轉移性骨癌：診斷與治療

Metastatic Bone Cancer: Diagnosis and Treatment

楊榮森(Rong-Sen Yang)

《物理治療》 34卷2期 (2009/04) Pp. 106-114

摘要

惡性腫瘤高居近年來國人十大死因之首位，成為醫療的重大課題。新近研發諸多新式診斷技術和治療方式，使臨床上得以早期診斷和治療癌症，有效控制病情，改善病患功能，增長存活期間和提高生活品質，但同時會增加腫瘤轉移到遠處的風險。骨骼是惡性腫瘤經常發生轉移的部位之一，臨床上經常轉移到骨骼的癌症包括攝護腺癌，乳癌，肺癌，腎細胞癌，甲狀腺癌，黑色素瘤等，其他如肝癌，鼻咽癌，結腸癌等也會發生。骨骼轉移癌症在臨床上並不少見，初期病患可能因疼痛症狀接受各種治療，任何醫療專業人員都可能有機會遇到。骨骼轉移癌症常會嚴重破壞骨骼結構而引起劇痛、病理性骨折、功能障礙，導致嚴重併發症；因此在治療骨骼轉移癌症病患時，須及早診斷和治療，定期追蹤病情，以免發生嚴重後果。本文將討論骨骼轉移癌症的特徵，包括好發部位，病理生理學特徵，臨床症狀與徵候，臨床評估檢查，治療方式，因物理治療對改善骨骼肌肉系統症狀上功效顯著，接受物理治療的病患日漸增多，物理治療師也可能會在實務作業上遇到骨骼轉移癌症病患的挑戰，增加對骨骼轉移癌症病患情況的瞭解，有助於早期轉診及治療，成果才會良好。

關鍵字

骨骼轉移 ； 臨床診治 ； 病理性骨折

並列摘要

Malignant neoplasm ranks as the first among the Ten Leading Cause of Death in the recent years and becomes a major challenge in medical practice. Many recent advances in the diagnostic techniques and treatment modalities enable the early diagnosis and treatment of the cancers, good controls of diseases progression, functional improvement, increased survival times as well as improvement of life quality. However, these will be accompanied by an increased risk of distant metastasis. Bone is one of the common sites for cancer metastasis. Some cancers commonly develop bone metastases, such as prostate cancer, breast cancer, lung cancer, renal cell carcinoma, thyroid cancer and melanoma, as do the hepatoma, nasopharyngeal cancer and colon cancer. The metastatic bone cancers are not rare in the clinical practice. The patients in the earlier stage may undergo various treatment for the control of pain. Any practice in every medical field may have chance to face such patients. The metastatic bone cancers usually cause extensive destruction of the bone structure accompanied with severe pain, pathological fractures, functional impairment and serious complications. Therefore early detection and treatment of metastatic bone cancers as well as regular follow-up of the disease progression is important to avoid serious consequences. In this article, we will discuss the characteristics of metastatic bone cancers, including common sites, pathophysiology, clinical symptoms and signs, clinical assessment and treatment modalities etc. Nowadays, physiotherapy is very effective for the symptomatic improvement of the musculoskeletal disorders, thus more and more patients undergo various kinds of physiotherapy. Therefore physical therapists may also have to face the challenges of the patients with metastatic cancers. More understanding of the characteristics of patients with metastatic cancers may help an earlier transfer and treatment followed by a better clinical outcome.

並列關鍵字

Bone metastasis ； Clinical management ； Pathological fracture