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Introduction to orthopaedic surgery in the palliation of cancer Introduction to orthopaedic surgery in the palliation of cancer
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Patient presentation Patient presentation
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Evaluation of a patient with a bone lesion Evaluation of a patient with a bone lesion
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Imaging of patients with metastatic bone disease Imaging of patients with metastatic bone disease
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Plain radiographs Plain radiographs
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Bone scintigraphy Bone scintigraphy
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Computed tomography Computed tomography
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Magnetic resonance imaging Magnetic resonance imaging
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Positron emission tomography Positron emission tomography
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Therapeutic considerations in patients with metastatic bone disease Therapeutic considerations in patients with metastatic bone disease
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Classification and characterization of impending pathological fractures Classification and characterization of impending pathological fractures
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Bone biology and biomechanics Bone biology and biomechanics
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Types of orthopaedic surgical interventions Types of orthopaedic surgical interventions
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Tumour excision Tumour excision
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Prosthetic joint replacement (arthroplasty) Prosthetic joint replacement (arthroplasty)
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Plate fixation Plate fixation
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Intramedullary fixation Intramedullary fixation
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Bone cement Bone cement
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Amputation Amputation
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Anatomic considerations Anatomic considerations
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Epiphyseal fractures Epiphyseal fractures
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Metaphyseal fractures Metaphyseal fractures
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Diaphyseal fractures Diaphyseal fractures
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Upper extremity Upper extremity
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Lower extremity Lower extremity
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Pelvis and acetabulum Pelvis and acetabulum
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Minimally invasive and adjuvant treatment options Minimally invasive and adjuvant treatment options
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Kyphoplasty and vertebroplasty Kyphoplasty and vertebroplasty
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Cryotherapy Cryotherapy
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Radiofrequency ablation Radiofrequency ablation
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Embolization Embolization
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Conclusion Conclusion
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References References
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Online references Online references
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12.5 Orthopaedic surgery in the palliation of cancer
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Published:March 2015
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Abstract
Metastatic spread of cancer to bone is frequent and causes pain, disability, and functional limitation. New understanding of the homing method of cancer cells to bone and the mechanism of cancer production of pain raise possible new treatment strategies. Non-surgical treatments such as chemotherapy and hormone therapy are effective in early disease. Bisphosphonates and inhibition of osteoprotegerin prevent progression of bone lesions and avoid pain, radiation, and surgery. Radiotherapy arrests disease and relieves pain in many cases. Surgery is needed when the bone is weak or fractured. It effectively relieves pain and preserves function. It usually requires replacing or bypassing the deficient bone with site-specific reconstructive surgery. Surgery should be selected based on projections of patient survival. New tools to make these projections have been validated and are now available. New targeted drug therapies appear to be changing metastatic bone disease into a more chronic condition. This will alter the management of local disease in many histological subtypes of metastatic cancers.
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