Some tumors, such as tumors of the lung, prostate, thyroid, kidney, etc., spread to the bones in their course. Doctors call the involvement of organs outside the original tumor called metastasis. The spine is the most common site for bone metastases.
In the following we will say that
What does bone metastasis feel like?
What are the types of bone metastases?
- Tumors that can increase bone production by spreading to the bones
- Breast tumors (adenocarcinoma)
- Prostate tumors (adenocarcinoma)
These metastases are called osteoblastic
Osteoblasts are bone-forming cells, and the term osteoblastic means to increase bone production.
- Tumors that cause bone destruction and therefore unusual fractures
Most cancers can cause this type of bone metastasis, in which case the bone is very weak, breaks easily and does not heal.
How bone metastases form
The most important factor that transmits cancer cells is blood flow. Cancer cells are present in the venous blood of the affected organ and leave the tumor. The distribution of these cells in organs such as the lungs and liver causes metastatic malignancy in these organs.
Bones are the third organ in which metastasis is prevalent
Where are bone metastases most common?
Bones of different areas of the body, including:
Which tumors are most associated with bone metastasis?
Tumors in the following areas are more likely to lead to bone metastasis:
How do bone metastases feel?
Tumors that involve the bones in any way are generally very painful, controlling the pain in the cancer will increase the patient’s tolerance for further treatment and recovery.
It has been shown that if the pain of a person with bone metastases is controlled, the patient will respond better to their treatments.
Bone metastases, as mentioned, either reduce bone density or cause extra ossification on old bone.
However, the involved bone becomes very weak and will break easily even with a small movement. Such fractures that occur in abnormal areas following very minor trauma are called pathological fractures.
As cancer cells spread to the spine, the space around the spinal cord may become narrower, or bone problems may put pressure on nerves, including the roots of the spinal nerves, and lead to paralysis of the limbs.
In fact, if left untreated, nerve damage and paralysis of the limbs can occur
In osteoclastic metastases where the bones are destroyed, the calcium removed from the bones enters the bloodstream, blood calcium rises (hypercalcemia); an increase in blood calcium can be accompanied by very fatal cardiac arrhythmias.
Symptoms of bone metastases
Before describing the symptoms, we emphasize that if you have the following symptoms, it is very important to inform your doctor because starting treatment early can prevent serious complications.
In the following, we will tell what the symptoms of bone metastases are and how they are felt:
- the pain:
The first sign of bone metastasis is pain
Bone pain worsens at night following metastasis
Bone pain following metastasis, in the early stages, improves with movement of the body, but as the disease progresses and spreads, bone pain becomes permanent and may worsen with physical activity and movement.
The treatment for metastatic pain in the bones varies depending on the type of primary tumor
In some tumors, primary tumor treatment causes shrinkage of bone metastases!!
Sometimes certain drugs are given so that the tumor cells do not reach the bones. Sometimes local treatments such as radiotherapy are needed
There are a variety of medications available to control pain and reduce the pain of bone metastases that can be used as painkiller tablets or pumps.
- Bone fractures:
Bones that have metastasized are so weak that they can break with normal body movements.
These fractures cause very severe and sudden pain
Fractures of the spine, arm or thigh will be possible
Sudden lower back pain in a person with cancer can be due to pathological fractures.
Doctors may use surgery or vertebroplasty, depending on the patient’s condition
Often after surgery, topical radiotherapy is used to prevent damage to the rest of the bones. We must say that radiotherapy does not strengthen the bone, but it can prevent it from breaking.
We emphasize that if the patient with cancer is weak and confused for any reason, you must inform the treatment team, because the use of mobility aids such as bath chairs, canes, walkers and handrails is essential for these people to avoid high-risk fractures.
Spinal cord compression
Spinal bone growth due to metastasis (osteoblastic metastases) narrows the space if it is inside the spinal canal and puts pressure on the spinal cord
The first sign of spinal cord compression is pain in the lower back and neck.
Lack of therapeutic intervention can lead to paralysis of the arms and legs (in case of involvement of the cervical vertebrae); or be accompanied by paralysis of the legs (in case of involvement of the lumbar and sacral vertebrae).
Symptoms of spinal cord compression include:
- Back pain that sometimes is radicular especially to one side
- Numbness of the legs
- Numbness in the skin of the abdomen
- Weak leg muscles
- Difficulty walking
- urinary incontinence
- Stool incontinence
Tell your doctor immediately if you notice any of the above symptoms.
Increased blood calcium or hypercalcemia
Calcium uptake from involved bones and bone destruction increase blood calcium, which is called hypercalcemia.
The following symptoms may be due to elevated blood calcium levels:
- feel sleepy
- feeling thirsty
- Muscle weakness
- Muscle aches
- Joint pain
- Decreased consciousness and coma
- Kidney failure
Intravenous fluid therapy maintains kidney health and the use of drugs such as bisphosphonates will rapidly reduce blood calcium levels.
When calcium levels return to normal, treatment for the primary tumor will continue.
Treatment of bone metastases
Read the treatments for bone metastases briefly below
Each type of primary tumor and each clinical condition requires a specific type of treatment determined by a physician.
Gamma radiation damages cancer cells’ DNA and kills cancer cells. The destructive effect of gamma rays on cells with high proliferation rates such as tumor cells will be much greater than normal cells
Radiotherapy cannot eliminate all bone metastases; it will only reduce their number.
Pain relief usually begins one to two weeks after starting radiotherapy, but the maximum pain relief will be a few months after treatment.
Drugs called bisphosphonates such as alendronate:
These drugs reduce the destructive activity of bones
- Hormone Therapy:
In breast and prostate cancers
Metastatic bone fractures often do not heal or heal difficultly. The doctor’s whole effort is to strengthen the bones at risk before the fracture occurs.
Pinning, joint replacement, and vertebroplasty, which is the strengthening of the vertebrae with special medical materials, are selected and performed at the patient’s request.