Reduce pain and prevent complications Multidisciplinary treatment of bone spread

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Article Jiang Ziliang (Clinical Assistant Professor, Department of Clinical Oncology), “Ming Pao”

Mr. Chen, 67 years old, has always been in good health. He does not smoke or drink. He started to suffer from low back pain 3 months ago. It turned out that the prostate cancer had spread to the bone.

Suddenly, Mr. Chen and his family were at a loss for what to do.

(Hong Kong News) Many cases of this type are encountered every year. The general public does not know much about the spread of cancer to the bone (or bone metastasis), and there are many fallacies, so this article is written to strengthen public awareness.

advanced cancer cells metastasized to bone

1. What is bone spread? Is it equal to bone cancer?

When the cancer reaches an advanced stage, some cancer cells may transfer from the original organ to the bones in the body, and then grow into another tumor, destroying the bone structure, which we call “bone spread”.

Bone metastases may occur in all bones of the body,

But the transfer site,

mostly concentrated in the spine, ribs, pelvis,

Femur and upper arm bones.

Generally speaking, below the elbow joint and below the knee joint,

Bone spread is less common.

primary bone cancer,

Generally refers to tumors originating in the bone,

relatively rare,

Treatment is quite different from bone spreading.

3 The probability of cancer metastasizing to the bone is high

2. Which tumors are more prone to bone spread?

Prostate cancer, breast cancer, and lung cancer have a higher probability of metastasizing to bones. Of course, other cancers also have a risk of bone metastases in advanced stages.

Bone proliferation does not mean short lifespan

3. Bone spread, does it mean that the condition is very serious?

Generally speaking, if the cancer spreads to the bone, it means that the cancer cells have spread to distant organs through the blood, and the cancer has reached the fourth stage, so the condition is considered serious. However, the survival rate of patients depends on different tumors and different diseases (such as whether other major organs: liver, lung, brain, etc. have spread), and the difference can be great. Therefore, even if a patient has bone spread, it does not mean that the patient’s life span must be short.

cause bone loss bone brittle

4. How does bone diffusion damage the bone structure?

There are two types of cells in human bones, one is called osteoclast and the other is called osteoblast. The function of osteoclasts is to break down bone, while the function of osteoblasts is to manufacture bone. In normal bones, the growth of these two types of cells is in a balanced state, which keeps the bone stable for a long time. But when the tumor spreads to the bone, it will release substances that accelerate the growth of osteoclasts, while the growth of osteoblasts is relatively weakened, disrupting the balance between the two. As a result, bone mass is lost and bones become weaker and weaker.

80% of bone spreads are painful

5. What kind of discomfort will the bone spread cause? Do all patients with bone spread also experience pain?

Not all bony extensions are also painful, but the chances are high. According to statistics, about 80% of patients with bone spread will feel pain. The discomfort the patient feels is as follows:

◆Local pain

This is the most common symptom.Tumors that spread to the bone will proliferate and cause local inflammation, compress local tissues, or invade nerves, causing pain and numbness

◆Fracture

Bone diffusion can lead to bone loss, damage the structure, and make the bones fragile. For example, bone diffusion occurs in the femur or upper arm bone, etc. These relatively young bones that need to bear weight are more prone to fractures

◆Spinal cord compression:

This is the most dangerous complication of bone spread. The bone spreads to the spine, and the tumor grows backward and compresses the spinal nerves, causing paralysis, weakness of limbs, and even paralysis and incontinence.Once it is not treated in time, the damage to the spinal cord nerves often cannot be repaired, causing permanent damage

◆Hypercalcemia

As bone breakdown increases significantly, calcium is released into the blood.Symptoms of hypercalcemia are usually not obvious. Possible symptoms include: fatigue, irregular heartbeat, nausea, vomiting, constipation, dehydration and confusion, etc.

◆Affect bone marrow hematopoietic function

As the bone spread occupies part of the bone marrow space, it may affect the patient’s hematopoietic function, resulting in anemia, low white blood cells or insufficient platelets, affecting the patient’s spirit, resistance and hemostasis function, etc.

Electrotherapy improves pain and reduces fractures

6. How does electrotherapy help bone diffusion?

◆Reduce Pain: Studies have shown that within about 1 month of electrotherapy, about 70% of patients’ pain will be partially or completely improved.Generally speaking, the pain will not be relieved immediately after electrotherapy, and it usually takes about two weeks to gradually improve

◆Strengthen the local control of the tumor and maintain the patient’s self-care and mobility

◆Reduce the incidence of complications such as fractures or compressed nerves

Insufficient precision of traditional electrotherapy

7. What is the difference between traditional electrotherapy and stereotactic radiation therapy (SBRT) in the treatment of bone spread?

Traditional electrotherapy techniques are often used to treat bone spread, but due to lack of precision, in order to avoid damage to nearby nerves and normal tissues, the dose of electrotherapy that can be irradiated is often low, and the pain relief and control effects are relatively short-lived.

Stereotactic radiotherapy (SBRT) combines precise positioning and image navigation technology, the accuracy can be increased to about 1 to 2 mm, and the electrotherapy dose can be increased. Studies have shown that the pain relief effect of patients is better; and the local tumor control can reach 90% in one year, which greatly reduces the impact of bone proliferation on patients.

Surgery to assist spinal nerve decompression

8. What other treatment methods are there for bone proliferation?

A. Surgical treatment

I. When the patient’s bone spread causes the spinal bone structure to become unstable and compress the spinal cord nerves, the doctor will consider surgery to help the spinal nerves decompress as soon as possible to avoid permanent damage

II. When the patient’s weight-bearing bones (lower extremity bones) are severely damaged, and fractures have occurred or are likely to occur, the doctor will consider surgery to help the bones restore structural stability and reduce the patient’s pain

B. Non-surgical treatment

I. Painkillers: assist other treatments to reduce pain symptoms of patients

II. Bone needles: Patients need regular injections. The principle of the drug is to reduce the osteoclasts in the bones, thereby slowing down the destruction of the bones by the tumor.Studies have shown that patients who receive bone needle injections experience less pain and are less likely to suffer from complications such as fractures or spinal cord compression

All in all, there is no cure for bone spread. Multidisciplinary treatment (precise electrotherapy, combined with surgery and drug treatment) can greatly reduce the pain of the patient and cause terrible complications (such as fracture or spinal cord compression leading to paralysis or incontinence) risk and improve the patient’s quality of life.

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