Palliative care 2017

Pathofysiology of bone metastases

Cascade of events - progressive growth at the primary site - tumor neo-vascularization - detachment of tumor cells from the primary tumor

- invasion in the neighboring tissues - intravasation into the blood stream - survival in the circulation

- homing and arrest at the level of the bone marrow - extravasation - evasion of the host defence - growth and stimulation of the osteoclast mediated bone resorption

(Mareel et al., 1991; Choong, 2003; Vakaet et al, 2009)