What is Bone Metastasis?

Many cancer patients are informed every year that their cancers have spread to bones. Bone metastasis may spread from breast tumours to the bone, while prostate cancer may spread to the bones and lung cancer may progress to bone metastasis or in other body parts.

The initial symptom that enables us to recognize  bone metastasis is mostly pain in the boneS. You may wonder about how it may happen especially if you have received an aggressive treatment and “fugitive” cancer cells at an early stage. You may also be concerned about what will happen in the future.

Cancer that has spread to the bone can not be completely cured, but could be treated. The pain can be alleviated and the progression can be slowed down through a wide range of treatment options for bone metastasis. Please continue reading to learn what is happening in your body and what you should expect during the treatment.

How Does Cancer Spread to Bones?

When a cancer has already metastasized, the condition generally appears within two to three years after the diagnosis is made or it may also be recognized beyond this time frame. Sometimes, the condition does not cause any symptoms.

How does bone metastasis occur?

Metastasis occurs when cancer cells detach from the primary tumor, where the cancer originates from. Then, these cells may spread to the bone marrow through bloodstream or lymphatic system.

Cancer cells can remain hidden and sessile in the bone for a long time. This implies that they may also be hidden from effects of the treatment. However, these cells start dividing at one point and form new blood vessels for oxygen and nutrient supply. Thus, one or multiple tumors develop.

Scientists have, recently, just understood the underlying cause of this process in the bone. When metastasis initiates, “ a vicious circle that perpetuates the condition” may emerge. Release of cytokines may allow much more cancer cells spread to the bone marrow and this condition may help cancer cells survive.

What are symptoms/signs of bone metastasis?

Bone metastasis may cause insufferable pains. Compared to other bones, the pain is severe in the bones that bear weight of the body. For example, metastasis to the hip bone may be more insufferable than the one in the rib.

At the beginning, it may be difficult to reveal out the underlying cause of the symptom. It may not be possible to consider that cancer is not the only factor leading to the pain. It is, therefore, important to visit a doctor when you notice any sign of bone metastasis.

  • Bone pain. It is usually the first symptom of bone metastasis. It may be intermittent at the beginning. Generally, the pain worsens at night and regresses as you move. However, this pain does not disappear in time.
  • Bone fractures. Metastasis weakens the bones and accordingly, the risk of bone fractures increases. Fractures occur mostly in bones of legs and arms as well as vertebra.
  • Numbness, paralysis and difficulty urinating. These conditions occur when bone metastasis spreads to the spine and compresses the spinal cord.
  • Loss of appetite, nausea, excessive thirst, confusion or tiredness. These symptoms may be secondary to high calcium concentrations in bloodstream. While metastasis grows in the bone, calcium is secreted to the bloodstream.

How is bone metastasis diagnosed?

In case you notice these symptoms, your doctor will possibly order a more comprehensive physical exam, blood tests and bone scan (scintigraphy). Depending on laboratory results, location of the bone and severity of the condition, X-ray, PET or CT is usually ordered. Your doctor may ask for a biopsy of the bone tissue to be examined under microscope in order to verify the diagnosis.

What are treatment options for bone metastasis?

Doctors will decide how to manage the bone metastasis depending on location of lesions and extent of spread. Some of treatment options for Bone Metastasis are as follows:

  • Treatment of underlying cancer: Treatment depends on type of the tumor and part of the body it originates from. Typically, treatment involves combination of medications used to treat the primary cancer when your initial diagnosis is made.
  • Bisphosphonates: Bisphosphonates prevent the bone loss resulting in the pain and reduce the risk of bone fracture. Doctors may administer Bisphosphonates intravenously at four-week intervals to stop or slow down the development of metastasis and prevent fractures.

Bisphosphonates are important especially when metastasis exists in the bones that bear weight of the body or it causes severe pains. If the metastasis in the spine causes severe pain and poses the risk of vertebral compression fracture, doctors usually refer the patient for orthopedic exam. Patients often need intravenous fluid therapies, Bisphosphonates and other medications to decrease high calcium levels.

If a fracture is very likely in the near future, an orthopedic surgeon may place a rod or a pin to stabilize the bone. At Neolife, radiotherapy is also given for several sessions to further stabilize the bone. During radiotherapy, high-energy X-rays are delivered to the tumor to kill cancer cells. If surgery is not deemed necessary, radiotherapy alone may alleviate pains. This therapy is given for five to ten cycles depending on location of tumors and extent of spread.

Treatment of bone metastasis can prolong survival and alleviate symptoms. These outcomes largely depend on type of cancer, patient’s age and the time that has elapsed since the diagnosis of cancer. However, many patients feel better for a long time.

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