癌症骨轉移與骨骼疼痛

Metastatic Bone Cancer and Bone Pain

惡性骨腫瘤引發之骨骼疼痛目前已有廣泛性的研究。以鼠類模式研究遠端股骨骨肉瘤發現：除惡性腫瘤本身因素外，主因骨質破壞而導致骨骼疼痛；經由放射線及組織型態學檢查發現，疼痛級數及神經化學物質的變化與蝕骨作用的程度呈關聯性；據此可回溯至人類骨轉移病灶、骨質破壞和骨骼疼痛之間的相關性。癌症骨轉移約占所有惡性骨腫瘤之70%。儘管大多數癌症骨轉移在臨床上無明顯發現，骨骼疼痛仍為其主要症狀且對生活品質有顯著影響；在男性最常見之骨轉移病灶為攝護腺癌，女性最常見之骨轉移病灶則為乳癌，同時亦為骨骼疼痛的常見病因。一般而言，乳癌較常表現蝕骨性轉移病灶，而攝護腺癌則常見造骨性轉移病灶。藉由回顧惡性骨腫瘤階段性的組織形態學變化，期能進一步釐清不明的效應。

Bone pain induced by bone cancers has been widely investigated. Using a murine model of distal femoral sarcoma, in addition to the malignant tumor itself, bone destruction has been shown to contribute to the generation of pain. Assessment by radiography and histomorphology, there were findings that the levels of pain and neurochemical alternations were correlated with the extent of osteolysis. It is therefore interesting to review the correlation between metastatic bone cancers, bone destruction and bone pain in human. Skeletal metastases constitute about 70% of all malignant bone tumors. Although the majority of metastatic bone cancers are clinically silent, bone pain is the main symptom if present and a significant impact on quality of life. It has been noted that the most common origin of metastatic bone cancers in men is the prostate and in women the breast. They have also been thought to be the most common causes of bone pain. In general, however, though the breast cancer is an osteolytic metastasis, the prostatic cancer is considered to be an osteoblastic one. By reviewing the sequential histomorphologic changes in these malignant bone tumors, the uncertainty may be able to be clarified.