What types of cancer commonly metastasize to the spine?

Cancers That Metastasize to the Spine

More than 50% of spinal metastases originate from breast, lung, or prostate carcinomas, with renal cell carcinoma also being a common primary source. 1

Most Common Primary Cancers

The following malignancies account for the majority of spinal metastases:

Solid Tumors

• Breast cancer: Bone metastases occur in 65-75% of patients with advanced disease, with 70% developing bone involvement overall 1
• Prostate cancer: Bone metastases occur in 65-85% of patients with advanced disease 1
• Lung cancer: Bone metastases occur in 30-40% of patients with advanced disease 1
• Renal cell carcinoma: Bone metastases occur in 20-40% of patients with advanced disease 1, 2

Hematologic Malignancies

• Multiple myeloma: Affects the spinal column in 95% of cases, with bone pain (particularly in the back due to vertebral fractures) being a presenting feature in three-quarters of patients 1
• Lymphomas: May also affect the spinal column, though less frequently than multiple myeloma 1

Clinical Significance

Postmortem examinations demonstrate that spinal metastases are present in approximately 70% of patients with cancer, making the spine the most frequent site of skeletal involvement. 1, 2

Key Clinical Points

• The axial skeleton (spine) is affected more frequently than the appendicular skeleton 1, 3
• Spinal metastases can lead to devastating complications including pathological fractures, spinal cord compression, neurological deficits, and severe pain that profoundly impacts quality of life 1
• Despite the osteosclerotic appearance of prostate cancer bone metastases, histomorphometric studies demonstrate increased osteolysis within affected bone, making skeletal-related events very common 1

Less Common Primary Sources

While the above cancers account for the majority of cases, spinal metastases can also arise from:

• Gastric cancer 4
• Liver cancer 4
• Bladder cancer 4
• Malignant melanoma 4
• Thyroid cancer 5

Pediatric Considerations

In children, the primary malignancies that metastasize to the spine differ significantly and include leukemia, Ewing sarcoma, rhabdomyosarcoma, and neuroblastoma 4

Diagnostic Implications

In patients presenting with vertebral fractures from minimal or no trauma, malignancy should be suspected and detailed examination performed, as 10% of patients with cancer are diagnosed by vertebral metastasis. 4