, metastatic