Osteotropic cancers: From primary tumor to bone

It has long been recognized that primary cancers spread to distant organs with characteristic preference. Bone metastases occur in ∼70% of patients with advanced breast and prostate cancer, causing severe morbidity and hospitalization. In the last decade, we have gained a better understanding of the mechanisms by which certain tumor types tend to metastasize specifically to bone. It appears that the interaction between the organ microenvironment and cancer cells is fundamental for establishing metastatic growth. Accordingly, Stephen Paget’s ‘seed and soil’ hypothesis – stating that circulating cancer cells (the ‘seeds’) disperse in all directions, but can accomplish metastases only in organs where the microenvironment (the ‘soil’) is permissive for their growth – still holds forth today. For this reason, this review uses the ‘seed and soil’ hypothesis as a template to discuss novel insight and developments in the bone metastasis field.