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Pathofysiology of bone metastases
Cascade of events
- progressive growth at the primary site
- tumor neo-vascularization
- detachment of tumor cells from the pri
mary 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)