Cancer metastases to the bone – treatment, consequences

Proven content

Cancer metastases to the bone usually occur in adults and the elderly. They make up a significant percentage of the total number of bone tumors. The most common bone metastases are prostate, kidney, breast, thyroid, stomach and bronchial cancers. The first symptom of bone metastases is often considered to be a pathological fracture.

Cancer metastases to the bone

Bones are one of the most common sites where cancer has metastasized. The vast majority of these metastases are found in pediatric cancer, cancer of the prostate gland, cancer of the thyroid gland, lung, kidney and gastrointestinal tract.

Pain in cancer patients may occur in some patients, usually as a consequence of infiltration of the periosteal tissue by a growing neoplastic lesion or as a result of bone metastases. In advanced neoplasm, most of the pain is caused by these causes.

The basic diagnostic tests are:

1. bone scintigraphy – a very sensitive test that detects bone metastases. In the case of metastases to the spine, this examination allows to reveal metastatic changes even six months in advance;
2. radiological examinations (they may not be able to detect focal lesions less than 1 cm in diameter);
3. computed tomography / NMR / myelography – these are tests performed when metastases to the spine are accompanied by pressure on the spinal cord;

The basis for the implementation of bone tests are bone pain and high levels of alkaline and / or acid phosphatase in the blood. In addition, testing for tumor markers such as CA 15.3 (breast cancer) and PSA (prostate cancer) is useful.

The most common tumors that metastasize to the bone

Among the cancers that most often metastasize to the bone, we can distinguish:

1. ovarian cancer,
2. breast cancer (up to 50%),
3. lung cancer
4. prostate cancer (up to 80% of cases give metastases of the osteosclerotic type),
5. thyroid cancer
6. stomach cancer.

Osteolytic metastases, occurring in most cases with bone resorption (atrophy), may cause symptoms such as hypercalcaemia (excess calcium in the body). Osteolytic lesions cause bone damage and, consequently, pathological fractures.

Treatment of metastases

The severity of metastatic lesions and their number are decisive in choosing the treatment method. If a patient has single metastatic changes, radiotherapy is usually implemented, which not only destroys the diseased tissues, but also has an analgesic effect. Pain is reduced by up to 80 percent. patients, and about half of it disappears completely. However, in the event of multifocal lesions, pharmacological analgesic treatment is used. In addition, they may be an indication for the use of radioactive strontium isotope, which, like radiotherapy, has analgesic and healing properties. In the case of bone metastases, it is worth considering the use of chemotherapy.

Consequences of bone metastases

In patients with cancer, bone metastases very often cause pathological fractures that previously forced the patient to stay in bed for a long time. Then the patients developed pressure ulcers, pain and even pneumonia. Ultimately, this led to a quick death due to patient suffering and discomfort due to being immobilized in a plaster cast. At that time, patients with metastatic disease had a survival of about seven months.

The use of surgical treatment allowed to extend the patient’s life (even three times), thanks to which his quality of life has significantly improved.

Infiltration of the bones

Pain in the course of cancer may also result from bone infiltration due to the growth of the cancerous tumor, which irritates and compresses the surrounding nerves. The consequence is disturbances in proper blood supply and thus pain.

symptoms

The most common symptoms of compression by the tumor are:

1. back pain
2. pressure pains.

Decompression of the core may also occur, even without symptoms of its damage, then the following occurs: muscle weakness or tension, problems with urine and faeces, loss of sensation or loss of temperature below the damage. The loss of walking ability is recoverable in about 10%, while quick diagnosis (while the patient is still walking) gives a chance that the patient will not lose the total ability to move. Typically, the diagnosis of core damage 24 hours after its onset is permanent.

Among the tests that should be performed immediately in case of tumor compression on the spinal cord, we can distinguish:

1. computed tomography,
2. myelography.

If pressure is suspected, the patient should also be given dexamethasone and surgical treatment and irradiation should be started.