Analysis of serum concentrations of calcium should be one of the standard investigations in patients with spinal metastases, because it is important to identify potentially life threatening hypercalcemia in patients with bone metastases (1). In unknown primary tumors, electrophoresis may provide an indication of the underlying tumor pathology, and in men, a PSA test should be performed. Further to several routine parameters we also always do a full blood count. This helps to diagnose a leukoerythroblastic picture, which would indicate prognostically poor bone marrow carcinoses that would require intensive systemic therapy. In hormone sensitive breast cancers, polychemotherapy to induce rapid remission should be preferred to endocrine therapy in such cases.
The authors did not mention the importance of computed tomography in spinal metastases; this is particularly useful for imaging the bony structures of the spine in detail and enables planning local therapeutic measures (2).
It should be mentioned that szintigraphy of the skeleton is of no importance in multiple myeloma, because even extensive bone manifestations usually appear normal on the image (3), as long as no fractures have occurred.
In medical analgesia for spinal metastases, I would further add that non-steroidal anti-inflammatory drugs (NSAIDs) are of great importance for the pain caused by bone metastases, which is also true for the combination of NSAIDs and opioids (4). The authors rightly pointed out the importance and differential indication of coanalgesics in the context of medical analgesia.
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
- 1.Vassilopoulou-Sellin R, Newman BM, Taylor SH, et al. Incidence of hypercalcemia in patients with malignancy referred to a comprehensive cancer center. Cancer. 1993;71:1309–1312. doi: 10.1002/1097-0142(19930215)71:4<1309::aid-cncr2820710423>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
- 2.Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol. 2004;22:2942–2953. doi: 10.1200/JCO.2004.08.181. [DOI] [PubMed] [Google Scholar]
- 3.Dimopoulos M, Terpos E, Comenzo RL, et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia. 2009;23:1545–1556. doi: 10.1038/leu.2009.89. [DOI] [PubMed] [Google Scholar]
- 4.WHO. 2nd edition. 1996. Cancer pain relief; p 17 pp. [Google Scholar]
- 5.Delank KS, Wendtner C, Eich HT, Eysel P. Therapy of spinal metastases. Dtsch Arztebl Int. 2011;108(5):71–80. doi: 10.3238/arztebl.2011.0071. [DOI] [PMC free article] [PubMed] [Google Scholar]