Which cancer is NOT typically a vertebral metastasis?

• A. Prostate
• B. Thyroid
• C. Leukemia
• D. Lymphoma

Answer: (C)

Vertebral metastases are most typical of cancers that spread to bone from solid tumors, seeding the vertebral bodies through the bloodstream. Prostate cancer is well known for frequently metastasizing to the spine, often creating osteoblastic lesions. Thyroid cancer can also spread to bone, including the vertebrae, and lymphoma can involve bone in systemic disease as well. Leukemia, however, originates in and primarily involves the bone marrow and blood, with bone involvement usually as diffuse marrow infiltration rather than discrete vertebral metastases. That marrow-centric pattern means vertebral metastases are not the classic presentation for leukemia.