Bladder Metastasis Presenting as Neck, Arm and Thorax Pain: A Case Report
SOURCE: Chiropractic & Manual Therapies 2016 (May 4); 24: 14
Clinton J. Daniels, Pamela J. Wakefield
and Glenn A. Bub
VA St. Louis Healthcare System
Background A case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported. A brief review of urothelial and metastatic carcinoma including clinical presentation, diagnostic testing, treatment and chiropractic considerations is discussed.
Case presentation This patient presented in November 2014 with progressive neck, thorax and upper extremity pain. Computed tomography revealed a destructive soft tissue mass in the cervical spine and additional lytic lesion of the 1st rib. Prompt referral was made for surgical consultation and medical management.
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Conclusion Distant metastasis is rare, but can present as a musculoskeletal complaint. History of carcinoma should alert the treating chiropractic physician to potential for serious disease processes.
Keywords Chiropractic Neck pain Transitional cell carcinoma Bladder cancer Metastasis Case report
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Urothelial carcinoma (UC), also known as transitional cell carcinoma (TCC), accounts for more than 90% of all bladder cancers and commonly metastasizes to the pelvic lymph nodes, lungs, liver, bones and adrenals or brain. [1, 2] The spread of bladder cancer is mainly done via the lymphatic system with the most frequent location being pelvic lymph nodes. Bladder cancer is the most common malignant disease of the urinary tract with a higher incidence in older age and more prevalent in men than women.  There is a higher prevalence in white persons; however, delayed diagnosis has lead to higher mortality rates in black persons.  More than 80% of skeletal metastases are from carcinomas of the lung, breast and prostate with bladder tumors responsible for just 4% of all bone metastases. [5, 6] Although uncommon, studies confirm that bone is the preferred site of metastasis (35%) of UC outside of the pelvis, with the spine being most common site (40 percent of bone metastases).  The cervical spine is only affected in 8 to 20% of metastatic spine disease cases. [8, 9] The most serious complication of UC is distant metastasis — with higher stage cancer and lymph involvement worsening prognosis and cancer survival rate.  The 5-year cancer-specific survival rate of UC is estimated to be 78%. [10, 11]