Cancer in the later stages has the ability to metastasize to any organ in the body, especially bone metastases . Symptoms of cancer that have spread to the bones are often not obvious. This condition is difficult to detect early so that timely intervention can be taken.
What is bone metastases?
Bone metastasis is a condition in which cancer cells from the primary site metastasize to bone tissue, causing damage to the bone structure. Metastatic cancer is simply cancer that is already at a late stage. The skeletal system is considered to be the most commonly metastatic organ. All types of cancer metastasize to the bone, seriously affecting the quality of life of the patient.
Currently, there is no cure for cancer that has spread to the bone completely. Treatment options only help relieve symptoms, limit the spread of advanced tumors to prolong the patient’s survival time, and improve the quality of life for the rest of the patient’s life.
Common types of bone metastases
Common types of metastatic bone cancer include:
- Spinal bones (most common site of metastasis).
- Pelvic bones (hip bones, acetabulum, pubic branches, etc.).
- Proximal end of femur, shin bone, humerus.
- Skull bones
Signs of bone metastases
The first symptom of cancer that has spread to the bone is pain. The initial pain may be intermittent. Over time, the pain can become constant, more severe with movement. Bones can be so weak that they break easily.
2. Broken bones
Fracture symptoms can occur when a person suffers a fall or injury. However, even during normal activities, the patient is also likely to break because the bone is already weakened with bone destruction, causing a pathological fracture.
Commonly fractured areas include the long bones of the arms, legs, and spine. When the vertebral column is broken, the person may experience sudden pain in the middle of the back. On the X-ray results, the doctor finds that the bones of the upper or lower limbs (arms or legs) are likely to be broken (threatened to break) or have a real pathological fracture.
In the case of threatened fracture, the patient may be indicated for preventive bone fusion surgery by placing a metal nail in the weak bone area to strengthen the weak spot. If the bone has broken, the doctor usually surgically recombines the bone with a nail or metal brace to fix the broken bone.
3. Compression of spinal cord
Cancer growing in the bones in the back can put a lot of pressure on the spinal cord. One of the earliest, typical symptoms is pain in the back or neck. If spinal cord compression does not have immediate intervention, the patient is likely to be paralyzed.
Patients with spinal cord compression often experience back pain , numbness in the legs or abdomen, leg weakness, and difficulty moving their legs. If these symptoms appear, the patient should quickly go to reputable medical facilities for timely intervention.
4. High blood calcium levels
High blood calcium levels can cause constipation, frequent urination, feeling lethargic, sleepy, feeling thirsty all the time and drinking a lot of fluids, muscle weakness, muscle and joint pain, coma, failure kidney.
Causes of bone metastases
Bone metastasis is a condition in which cancer cells arise, break free, and spread to the bone from the original tumor. Experts are still not sure what causes some cancers to spread, moving to the bone instead of affecting another site, such as the liver.
Methods of diagnosis
To diagnose cancer that has spread to the bone, the doctor will rely on laboratory methods such as:
This diagnostic method helps doctors detect signs of cancer spreading into the bones. X-ray is a simple method that is often indicated first when a cancer patient has bone pain or other symptoms that suggest bone metastases. In addition, the method also helps detect fractures due to metastases.
2. Computed tomography (CT)
CT scans can analyze 10 times more detailed images than conventional X-rays. This method helps to determine the location for bone biopsy under CT scan.
Computed tomography also helps doctors assess the size and shape of metastatic tumors in the bone and how strong the bone is.
3. Magnetic Resonance Imaging (MRI)
The results of an MRI scan help the doctor see the invasion of the marrow, surrounding soft tissues and probe the spinal canal. This is a highly sensitive probing technique, which helps to probe the bone marrow accurately.
4. Bone scintigraphy
Bone scintigraphy is a highly sensitive diagnostic method for detecting bone metastases. This method is capable of exploring all skeletal systems that no other diagnostic method can do. Bone scans help doctors detect bone metastases before a patient has symptoms, about 3-6 months earlier than X-rays. In addition, the doctor may order this diagnostic method to monitor the response of bone metastases to treatment.
5. Other tests
When cancer spreads to the bone, the cancer cells or other cells can produce certain substances that can be detected in blood tests, such as:
- Calcium: Bone metastases cause bone to dissolve, calcium levels in the blood increase, causing hypercalcemia.
- Alkaline phosphatase: Alkaline phosphatase levels may increase as bone dissolves. However, the liver is also capable of producing alkaline phosphatase. Therefore, elevated phosphatase levels may also be indicative of liver disease.
- Urinalysis: Damage to bones caused by metastatic cancer can cause certain substances to appear in the urine.
- Tissue biopsy: For cases where cancer has not been diagnosed before, the doctor will take tissue from the suspected cancer site to determine whether the cells are malignant, possibly identifying bone metastases. from any organ in the body. On the other hand, if the patient has been diagnosed with cancer before, has checked for bone metastases with bone scans and blood test results, the doctor will not need to do a biopsy.
Methods of treating diseases
1. Taking medicine
Commonly prescribed medications for patients include:
- Osteoporosis medications : Medications commonly prescribed for osteoporosis can also help patients with bone metastases. The effect of the drug is to strengthen bones, reduce pain caused by bone metastases, and reduce the need for strong analgesics. However, medications for osteoporosis can cause temporary bone pain and some kidney problems. The drug has the potential to increase the risk of rare but serious osteonecrosis of the jaw (osteonecrosis).
- Intravenous radiotherapy: In case of multiple bone metastases, some intravenous radioactive drugs may be prescribed. Once in the body, the drug moves to the areas of bone metastases and releases radiation. Medications to help control pain caused by bone metastases. Side effects may include bone marrow damage and anemia.
- Pain relievers: Medicines to help control pain caused by bone metastases. Many pain relievers are indicated in the treatment of cancer pain. In addition, there are many different ways to use pain relievers such as pills, patches, infusions.
- Steroids: Drugs that help relieve pain associated with bone metastases by reducing swelling and inflammation around cancer sites. The drug works quickly and effectively. However, the use of steroids requires special caution. Because the drug has many side effects, especially in cases of long-term use.
If the cancer has spread to many bones, your doctor may recommend chemotherapy . This method can be taken as an oral medication, intravenously, or a combination of both. Side effects depend on the specific chemotherapy drugs you take.
3. Hormone therapy
This therapy may involve the use of drugs to reduce natural hormone levels or to block interactions between hormones and cancer cells. Another option is to surgically remove hormone-producing organs such as the ovaries and testicles. Prostate and breast cancers are often sensitive to hormone-blocking treatments.
4. Targeted Therapy
Targeted drug treatments focus on specific abnormalities present in cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
5. Radiation therapy
Radiation therapy is a method of using high-energy beams of radiation (X-rays and protons) to destroy cancer cells. This approach may be an option when bone metastases are causing pain that cannot be controlled with analgesics or when pain is limited to a few small areas. Depending on the patient’s condition, the dose of radiation to the bone will be different. Side effects of this method depend on the treatment site and its size.
Several types of surgery are often indicated in the treatment of metastatic bone cancer, specifically:
- Bone stabilization surgery: When the bone is at risk of fracture due to bone metastasis, the doctor can stabilize the bone by using metal rods and screws to fix it, thereby reducing pain and improving function.
- Surgery to inject cement into the bone: Some bones are difficult to strengthen with metal plates or screws, such as the pelvis and spine. For these cases, the doctor may appoint the patient to perform bone cement injection.
- Surgical repair of a broken bone: When bone metastases cause a bone to break, a surgeon can surgically repair the bone using metal rods and screws to stabilize the bone.
7. Heat or freeze the tumor
Killing cancer cells with heat or cold can aid in pain control. These procedures may be an option when the patient has only one or two areas of bone metastases that have not responded to other treatments. Possible side effects include damage to nearby structures such as nerves and bone damage, potentially increasing the risk of fracture.
Bone metastases and some related diseases
Bones undergo constant remodeling under normal conditions. This process is accomplished through osteoblasts (bone-forming cells involved in bone mineralization and formation) deposition and osteoclasts through mediated resorption. At this time, bones are regularly adjusted to balance calcium levels in the body, maintaining bone structure.
When metastasized, cancer cells cause osteolytic (bone resorption) or osteoblastic (osteoblast) damage, and adversely affect the development of reflex mechanisms in the body. The osteoblastic metastases are more active and more severe than the osteoblastic metastases. However, regardless of the type of disease developing, patients are at high risk of hypertrophy, proliferation of osteoclasts.
Types of lesions, primary tumors include:
- Bone loss damage
- Kidney cancer .
- Thyroid cancer .
- Lung cancer .
- Non-Hodgkin lymphoma.
- Multiple myeloma disease.
- Malignant tumor.
- Langerhans cells lose stem cells.
- Stem cell injury
- Thorough myeloma.
- Hodgkin’s Lymphoma
- Small cell lung cancer
- Prostate cancer
- Mixed injury
- Breast cancer
- Testicular cancer
- Ovarian Cancer
- Gastrointestinal cancer
- Squamous cell skin cancer.
Survival prognosis of patients with metastatic bone cancer
Bone metastases are a serious stage of the disease that is difficult to control. In this stage, the main treatment regimen is to reduce the symptoms of the disease, helping to prolong the patient’s life.
Depending on the physical and mental status of each patient and the type of cancer metastasized to the bone, the survival time of each person will vary, usually, about 16-24 months when treated actively and in the right direction. Therefore, early detection and treatment of bone metastases is a prerequisite for increasing survival time for patients.
According to the pathology website Cancer.org, hereditary cancers account for only about 5-10% of all cases. Meanwhile, most diseases are caused by the lifestyle of the patient. To prevent this cancer, each person should adjust a healthy lifestyle, limit high risk factors such as smoking, using stimulants.
You should protect your body in the sun, ensure that you provide enough nutrients in your diet, maintain a balanced body, and exercise regularly. In addition, each patient needs to maintain a routine of regular health check-ups or cancer screening in order to detect cancer early, thereby taking timely intervention measures to prevent serious progression.