It's good that cancer metastasis to the bone hurts! Under no circumstances should you disregard this warning signal and be seduced by the promise of healing with painkillers. Especially for this signal should be sensitized women who have undergone breast cancer therapy. Feeling a chronic pain in the spine, hip joints or shoulder joints, they should report to the leading oncologist as soon as possible.
It hurts, so it threatens ...
Paradoxically, the most important asset in the fight against cancer metastases is the severe pain of bone cancer attacked. This signal means that something bad is going on in the bones. Anyone at risk for bone metastases should be disturbed by spine pain, nerve roots; hip joints, shoulder joints, etc. And it should not calm down in the mind that it is just ordinary rheumatic pain.
Cancerous process of bone tissue destruction - tumor osteolysis
Osteolysis is a fast-acting process of bone tissue destruction resulting from tumor metastasis to the skeletal system. It involves increased bone destruction by its own bone cells called osteoclasts. In the body functioning properly, the process of bone formation and destruction is balanced. In osteolysis, it is disturbed by destruction. Cancer cells find inside the bones conditions favorable for development. The marrow found here produces substances that stimulate the development of blood cells. Cancer can absolutely use this power source to accelerate the growth of its own cells.
Photo.1 Healthy and strong bone structure
Photo 2. Osteolysis osteolysis focal point
- disappearance of the trabecular bone structure
Bone metastases to the bone are most often located in the spine, ribs, pelvis as well as in the femoral and humeral bones
In these places they perfectly imitate discopathy, rheumatoid arthritis, radiculitis, etc. It is better to make a false alarm than to disregard a disturbing pain signal. Unfortunately, it often happens that women after surgical treatment of breast cancer, using chemotherapy or radiotherapy - due to a tragic misdiagnosis of their own or a doctor - can be treated for many years for arthritis or discopathy. The patient loses the priceless time necessary for proper life-saving therapy.
Types of cancer that give bone metastases
Cancer cells from the organ in which the primary focus is located - after entering the blood stream and the lymphatic system, they can settle in the lungs as well as in more distant organs, e.g. in the liver, pancreas or bones. In the case of breast cancer, multiple myeloma, thyroid cancer, as well as some lung cancer - bones are the most common site of cancer metastasis.
The oncological anxiety of the patient is assessed by the oncologist
The oncologist will make the right diagnosis through radiological bone examination. This study uses the difference in x-ray absorption between healthy bone and cancer. It should be remembered that in the classical radiological examination, only changes that are clearly clearly advanced, i.e. greater than 1 cm in diameter and at least 40%, are visible. loss of bone mass in the cancer focus. These types of cancerous lesions are visible on the X-ray film, as spotty lesions resembling radiologists' image of "going through the moths".
Early detection of bone metastases
The test that allows earlier detection of bone defects is a scintigraphic examination that covers the entire skeleton.It indicates places of intense bone changes, but it is not certain that these are cancerous changes, and not, for example, strong osteoporosis. Such assurance is provided by research using computer tomography and magnetic resonance.
Treatment of bone metastases
The most important methods of inhibiting osteolysis and bone metastases include:
- radiotherapy,
- hormonotherapy
- pharmacological treatment with the use of modern drugs from the group of bisphosphonates, glucocorticoids
- sometimes surgical resections of single metastases are used
- in the case of pathological changes in the spine that threaten fractures, it is sometimes recommended to use corsets that provide external support for the weakened skeleton.
Radiotherapy combats the pain caused by the effects of osteolysis
The basis of current painkillers is irradiation with radiotherapy of tumor foci in the bones. In 80% of patients it brings quick pain relief. In some patients, this improvement is permanent. If metastases are numerous, an intravenous infusion of a radioisotope is used, which along with the circulation reaches the cancerous foci throughout the body. Radiotherapy is not painful, it brings clear improvement.
Hormone therapy prevents the metastasis of hormone-dependent tumors
In the suppression of hormone-dependent metastases of malignant tumors of the breast and prostate, hormonal therapy is also used. Hormonal treatment to prevent metastases of breast cancer to the bone is like in the prevention of breast cancer to lower the level of female hormones. In addition, calcitonin is used that promotes calcification of bone weakened ostolysis.
Biphosphonate pharmacotherapyand
Due to the risk of fractures as well as systemic, harmful effects of calcium leakage from the bones (hypercalcaemia), calcium binding drugs - bisphosphonates are used. The greatest hope is recently in bisphosphonates - synthetic compounds that are very helpful in the treatment of bone metastases. In Poland, a number of such medicines are currently registered on the basis of such medicinal substances as clodronate and pamidronate. Bisphosphonates are used primarily in patients with breast cancer complicated by bone metastases, although positive treatment effects have also been found in patients with prostate cancer and multiple myeloma.
The use of bisphosphonates in such cases allows to limit further metastases and inhibit the development of already existing cancer foci.
Biphosphonates act multilaterally and therapeutically
First, they build into the bone mineral matrix and strengthen the bone structure. This enhancement protects the bone from destruction that bone cells perform constantly (in contrast to the constant bone reconstruction by osteogenic cells). This is important because cancer focuses the action of bone cells. Secondly, they limit the numerical development and the ability of the bone cells to move to the appropriate bone site, which hinders their effective functioning. This allows to effectively reduce the activity of bone cells responsible for the rapid destruction of bone tissue and the associated pain and bone fractures.
The use of bisphosphonates in the early stage of bone metastases is particularly advantageous in a prolonged manner
Chronic use of bisphosphonates significantly reduces the risk of subsequent metastases. In a study at the university hospital in Haidelberg, it was determined that clodronate administered 2 years to patients with breast cancer, with their presence in the presence of cancer cells in the bone marrow - significantly reduced the number of new bone metastases. Interestingly, a reduction in metastases was observed, not only to bones, but also to visceral organs (lungs, liver, etc.). Most cancers have the ability to release their cells and move them to bones and other organs.
Prophylaxis of bisphosphonate bone metastases?
Can higher-hopes for safer prophylaxis against multiple neoplastic metastases be associated with bisphosphonates? Certainly yes. It is already known that the use of bisphosphonates on time allows to maintain much longer physical fitness and permanently get rid of severe pain, sometimes without the need for additional painkillers. Thus, they help to maintain the necessary minimum of life comfort in patients.
ed. Edward Ozga Michalski
consultation - dr n. med. Ewa Krzęcio
