title: Bladder metastasis presenting as neck, arm and thorax pain: a case report.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA ; 811 Rowell St., Steilacoom, WA 98388 USA.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Daniels
authors.affiliation: Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Wakefield
authors.affiliation: Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA.
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Bub
keywords: Bladder cancer; Case report; Chiropractic; Metastasis; Neck pain; Transitional cell carcinoma