Evaluation of the Patient with Carcinoma of Unknown Origin Metastatic to Bone

Metastatic carcinoma to bone of uncertain primary origin is a common clinical diagnostic scenario. The authors present a simple and effective system to identify the majority of primary malignancies. The clinical history, physical examination, laboratory studies, and appropriate radiographic studies are critical to the success of this diagnostic strategy. A core needle or open incisional biopsy is frequently needed as a confirmatory study for carcinoma or to rule out primary bone sarcomas. Patients who present with a displaced pathologic fracture require an urgent diagnostic and treatment plan that does not compromise future treatment options and provides durable skeletal reconstruction.