In fact, the skeleton is a common site of secondary damage by tumors of various localizations. The reason for this is the continuous complex processes of bone formation and an extensive circulatory network. Most often, the affected area is the lumbar and thoracic spine, ribs, pelvic bones, thigh, and jaw.
Where does bone cancer metastasize?
There are 2 types of metastases:
- osteoblastic;
- osteolytic.
The former lead to stimulation of osteoblasts and compaction of bone tissue. The second type of tumor is characterized by thinning of the bone walls. The mechanism of bone formation is disrupted, bone and cartilage tissue is replaced by immature tumor tissue. The organ can no longer normally perform its motor and support functions. When penetrating the bone marrow canal, the process of hematopoiesis is disrupted.
How and where does bone cancer metastasize?
Malignant bone tumors are also prone to metastasis. This happens at stage 4, and not much time passes from the onset of the disease to the formation of distant tumors (from 1 year). in 90% of cases it spreads through the bloodstream, that is, hematogenously. Most often it affects the lungs. Also, a tumor from one bone can metastasize to another.
It is noteworthy that at the stage of metastasis, microscopic tumor cells can be located in any corner of the body and cannot be detected. Only after the tumor reaches a certain size is it visible on an x-ray.
Bone metastases in cancer: symptoms
Sometimes metastases in the skeleton are hidden and do not manifest themselves in any way. They can only be identified during a routine examination.
But most often the main symptom of bone metastases is pain. It is constant, aching in nature, increasing at night and after active movements. Pain from bone metastases cannot be relieved with painkillers. She is making steady progress. Experts believe that the pain is associated with increased intraosseous pressure, irritation of nerve endings by a growing tumor and tissue stretching.
Over time, signs of bone metastases become obvious. Depending on their location, a defect appears in the form of a swollen, protruding area on the leg, arm, head or other parts of the body. It is a consequence of tumor growth and bone deformation. Upon palpation, a person feels pain. The tumor also hinders movement and the bone becomes brittle. All this significantly reduces the quality of life, and fractures can even cause death.
Another sign of bone cancer is hypercalcemia, that is, an increased concentration of calcium in the blood (from 3 mmol/L). It is a consequence of mechanical destruction of bone and osteolysis, and against its background these processes only intensify. Hypercalcemia is accompanied by a variety of manifestations, including: muscle and general weakness, joint pain, nausea, vomiting, drowsiness, arrhythmia. Persistent disturbance of calcium levels (3.7-4.5 mmol/L) leads to renal failure, coma and death.
Bone metastases in lung, kidney, liver, intestinal, cervical, ovarian, breast, thyroid and prostate cancer
Breast cancer with bone metastases is common (it is diagnosed in 70% of women). Tumor cells spread through a vast network of lymphatic and blood vessels. Possible damage to the spine, pelvic and facial bones. Bone metastases in breast cancer are often accompanied by hypercalcemia and spinal cord compression syndrome. In 25% of cases, pathological fractures are observed (most often occurring in the vertebrae), which is due to the lytic nature of the lesion. Metastases to the bones in kidney cancer have the same feature.
It is not uncommon for women to encounter metastases of ovarian cancer that penetrate the bones. This type of cancer is characterized by a long asymptomatic course, as a result of which women go to the doctor when the tumor has already spread throughout the body. Skeletal involvement is rare, since in most cases ovarian cancer “migrates” to the abdominal cavity. When cancer spreads to distant organs, the patient's condition worsens significantly, possibly a sharp loss of appetite and weight, depression, and insomnia. Pain in the limbs is also a main symptom.
Bone metastases in prostate cancer in men can occur in the early stages. They are usually found in the hip, pelvis and lower spine. They manifest themselves in the form of lower back pain. Along with this, there are disorders of the genitourinary system.
Bone metastases in liver cancer are rarely diagnosed and mainly in the last, 4th stage. Signs include severe pain and pathological fractures.
3rd place is given to metastases in the ribs. Their development can be very rapid. The main symptom is chest pain that appears during breathing movements.
Metastases to the bone are not so dangerous. They can be removed without any complications, after which the prognosis is more or less favorable. Of course, this does not apply to extensive, multiple lesions. The incidence of metastases in the femur is determined by its size and constant load. Thinning of the bone leads to unnecessary fractures, therefore, as with metastases in the pelvic bones, it is better to rely on crutches or a cane when walking.
Metastases in the skull bone are usually found earlier than the primary tumor, due to the fact that the space in the skull is very limited, the tumor has nowhere to grow, so it is easy to notice. They spread from kidney, thyroid, breast, and lung cancer. Cancer cells invade the vault and base of the skull and other bones of the face. Metastases in the frontal bone occur more often in children with medulloblastoma. Of the facial bones, the paranasal and jaw bones, as well as the orbits, are most affected. accompanied by an increase in intracranial pressure, headaches, mental disorders, and changes in the fundus. In later stages, epileptic seizures occur.
If metastases are detected in the bones of the skeleton, it is necessary to avoid physical activity to avoid a fracture. To strengthen damaged structures, special operations are performed.
Diagnosis of cancer metastases in bones
Diagnosis of bone metastases is made using imaging methods such as X-ray, scintigraphy, MRI, CT.
In this case, X-ray will be of little information, since with its help it is impossible to identify foci of the disease that are just emerging. Also, X-ray examination does not make it possible to determine the exact size of the lesion and the type of cancer.
A more advanced way to diagnose skeletal metastases is scintigraphy with radioisotope scanning. Its principle is to introduce radioactive isotopes into the body, which are absorbed by the bones within a few hours. After this, the person is placed in a special gamma camera and scanned. This procedure is not dangerous, since radioactive radiation is minimal, and isotopes are completely removed from the body. As a result of scintigraphy, images of all parts of the skeleton are obtained, which show the smallest foci of the disease in the initial stages. This method allows you to determine where the processes and formation of bones, fractures and other types of injuries are disrupted.
Control research methods are CT and MRI. Only they will allow you to accurately establish a diagnosis and draw up a treatment plan. Tomography results are three-dimensional computer images. Using them, the doctor can outline a plan for the operation. It is carried out under the control of computed tomography, during which part of the tumor material is taken for examination for histology and cytology.
To obtain information about the amount of calcium and other components in the blood, blood tests are prescribed.
Treatment of cancer metastases to bones
Cancer treatment tactics for bone metastases depend on the type of primary tumor and the number of secondary lesions. The main tasks of doctors are to suppress the growth of malignant tumors and stop the process of osteolysis, after which they try to restore bone structures.
To solve them, they resort to the following methods: surgical removal, treatment with bisphosphonates and hormones, chemotherapy and radiation. Patients also need pain relief and relief from side complications, such as hypercalcemia, fractures and spinal cord compression.
Surgical removal of bone metastases
The doctor's goal is to completely remove the affected area. In order not to leave cancer cells, the formation is excised, including surrounding tissue. It is not uncommon for the entire bone to be removed. After this, it is necessary to install an artificial endoprosthesis or graft. Such operations are called organ-preserving. They can be performed not only on the arms and legs, but also on the jaw and pelvis.
Organ-conserving surgery shows good results in the case of a single tumor, but in case of extensive metastases it will only help to improve the patient’s condition. Sometimes amputation is necessary to completely remove the tumor. Of course, the removal of a limb leaves an impact on future social life, although they can be replaced with prosthetics. Previously, amputation was the only option, but now prosthetic technology is widely developed, which makes it possible to choose. 90% of patients with metastases in the bones of the extremities manage to maintain their functional activity. The disadvantage of organ-preserving operations is the high probability of the need for repeated interventions.
When the tumor is located in places such as the spine, skull, or pelvis, it can be very difficult or impossible to excise it completely. Then cryotherapy and radiosurgery come to replace conventional surgical removal.
Cryotherapy is based on freezing cancer cells with liquid nitrogen. Radiosurgery is used in installations such as. This is a radiation therapy technique where a malignant tumor is irradiated with a large dose of radiation at a time, resulting in the death of its cells. To perform such operations, a small hole is made in the bone, which is then closed with bone cement.
To treat stage 4, it is necessary to remove not only the affected bone, but also distant lesions (metastases). When located in the lungs, this can sometimes be very difficult, because vital organs are nearby. The doctor needs to carefully study the CT and MRI data to outline treatment tactics.
Chemotherapy
Its goal is to suppress the growth of primary and secondary tumors. Chemotherapy for metastases in bone tissue is mainly carried out in combination with surgery, which significantly increases survival. If surgery is contraindicated, chemotherapy is the main treatment method.
Cytostatic drugs for the treatment of bone metastases: Doxorubicin, Mitomycin, . Usually a combination of several drugs is prescribed. They need to be taken in courses.
The choice of drugs and their dosage regimen is made by a specialist, based on data about the primary tumor. For example, chemotherapy for prostate cancer with bone metastases includes taking Doxorubcin or Estramustine phosphate, and for patients with breast cancer a combination of Cyclophosphamide, Adriablastine and Fluorouracil is used.
It is worth noting that if the patient’s bone is very thin and there is a risk of fracture, then before treatment begins, measures are taken to immobilize the damaged area.
Radiation therapy
Radiation therapy for bone metastases can be used as a last resort for extensive lesions when total resection is not possible. Irradiation of the residual tumor is aimed at destroying its cells.
Practice shows that this method helps reduce pain. In addition to conventional external irradiation, they use the method of radiotherapy, which involves the injection of radioactive elements (for example, strontium) into the veins, which accumulate in cancer cells and destroy them. Such procedures differ in the duration of action. They are mainly prescribed for the treatment of prostate cancer with bone metastases. But in general, radiation therapy is rarely used due to the fact that it does not help reduce hypercalcemia and the incidence of fractures, and also because of the lack of therapeutic effect in large lesions.
Bisphosphonates
In cases of bone metastases, bisphosphonates slow down the activity of osteoclasts, resulting in a reduction in the processes of bone tissue destruction. In other words, bisphosphonates have an anti-osteolytic effect.
Medicines for bone metastases: Etidronate, Aredia, Zometa, Pamidronate, Clodronate, Tiludronate, Bondronate.
In contrast to radiation therapy, bisphosphonates are safer; they eliminate hypercalcemia, have a beneficial effect on bone tissue, restore it and eliminate pain. The need for the use of narcotic painkillers and radiation therapy is reduced. Patients are significantly less likely to experience pathological fractures and spinal deformities. Experiments have also shown that bisphosphonates for the treatment of bone metastases have antitumor activity, reducing the likelihood of their further spread. Therefore, the prescription of these drugs always comes first.
Hormone therapy
This method is used for hormone-dependent tumors (thyroid, breast, etc.). The patient is administered various hormones to stabilize their content in the body and improve the person’s condition.
Symptomatic treatment
Anti-inflammatory and painkillers for bone metastases help cope with pain. Depending on the degree of pain, narcotic and non-narcotic analgesics are used.
Treatment for bone metastases that are accompanied by hypercalcemia includes:
- administration of saline solutions (up to 500 ml per hour) aimed at restoring blood volume;
- taking diuretics (to increase calcium levels in the blood);
- administration of corticosteroids orally and intravenously. Prescribe Hydrocortisone or;
- bisphosphonates. After completing the first 3 points, the administration of Clodronate or Pamidronate is prescribed. The duration of infusions ranges from 2 to 6 hours. A single administration of large doses or a 5-day course is possible;
- administration of calcitonin. Calcitonin is a hormone that affects the exchange of calcium and phosphorus, thereby regulating the processes of bone resorption. Its use gives positive results in patients with cancer of the skeleton.
Calcium levels return to normal after 4 days. Next, it is necessary to monitor blood counts, since after some time calcium increases again, which requires repeating the course of bisphosphonates.
Spinal cord compression syndrome also requires urgent care in the form of increased doses of corticosteroids, the prescription of vascular drugs and drugs that improve the metabolism of nervous tissue.
Bone cancer with metastases: prognosis
Is it possible to cure bone metastases? If the foci of cancer are isolated, they are located in the extremities, then cure is quite possible. In cases of timely detection and comprehensive treatment, metastases have little effect on the prognosis of life. In other situations, doctors are only able to briefly improve the patient's quality of life.
In general, people with metastatic cancer live about a year, although this varies for each individual patient.
Life expectancy at:
- Lung cancer with metastases to bone tissue averages from 3 to 6 months;
- breast cancer is a little more comforting and is more than 19 months, the same life expectancy for metastatic kidney cancer;
- metastatic prostate cancer 12-35 months;
- for thyroid cancer, on average 4 years.
Each person's chances depend on many factors, including age, stage of the disease and type of tumor. Some forms of cancer such as are considered aggressive. Their development takes literally 1-2 years. Others remain at the initial stage for a long time and do not progress.
Informative video
Experts have found that bone tissue is one of the most susceptible structures of the human body to cancerous tumors. Most often, this is a secondary lesion, metastasis. It is difficult to judge the life expectancy of bone metastases - it is necessary to take into account many associated factors, for example, the age of the cancer patient, the total number of secondary cancer foci. However, most often the prognosis is unfavorable.
Causes of metastases
In almost every malignant neoplasm, cancer cells move into bone structures. The reason for this process is their fairly good blood supply. However, not all bones are equally susceptible to the formation of cancerous lesions. Most often this applies only to the largest of them. After all, the larger the bone, the more nutrients it receives through the vascular bed.
A cancer cell can leave the primary tumor focus only if it has reached its maturity and begins to produce metastases - this is stage 3B–4 of the oncological process. Against this background, the protective forces of the human body are already so undermined that the protective cells are no longer able to cope with the pathological process.
The life of a cancer patient is also significantly shortened by the lack of adequate complex antitumor therapy. If there are a lot of metastases in the bone structures, only one of the methods - chemotherapy, radiation therapy - is not enough - they must act in combination.
Symptoms of metastases and life expectancy with them
In addition to the main clinical manifestations - pain impulses increasing in intensity and duration, limited mobility in the area of the body affected by cancer, cancer patients also have other symptoms indicating the formation of secondary tumor processes.
The pathogenesis of bone metastases and the prognosis of life expectancy can differ significantly - this directly depends on the location of the malignant neoplasm, its structure, as well as the stage of the oncological process:
- When diagnosing cancer of the renal elements, metastasis to the bones will be manifested by pain impulses in the area where the bone affected by the tumor is projected. If the pathological process leads to a fracture and compression of the spinal nerves, the person’s life path is significantly shortened.
- Cancer of the pulmonary structures is quite often complicated by metastases to the bones, especially to the thoracic part of the spinal column, as well as the ribs, elements of the skull, and pelvis. A particular danger lies in the fact that primary symptoms are most often absent, and pain impulses arise even when the lesions are gigantic in size. This form of cancer is characterized by a state of hypercalcemia, accompanied by severe dry mouth, nausea, vomiting, and polyuria.
- Cancerous lesions of breast tissue often give rise to complications in the form of metastases to various bone parts - from the elements of the spine to the skull and lower extremities. A person can live with this condition for several more months, or less often years, but the quality of life is significantly reduced - the person is bothered by constant pain, severe weakness, lack of appetite, and significant weight loss.
- In the male part of humanity, one of the most common types of cancer is a malignant neoplasm in the tissues of the prostate. In addition to difficulty emptying the bladder and sexual dysfunction, metastases will be observed in the pelvic bones and the lumbosacral region of the spine. This is accompanied by an intense pain syndrome.
To get a complete picture of what is happening in the body of a cancer patient, a specialist recommends a set of diagnostic procedures. Only after receiving all the information is it possible to make a forecast in each specific case.
Localization of metastases and survival
In many ways, when making prognoses, experts rely on their localization in the bone structures for how long a cancer patient lives with metastases.
When diagnosing metastases in the structures of the spine, there is a high risk of developing compression syndrome - a pathological fracture of the vertebral arches with subsequent compression of the nerve fiber. Against this background, various paresis and paralysis appear. A person loses the ability to move and self-service. In general, a favorable background is created for the formation of other somatic pathologies, ultimately leading to death.
Metastases to the pelvic bones and hip joints are a common complication of prostate and ovarian cancer, as well as thyroid structures, liver, and lungs. If the number of secondary lesions is large, the structure of the bone tissue is significantly disrupted and the threat of pathological fractures and immobilization of the cancer patient, shortening the person’s life, again appears.
The extremities occupy third place in the ranking of zones where cancer cells often move from the primary focus. The shoulder areas are affected by malignant cells from the thyroid or mammary gland, pulmonary structures, and intestinal loops. In addition, melanoma and paraganglioma can produce similar metastases. Lesions in the ulna and radius bones are formed for the same reasons.
The tibia is susceptible to attack by cancerous elements from the primary focus in the lungs, while the fibula is susceptible to attack from a tumor of the colon or prostate, but the foot is susceptible to breast cancer.
The prognosis is especially unfavorable when secondary cancer processes are detected in the structures of the skull - not only the vault and base, but also the facial spines can be affected. Often a situation may arise that the metastasis is diagnosed first, and only then the primary cancer focus. Negative neurological symptoms significantly affect the quality of life of a cancer patient and shorten the already short life span.
Treatment tactics for metastases and life expectancy
Diagnosing a secondary tumor focus in bone structures is not a death sentence at the moment. The main thing in this situation is to undergo complex treatment that can suppress not only the active growth of the primary localization of cancer, but also the development of metastases.
The main directions of treatment tactics that prolong the life of a cancer patient:
- Taking biosphosphonates helps slow down pathological processes in bones. This subgroup of medications not only optimally relieves pain impulses, but also significantly reduces the risk of fractures and also regulates mineral metabolism. As a rule, they are administered parenterally.
- Radiation therapy helps destroy cancer cells. The total number of procedures is determined individually by the specialist, but their average number is at least 10 times. The prognosis is favorable if recurrence of secondary lesions does not occur.
- Chemical and hormonal therapy are also aimed at destroying tumor elements, suppressing their growth and reproduction. With the use of specific medications, many side effects occur, however, the duration of active life is extended.
Other methods for suppressing the metastasis process are:
- excision of the lesion - single or several, through surgery;
- immunotherapy – the use of special vitamin complexes, which helps reduce the tumor process, maintaining the defenses of the cancer patient’s body at an optimal level, which ultimately also extends life;
- radiopharmaceutical therapy - the introduction of a special solution that can destroy cancer cells.
The selection of the optimal set of treatment procedures is carried out by a specialist individually - based on the diagnosed area of bone metastases, their total number, the age category of the cancer patient, the initial state of his body, as well as susceptibility to the therapy.
Some people prefer to turn to traditional medicine recipes. They, of course, can somewhat alleviate negative symptoms and prolong a person’s life, however, they do not provide a complete guarantee of healing. It is recommended that each of the selected recipes be previously agreed with your doctor.
Metastases of tumors to the bone, unfortunately, are a fairly common phenomenon in oncology. This manifestation of the tumor process is one of those factors that significantly reduces the quality of life. And therefore we decided to devote a short article to this topic.
The structure of bone tissue
Bone tissue consists of organic and inorganic (mineral part). The first is collagen, albumin and other proteins. The inorganic part of the bone, which accounts for approximately 65% of the weight, consists of hydroxyapatite (it contains calcium and phosphorus).
Bone tissue is constantly regenerating, that is, being restored. Due to the cells that destroy bone tissue (osteoclasts) and the cells that create it (osteoblasts), constant renewal occurs. Complete renewal of bone tissue occurs approximately every 10 years.
Regulation of this process occurs due to the influence of the endocrine system (parathyroid glands).
What tumors metastasize to bones?
Bones can be a target for metastasis of many tumors. However, most often metastases to bone tissue are observed in breast cancer, prostate cancer, and thyroid cancer.
Tumor Frequency of bone metastases (%)
Breast 47-85
Prostate gland 54-85
Thyroid 28-60
Kidney 33-40
Light 32-40
Liver 16
Ovaries 9
Esophagus 5-7
Rectum 8-13
Cervix 0
In which bones are metastases most often found?
Localization Frequency of lesion (%)
Lumbar spine 59
Thoracic spine 57
Pelvic bones 49
Ribs 30
Femur 24
Skull 20
Cervical spine 17
Humerus 13
Other 3
What types of metastases are distinguished?
There are 2 types of bone tissue damage - osteolytic and osteoblastic metastases. Osteolytic damage is characterized by leaching of the mineral part of the bone, its thinning, and fractures. Osteoblastic metastases, on the contrary, are characterized by compaction of the mineral part. Why is this happening?
The fact is that tumor cells can both directly destroy bone tissue and stimulate cells that renew this tissue. Thus, when osteoclasts (bone resorbing cells) are stimulated, osteolytic metastases occur; when osteoblasts (cells that deposit hydroxyapatite) are stimulated, osteoblastic lesions occur.
How do bone metastases manifest?
The main manifestation of tumor metastases in the bone is:
- pain syndrome, which occurs in most cases. Pain occurs as a result of tumor infiltration of nerve endings, increased intraosseous pressure, fracture, and stimulation of nerve endings by substances secreted by the tumor.
- Characteristic of osteolytic metastases are pathological bone fractures.
- Hypercalcemia- increased calcium levels in the blood. This condition is typical for osteolytic metastases.
How does hypercalcemia manifest?
Increased blood calcium levels have the following symptoms:
- general and muscle weakness
- depression
- mental disorders
- lack of appetite
- nausea and vomiting
- constipation
- lowering blood pressure
- heart rhythm disorder
As hypercalcemia worsens, dehydration, renal failure, coma, and death develop.
How are bone metastases diagnosed?
In the diagnosis of the metastatic process, the following are used:
- clarification of the patient’s complaints, examination of the patient and physical examination
- Calcium and alkaline phosphatase level tests
- bone scintigraphy (radioisotope study)
- X-ray methods for studying bones (x-ray, computed tomography)
- nuclear magnetic resonance
How is the treatment carried out?
Treatment of tumor metastases in bone has several directions:
- antitumor therapy. As a rule, we are talking about chemotherapy, which can suppress the growth of tumor cells. It is not always possible to influence the tumor, but when possible, treatment is mandatory
- radiation therapy. It can be used both to reduce pain and for therapeutic purposes. With single metastases in the spine and if it is possible to administer a therapeutic dose, the metastasis can regress until it disappears completely. In this case, the period of remission can be quite long.
- Drug treatment of metastatic lesions. For this purpose, several groups of drugs are used, of which the most effective are bisphosphonates (Etindronate, Bonefos, Bondronat, Aredia, Zometa)
The use of bisphosphonates is currently the most effective way to treat osteolytic bone metastases. The effect of treatment is observed in most patients. The effect appears:
- in reducing pain
- in bone tissue restoration
Bisphosphonates are easy to use. Thus, Bonefos is available in both ampoule and tablet form. The convenience of using Aredia is that this drug can be administered once every few weeks.
Bisphosphonates rarely cause side effects and are easily tolerated.
References
E.K. Vozny. Use of bisphosphonates in clinical practice
Modern tactics of treating patients with malignant neoplasms with bone metastases. A manual for doctors. St. Petersburg, 1996
One of the complications of cancer is that it can spread to soft tissues and distant organs.
Metastasis also occurs in the bones. In fact, bone metastases are secondary cancerous tumors of bone tissue, formed as a result of the transfer of atypical cells from the main focus through the blood and lymph flow.
Typically, bone metastases occur in the last stages of cancer pathology. Moreover, about 80% of cases of bone metastasis occur against the background of and. Such formations manifest themselves with severe pain, frequent fractures and hypercalcemia.
Causes
Most often, metastasis to bone structures occurs with prostatic and mammary glandular cancer, malignant formations in and gastrointestinal structures, and.
They metastasize to bone tissue and other malignant neoplasms, but much less frequently.
When a person is healthy, his bone tissue is constantly renewed. In general, bone structures are characterized by processes of resorption, remodeling and bone formation. These processes are carried out due to the cellular activity of osteoblasts and osteoclasts. These cellular structures are responsible for the formation, absorption and destruction of bone tissue.
If atypical cells penetrate into the bone structures, then a disruption in the functioning of the bones occurs. Healthy cells are displaced, the processes of interaction between osteoblasts and osteoclasts are disrupted, which leads to the dissociation of their activities.
For breast cancer
Metastasis to bone structures in breast cancer occurs in a lymphogenous and hematogenous manner. Such localization of metastases in breast cancer is quite common.
Cancer with such metastases is characterized by severe pain and an excessive tendency to pathological fractures, especially in the chest and pelvic bones.
Types
Depending on the type of cell activation, oncologists distinguish several types of bone metastases:
- Osteoplastic– accompanied by the formation of compactions on the bones;
- Osteolytic– when there is a predominant destruction of bone structures.
Pure types are relatively rare in medical practice; mixed forms are much more common.
The bones that have a rich blood supply are most susceptible to metastasis, i.e. in the humerus and femur, ribs and vertebrae, cranial and pelvic bones. At first, bone metastases do not manifest themselves in any way, but over time they become the cause of intense pain, which is associated with stimulation of periosteal pain receptors.
Symptoms of bone metastases
At first, secondary bone tumors develop asymptomatically, but with the development of the tumor process, a certain clinical picture is formed:
- Presence of hypercalcemia;
- Tendency to pathological fractures;
- Presence of spinal compression.
Hypercalcemia is a life-threatening complication that is found in approximately 30-40% of cancer patients with bone metastasis.
This condition occurs due to excessive activity of osteoclasts, leading to an increase in the level of calcium in the blood, which in turn causes a pathological increase in the excretory capacity of the kidneys.
As a result, in cancer patients with metastatic foci in the bones, in addition to hypercalcemia, hypercalciuria develops, and the reabsorption of fluid and sodium is impaired, leading to polyuria.
As a result of such changes, the activity of many systems and organs in cancer patients is disrupted:
- In nervous system activity, signs such as lethargy and mental disorders, confusion and affective disorders are noted;
- In cardiovascular activity, deviations such as arrhythmia and low blood pressure, decreased heart rate occur, and the risk of cardiac arrest is high.
- The kidneys are affected by nephrocalcinosis and polyuria;
- In the gastrointestinal area, nausea and vomiting syndrome, frequent constipation and lack of appetite are observed, and pancreatitis may develop.
If more than half of the cortical layer is destroyed during bone metastasis, pathological fractures appear. They are usually found in the bone tissues of the spine (lumbar or thoracic) and femurs. A fracture can occur even in minor traumatic situations such as an awkward turn or a weak blow.
Often such fractures appear for no apparent external reason. With a pathological fracture, displacement of bone fragments can occur, which leads to functional impairment of the limb (if the fracture is localized on a long tubular bone) and neurological disorders (if the fracture is localized on vertebral structures), which significantly worsens the quality of life of the cancer patient.
A growing tumor and bone fragments can put pressure on neighboring tissues.
With tumor compression, the cancer patient experiences increasing pain, weakness of muscle tissue worries, signs of impaired sensitivity appear, and in the terminal stages dysfunction of the pelvic organs and paralysis occur.
If metastasis is observed in the vertebral tissues, then spinal compression sometimes occurs in cancer patients. Typically, this phenomenon occurs with metastasis to the thoracic vertebrae. Disorders caused by compression can develop gradually (if the metastasis is compressed) or acutely (if compressed by a bone or its fragment).
Symptoms of compression occur suddenly. If such a symptom is detected at its initial stage, then its reversibility (at least partial) is quite possible. If you do not act during compression, then the paralysis becomes irreversible.
With timely therapeutic assistance, specialists are able to achieve a significant reduction in symptoms, although only 10% of cancer patients with paralysis can move independently after treatment.
How to determine bone metastases?
The most informative diagnostic method for identifying bone metastases is skeletal, which allows you to accurately determine the extent and extent of metastasis.
A similar procedure can find metastases in any part of the human skeleton. Moreover, detection of the spread of tumor cells is possible at the very initial stages, when obvious disorders in bone structures are just beginning.
Using X-ray examination, bone metastasis can be detected only at the stage of sufficient maturity of the secondary formation, when about half of the bone mass has already been destroyed.
Photo of metastases in the hip bones on x-ray
But such diagnostics make it possible to differentiate the specific type of metastasis. Light white spots indicate blastic metastases, while gray-white spots indicate the lytic type of metastases.
Radioisotope diagnostics or osteoscintigraphy is carried out using the radiopharmaceutical Rezoscan, which is administered to the cancer patient approximately a couple of hours before the scan.
Diagnostics may also include MRI, detection of resorption markers in urine, blood tests, etc. If metastasis is detected in the cranial bones, then oncologists recommend carefully examining all organs to exclude the possibility of damage to them.
Are they being treated?
Metastasis to the cranial bones is observed mainly in renal or thyroid cancer, and their treatment can be carried out using a variety of methods:
- Surgical interventions are performed for palliative therapy and are necessary for various types of complications (compression, fractures, etc.). After the operation, pain is eliminated, bone marrow or limb functions are restored, etc.
- and for bone metastasis, it is used in complex conservative treatment, as well as in the preoperative or postoperative period. These techniques allow you to destroy cancer cells and prevent their proliferation.
- Treatment with bisphosphonates. These medications slow down the processes of disorders in bone structures.
- Radiopharmaceuticals, when administered, lead to the destruction of active cancer cells.
- involves the use of special means to increase the body’s resistance so that the immune system resists the spread of the tumor throughout the body.
Video about drugs for the treatment of bone metastases:
Treatment with bisphosphonate drugs
Bisphosphonates are medications that prevent bone loss. They are designed to inhibit osteoclast activity and prevent bone destruction.
At the site of secondary tumor growth, bisphosphonates are absorbed by osteoclast cells, causing them to slow down or stop their activity. In addition, the use of bisphosphonates prevents the synthesis of osteoclasts, which become early dying or self-destructing.
Bisphosphonates are divided into 2 groups. One group of drugs contains nitrogenous compounds and is more effective against metastatic tumors. These include drugs like Ibandronate, Alendronate, Pamidronate, etc. The other group does not contain nitrogen, for example, Clodronate, Tidronate, etc. These drugs have a lesser therapeutic effect.
Bisphosphonate drugs penetrate into the bone mass, accumulate around osteoclasts and begin to inhibit them, which leads to a decrease in the destructive activity of these cells. As a result, the processes of bone destruction are stopped.
Prognosis and life expectancy
Final prognosis depends on the location of the primary cancer.
- If bone metastases are formed from lung cancer, the patient will live for about six months.
- If the primary focus is located in the prostate, then life expectancy will be about 1-3 years.
- If the source of metastasis to bone structures is a breast cancer tumor, then life expectancy will be approximately 1.5-2 years.
- Kidney cancer with bone metastases leaves the cancer patient about a year to live.
- With bone metastasis, life expectancy will be no more than six months.
- If it spreads to bone tissue, life expectancy will be about 4 years.
Bone metastasis is extremely dangerous. If it is detected in a timely manner, there is a high probability of saving the cancer patient’s life.
Bone metastases are the most severe pathology that accompanies cancer diagnoses. This mainly happens in the last, most severe – stage 4 cancer. Neoplasms are characterized by the penetration of cancerous cells into the bone tissue, entering there through lymph flows or blood.
Considered a secondary focus of a malignant tumor disease, metastases appear in every three out of four cases of cancer diagnosis. Very often, the pathology is a rather dense, large-sized formation. Up to 80% of this complication occurs against the background of breast cancer in women and prostate cancer in men.
Depending on the anatomical nature and specificity of tumor cells, in oncological practice there are two main types of them, which appear extremely rarely in the pure type, mainly showing their hybrid forms:
- osteoplastic– characterized by dense bone malignant neoplasms;
- osteolytic– there are no large tumors, rapid destruction of the bone tissue structure occurs.
Most often, metastases affect bones equipped with a large number of blood vessels - costal, humeral, large and small pelvis, external cranial. At the initial stage, they behave secretly, but as the affected cells multiply, a severe pain relapse occurs.
Signs
As noted, initially the metastasis behaves incubatively, remains hidden and does not cause discomfort - as a rule, a person does not even suspect its existence. However, over time, fairly clear clinical signs and symptoms are evident.
Most often, the following evidence indicates that the body is affected by metastases: their manifestations:
- fractures;
- intoxication;
- compression;
- pain syndrome;
- hypercalcemia.
Fractures. They are pathological in nature. It manifests itself in a sharp decrease in the hardness of the bone material - often even minimal mechanical or physical stress is enough - and the tissue breaks.
In advanced forms of pathology, when a large focus of tissue is affected by metastases, it happens taking too deep a breath or sneezing is enough so that, for example, a rib is broken. And when a sharp turn of the body or tilting too low, the skeletal pelvic part becomes vulnerable.
The main reason leading to this symptomatology is the leaching of the most important bone material responsible for their strength - biophosphate - as the tumor multiplies.
Intoxication. A very common syndrome. It manifests itself in the form of general weakness, loss of interest in food, and, as a result: critical loss of body weight, nausea, depression and apathy towards what is happening - up to a complete loss of interest in life. This is a nonspecific manifestation any type of cancer, which rapidly increases during the process of metastasis.
Compression. Tumors that arise in hard tissue are very dense and hard in composition and can exert significant pressure on the bloodstream. vascular system and nerve fibers.
Compression can lead to the most critical consequences nerve endings of the spinal cord. This threatens the cancer patient with general damage to the nervous system, and, as a result, complete or partial paralysis of the body.
At the initial stage, the symptom manifests itself in limb dysfunction. As the disease progresses, the degree of immobility increases.
Pain. This syndrome is the most common and hardest to tolerate by the patient. Painful sensations can cause severe torment and are difficult to correct with painkillers.
The syndrome is growing, reaching its peak at night and after even minimal physical activity in the affected area. In especially clinical forms of its manifestation, it is capable of driving a sick person to suicide.
Hypercalcemia. In medical terminology, it means an increase in the percentage calcium components in the patient's blood due to abnormal resorption of hard bone tissue.
It is accompanied by severe thirst, dryness of the oral mucosa, a tendency to frequent and copious urination, sudden manifestations of nausea and severe vomiting, slowness of reaction, and periodic disturbances in conscious perception of reality.
The most complex complication that poses a serious threat to human life, since in the shortest possible time it can lead to complete dysfunction of the main organs and systems vital functions of the body - heart failure, general dehydration, kidney disease.
Along with the listed symptoms, the following manifestations of the disease may occur:
- skin changes;
- ulcerative formations;
- osteochondrosis;
- manifestations of arthritis;
- rheumatism, not previously diagnosed.
People with metastases in the bones should pay extreme attention to all manifestations of the disease without exception - this may be the first warning sign that the doctor must know about. After the examination, he will determine how severe the pathology is and how to deal with it.
Causes and development of the disease
Almost every case of oncology is associated with metastasis, but not all bones of the human skeleton are equally susceptible to this pathology. What is the risk group?
Let's dwell on main types of bones and their inclinations and this process:
- hands and feet, feet, ribs, skull– are carriers of pathology only in situations where the disease is focally malignant;
- spine– for breast tumors;
- pelvic part– when the oncological process is close to it;
- femoral– due to its impressive size, it very often becomes a source of disease.
As a rule, the following diagnoses become the cause of bone metastasis:
- cutaneous superficial melanomas;
- lung cancer and respiratory tract oncology– the most common cause of hard tissue lesions – they grow into the spine;
- prostate tumor– slowly kills the femur, lumbar region and thoracic spine;
- lymph node cancer– lower limbs, radial and ulnar hard tissues are at risk;
- kidney oncology– affects the spinal cord;
- formations in the thyroid gland– affects the bones of the limbs.
Diagnostics
It is very important to correctly diagnose the type of metastasis in the bones - this allows you to at least somehow control the processes of damage and tissue destruction.
The following diagnostic methods are used:
- neurological examination– the specifics of the disease, its clinical features and manifestations are determined. During the examination, it is taken into account that signs of metastasis can appear both at the same time as the development of oncology, and much later; in addition, the absence of a neoplasm is not a reason to exclude them;
- scintigraphy- one of the ways to determine the presence of a disease using radiation. Radio drugs enter the body and, based on the isotope radiation pattern, I diagnose the disease;
- radiography– a method proven by practice and time, but in the early stages it may not reveal pathology;
- CT, MRI bone– indicated for diagnosing the spinal cord and brain;
- Blood chemistry– a very accurate method that shows an objective clinical picture of the development of the disease. Determines the degree of damage and the internal structure of cancer cells.
Treatment
The following methods of treating bone metastases are practiced:
- elective surgery– justified when the defeat process is not too advanced. Used in combination with other types of treatment;
- emergency intervention for spinal cord compression– a very dangerous form, any therapy other than surgery is powerless in this situation. The main task of the surgeon is to respond as quickly as possible to the growth of pathological disorders. There is little time allotted, and any delay can cost the patient his life;
- radiation therapy– used in a course for 2-3 weeks. The principle of operation is based on the susceptibility of cancer cells to the effects of radio rays. As for this problem, the method is not always effective;
- chemotherapy– inhibits further growth and spread of pathology. Works well at stages 1–2 of the disease;
- anesthesia– a method accompanying the main treatment. Mainly non-steroids and potent narcotic substances are used, which, when used systematically, cause dependence and a decrease in the effectiveness of the action.
Forecast
Metastases found in bones due to cancer kidney, if treatment is not carried out, they give the person the opportunity to live about a year, due to cancer thyroid glands – near 3-4 years, at melanoma – a few months.
If you consult a specialist in time to start therapy, you will undoubtedly have a greater chance of living a full life. With correct treatment and patient compliance with all recommendations, you can not only cope with the disease, but also return to a full life.
