Metastases in the tibia. Whether development in bones of a metastasis is a verdict. Bone metastases: types and characteristics

One of the complications of cancer is that it can spread to soft tissues and distant organs.

Metastasis occurs in the bones. In fact, bone metastases are secondary cancerous tumors of the bone tissue, which are formed as a result of the transfer of atypical cells from the main focus with the bloodstream and lymph flow.

Usually, bone metastases occur already at the last stages of oncopathology. Moreover, about 80% of cases of bone metastasis occur against the background of and. Such formations are manifested by severe pain, frequent fractures and hypercalcemia.

Causes

Most often, metastasis to bone structures occurs with and, prostatic and breast cancer, malignant tumors in and gastrointestinal structures, and.

Metastasize to bone tissue and other malignant neoplasms, only much less frequently.

When a person is healthy, his bones are constantly being renewed. In general, bone structures are characterized by the processes of resorption, remodeling and bone formation. These processes are carried out due to the cellular activity of osteoblasts and osteoclasts. These cellular structures are responsible for the formation, absorption and destruction of bone tissue.

If atypical cells penetrate into the bone structures, then there is a violation of the functioning of the bones. Healthy cells are displaced, the processes of interaction between osteoblasts and osteoclasts are disrupted, which leads to the uncoupling of their activity.

For breast cancer

Metastasis to bone structures in breast cancer occurs in the lymphogenous and hematogenous way. Such localization of metastases in breast cancer is quite common.

Cancer with such metastases is characterized by severe morbidity and an excessive tendency to pathological fractures, especially in the chest and pelvic bones.

Types

Depending on the type of cell activation, oncologists distinguish several types of bone metastases:

1. Osteoplastic- accompanied by the formation of seals on the bones;
2. osteolytic- when there is a predominant destruction of bone structures.

Pure types in medical practice are relatively rare, their mixed forms are much more common.

The most susceptible to metastasis are bones that have a rich blood supply, i.e., in the shoulder and femur, ribs and vertebral, cranial and pelvic bones. At first, bone metastases do not manifest themselves in any way, but over time they become the cause of intense pain, which is associated with stimulation of periosteal pain receptors.

Symptoms of bone metastases

At first, bone secondary tumors develop asymptomatically, but with the development of the tumor process, a certain clinical picture is formed:

• The presence of hypercalcemia;
• Tendency to pathological fractures;
• The presence of spinal compression.

Hypercalcemia is a life-threatening complication that is found in about 30-40% of cancer patients with bone metastasis.

This condition occurs due to excessive activity of osteoclasts, leading to an increase in the level of calcium in the blood, which in turn causes a pathological increase in renal excretory abilities.

As a result, in cancer patients with bone metastases, in addition to hypercalcemia, hypercalciuria develops, the reabsorption of fluid and sodium is disturbed, leading to polyuria.

As a result of such changes in cancer patients, the activity of many systems and organs is disrupted:

1. In the nervous system activity, signs such as lethargy and mental disorders, confusion in the mind and affective disorders are noted;
2. In cardiovascular activity, abnormalities occur such as arrhythmia and low blood pressure, a decrease in heart rate, while the risk of cardiac arrest is high.
3. The kidneys are affected by nephrocalcinosis and polyuria;
4. In the gastrointestinal tract, nausea and vomiting, frequent constipation and lack of appetite are observed, or pancreatitis may develop.

If more than half of the cortical layer is destroyed during bone metastasis, then pathological fractures appear. They are usually found in the bony tissues of the spine (lumbar or thoracic region) And thigh bones. Fracture can happen even in minor traumatic situations like an awkward turn or a weak blow.

Often, these fractures appear for no apparent external reason. With a pathological fracture, displacement of bone fragments can occur, which leads to functional disorders extremities (if the fracture is localized on a long tubular bone) and neurological disorders (if the fracture is localized on vertebral structures), which significantly impairs the quality of life of a cancer patient.

A growing tumor and bone fragments can compress adjacent tissues.

With tumor compression, the oncologist develops increasing pain, weakness of muscle tissues, signs of impaired sensitivity appear, and dysfunction of the pelvic localization organs and paralysis occur in the terminal stages.

If metastasis is observed in vertebral tissues, then cancer patients sometimes experience spinal compression. Usually a similar phenomenon occurs with metastasis to the thoracic vertebrae. Disorders caused by compression can develop gradually (if the metastasis is compressing) or acutely (with compression by the bone or its fragment).

Symptoms of compression occur suddenly. If such a sign is detected at its initial stage, then its reversibility (at least partial) is quite possible. If, however, the compression is inactive, then the paralysis becomes irreversible.

With timely therapeutic assistance, specialists manage to achieve a significant reduction in symptoms, although only 10% of cancer patients with paralysis can move independently after treatment.

How to identify bone metastases?

The most informative diagnostic method for detecting bone metastases is skeletal, which allows you to accurately determine the prevalence and degree of metastasis.

Such a procedure is able to find metastases in any part of the human skeleton. Moreover, detection of the spread of tumor cells is possible at the very initial stages, when obvious disorders in bone structures are just beginning.

With the help of X-ray examination, bone metastasis can be detected only at the stage of sufficient maturity of the secondary formation, when about half of the bone mass has already been destroyed.

Photo of metastases in the hip bones on x-ray

But on the other hand, such a diagnosis allows us to differentiate a specific type of metastatic formation. Light white spots indicate blastic metastases, and gray-white spots indicate a lytic type of metastasis.

Radioisotope diagnostics or bone scintigraphy is performed using the Rezoscan radiopharmaceutical, which is administered to a cancer patient about a couple of hours before the scan.

Also, diagnostics may include either MRI, detection of resorption markers in urine, blood tests, etc. If metastasis is found in the cranial bones, then oncologists recommend carefully examining all organs to exclude the possibility of their damage.

Are they being treated?

Metastasis to the cranial bones is observed mainly in renal or thyroid cancer, and their treatment can be carried out by a variety of methods:

• Surgical interventions are performed during palliative therapy and are necessary for various complications (compression, fractures, etc.). After the operation, the pain syndrome is eliminated, bone marrow or limb functions are restored, etc.
• and in case of bone metastasis, it is used in complex conservative treatment, as well as in the preoperative or postoperative period. These techniques allow you to destroy cancer cells and prevent their growth.
• Treatment with bisphosphonates. These medications slow down the processes of disorders in bone structures.
• Radiopharmaceuticals, when administered, lead to the destruction of active cancer cells.
• involves the use of special means to increase the body's resistance, so that the immune system resists the spread of a tumor throughout the body.

Video about drugs for the treatment of bone metastases:

Treatment with bisphosphonate drugs

Bisphosphonates are medications that prevent bone loss. They are designed to suppress osteoclast activity and to prevent bone destruction.

At the site of growth of a secondary tumor, bisphosphonates are absorbed by osteoclastic cells, as a result of which they slow down or stop their activity. In addition, the use of bisphosphonates prevents the synthesis of osteoclasts, which become early dying or self-destructive.

Bisphosphonates are divided into 2 groups. One group of drugs contains nitrogenous compounds and is more effective against metastatic tumors. These include drugs like Ibandronate, Alendronate, Pamidronate, etc. Another group does not contain nitrogen, for example, Clodronate, Tidronate, etc. These drugs have a lesser therapeutic effect.

Preparations of the bisphosphonate group penetrate into the bone mass, accumulate around osteoclasts and begin to inhibit them, which leads to a decrease in the destructive activity of these cells. As a result, the processes of bone destruction are suspended.

Prognosis and life expectancy

The final prognosis depends on the location of the primary cancer.

1. If bone metastases are formed from lung cancer, then the patient will live for about six months.
2. If the primary focus is located in the prostate, then life expectancy will be about 1-3 years.
3. If a cancerous tumor of the breast became the source of metastasis to bone structures, then life expectancy will be approximately 1.5-2 years.
4. Renal cancer with bone metastases leaves the cancer patient about a year of life.
5. With bone metastasis, life expectancy will be no more than six months.
6. With spread into bone tissue, life expectancy will be about 4 years.

Bone metastasis is extremely dangerous. If it is detected in a timely manner, then there is a high probability of saving the life of the cancer patient.

Experts have established that bone tissue is one of the most susceptible structures of the human body to cancerous growths. Most often, this is already a secondary lesion, metastasis. It is difficult to judge life expectancy with bone metastases - many concomitant factors must be taken into account, for example, the age of the cancer patient, the total number of secondary foci of cancer. However, most often the prognosis is poor.

Reasons for the appearance of metastases

In almost every malignant neoplasm, cancer cells move into bone structures. The reason for this process is their fairly good blood supply. However, not all bones are equally susceptible to the formation of cancerous foci. Most often, this applies only to the largest of them. After all, the larger the bone, the more it receives nutrients along the vascular line.

A cancer cell can leave the primary tumor focus only if it has reached its maturity and begins to release metastases - this is stage 3B-4 of the oncoprocess. Against this background, the defenses of the human body are already so undermined that the defender cells are no longer able to cope with the pathological process.

Significantly shortens the life of a cancer patient and the lack of adequate complex antitumor therapy. If there are many metastases in the bone structures, only one of the methods - chemotherapy, radiation therapy, is not enough - they should act in combination.

Symptoms of metastases and life expectancy with them

In addition to the main clinical manifestations - pain impulses increasing in intensity and duration, limited mobility in the area of ​​the body affected by the cancerous focus, cancer patients also have other symptoms indicating the formation of secondary tumor processes.

The pathogenesis of bone metastases and the prognosis of life expectancy can differ significantly - this directly depends on the location of the malignant neoplasm, its structure, and the stage of the oncological process:

• When diagnosing cancer of the renal elements, bone metastasis will be manifested by pain impulses in the area where the affected bone is projected. If the pathological process has led to a fracture and compression of the spinal nerves, life path a person is significantly shortened.
• The defeat of cancer of the lung structures is quite often complicated by bone metastases, especially in the thoracic part of the spinal column, as well as the ribs, elements of the skull, pelvis. A particular danger lies in the fact that the primary symptoms are most often absent, and pain impulses arise already with the giant size of the foci. Characteristic of this form of cancer is the state of hypercalcemia, accompanied by severe dry mouth, nausea, vomiting, and polyuria.
• A cancerous lesion of breast tissue often gives rise to complications in the form of metastases to various bone sections - from the elements of the spine to the skull and lower extremities. A person can live in this condition for several more months, less often years, but the quality of life is significantly reduced - a person is worried about constant pain, severe weakness, lack of appetite, significant weight loss.
• In the male part of humanity, one of the most common types of cancer is a malignant neoplasm in the tissues of the prostate. In addition to difficulty emptying the bladder and sexual dysfunction, there will be metastases in the pelvis and lumbosacral region of the spine. This is accompanied by an intense pain syndrome.

To compile a complete picture of what is happening in the body of a cancer patient, a specialist recommends a complex diagnostic procedures. Only after receiving all the completeness of the information, it is possible to make a forecast in each specific case.

Metastasis localization and survival

In many ways, specialists are guided in making predictions - how long they live with metastases, in one or another cancer patient, on their localization in bone structures.

When diagnosing metastases in the structures of the spine, there is a high risk of developing a compression syndrome - a pathological fracture of the vertebral arches with subsequent compression of the nerve fiber. Against this background, various paresis and paralysis appear. A person loses the opportunity for self-movement and self-service. In general, a favorable background is created for the formation of other somatic pathologies, ultimately leading to death.

Metastases in the pelvic bones and hip joints are a frequent complication of prostate and ovarian cancer, as well as thyroid structures, liver, and lungs. If the number of secondary foci is large, the structure of the bone tissue is significantly disturbed, and again there is a threat of pathological fractures and immobilization of the cancer patient, which shortens the life of a person.

The extremities occupy the third line in the ranking of areas where cancer cells often move from the primary focus. Shoulder areas are affected by malignant cells from the thyroid or mammary gland, lung structures, intestinal loops. In addition, such metastases can give melanoma, paraganglioma. Foci in the ulna, as well as the radius, are formed for the same reasons.

The tibia is prone to attack by cancerous elements from the primary focus in the lungs, while the fibula is from a tumor of the colon or prostate, but the feet are from breast cancer.

A particularly unfavorable prognosis in the detection of secondary cancerous processes in the structures of the skull - not only the vault and base, but also the facial spines can be affected. Often a situation may arise that it is the metastasis that is diagnosed first, and only then the primary cancer focus. Negative neurological symptoms significantly affect the quality of life of a cancer patient, shortening its already short period.

Tactics of treatment of metastases and life expectancy

Diagnosing a secondary tumor focus in bone structures is not a sentence at all at the moment. The main thing in this situation is to undergo a comprehensive treatment that can suppress not only the active growth of the primary localization of cancer, but also the release of metastases.

The main directions of treatment tactics that prolong the life of a cancer patient:

• The intake of biophosphonates helps to slow down the pathological processes in the bones. This subgroup of medicines not only optimally suppresses pain impulses, but also significantly reduces the risk of fractures, and also regulates mineral metabolism. As a rule, they are administered parenterally.
• Radiation therapy helps destroy cancer cells. The total number of procedures is determined by the specialist individually, but their average number is at least 10 times. The prognosis is favorable if recurrence of secondary lesions does not occur.
• Chemical and hormonal therapy are also aimed at the destruction of tumor elements, suppression of their growth and reproduction. Against the background of the use of specific medications, there are many side effects, however, the duration of active life is lengthened.

Of the other methods for suppressing the process of metastasis, the following are used:

• excision of the focus - single or several, by surgical intervention;
• immunotherapy - the use of special vitamin complexes, which helps to reduce the tumor process, maintain the body's defenses of the cancer patient at an optimal level, which ultimately also lengthens the life span;
• radiopharmaceutical therapy - the introduction of a special solution that can destroy cancer cells.

The selection of the optimal set of treatment procedures is carried out by a specialist individually - based on the diagnosed area of ​​bone metastases, their total number, the age category of the cancer patient, the initial state of his body, as well as susceptibility to the therapy.

Some people prefer to turn to recipes traditional medicine. They, of course, can somewhat alleviate negative symptoms and prolong a person’s life, however, they do not give a full guarantee of healing. Each of the selected prescriptions is recommended to be agreed in advance with the attending physician.

One of the complications of cancer is metastasis, which can spread to soft tissues and distant organs.

Metastasis occurs in the bones. In fact, bone metastases are secondary cancerous tumors of the bone tissue, which are formed as a result of the transfer of atypical cells from the main focus with the bloodstream and lymph flow.

Usually, bone metastases occur already at the last stages of oncopathology. Moreover, about 80% of cases of bone metastasis occur against the background of breast and prostatic cancer. Such formations are manifested by severe pain, frequent fractures and hypercalcemia.

Causes

Most often, metastasis to bone structures occurs with pulmonary and renal, prostatic and breast cancer, malignant tumors in the ovaries and gastrointestinal tract structures, lymphogranulomatosis, sarcomas and lymphomas.

Metastasize to bone tissue and other malignant neoplasms, only much less frequently.

When a person is healthy, his bones are constantly being renewed. In general, bone structures are characterized by the processes of resorption, remodeling and bone formation. These processes are carried out due to the cellular activity of osteoblasts and osteoclasts. These cellular structures are responsible for the formation, absorption and destruction of bone tissue.

If atypical cells penetrate into the bone structures, then there is a violation of the functioning of the bones. Healthy cells are displaced, the processes of interaction between osteoblasts and osteoclasts are disrupted, which leads to the uncoupling of their activity.

For breast cancer

Metastasis to bone structures in breast cancer occurs in the lymphogenous and hematogenous way. Such localization of metastases in breast cancer is quite common.

Cancer with such metastases is characterized by severe morbidity and an excessive tendency to pathological fractures, especially in the chest and pelvic bones.

Types

Depending on the type of cell activation, oncologists distinguish several types of bone metastases:

1. Osteoplastic - accompanied by the formation of seals on the bones;
2. Osteolytic - when there is a predominant destruction of bone structures.

Pure types in medical practice are relatively rare, their mixed forms are much more common.

The most susceptible to metastasis are bones that have a rich blood supply, i.e., in the shoulder and femur, ribs and vertebral, cranial and pelvic bones. At first, bone metastases do not manifest themselves in any way, but over time they become the cause of intense pain, which is associated with stimulation of periosteal pain receptors.

Symptoms of bone metastases

At first, bone secondary tumors develop asymptomatically, but with the development of the tumor process, a certain clinical picture is formed:

• The presence of hypercalcemia;
• Tendency to pathological fractures;
• The presence of spinal compression.

Hypercalcemia is a life-threatening complication that is found in about 30-40% of cancer patients with bone metastasis.

This condition occurs due to excessive activity of osteoclasts, leading to an increase in the level of calcium in the blood, which in turn causes a pathological increase in renal excretory abilities.

As a result, in cancer patients with bone metastases, in addition to hypercalcemia, hypercalciuria develops, the reabsorption of fluid and sodium is disturbed, leading to polyuria.

As a result of such changes in cancer patients, the activity of many systems and organs is disrupted:

1. In the nervous system activity, signs such as lethargy and mental disorders, confusion in the mind and affective disorders are noted;
2. In cardiovascular activity, abnormalities occur such as arrhythmia and low blood pressure, a decrease in heart rate, while the risk of cardiac arrest is high.
3. The kidneys are affected by nephrocalcinosis and polyuria;
4. In the gastrointestinal tract, nausea and vomiting, frequent constipation and lack of appetite are observed, intestinal obstruction or pancreatitis may develop.

If more than half of the cortical layer is destroyed during bone metastasis, then pathological fractures appear. They are usually found in the bones of the spine (lumbar or thoracic region) and femurs. Fracture can happen even in minor traumatic situations like an awkward turn or a weak blow.

Often, these fractures appear for no apparent external reason. With a pathological fracture, displacement of bone fragments can occur, which leads to functional disorders of the limb (if the fracture is localized on a long tubular bone) and neurological disorders (if the fracture is localized on vertebral structures), which significantly worsens the quality of life of the cancer patient.

A growing tumor and bone fragments can compress adjacent tissues.

With tumor compression, the oncologist develops increasing pain, weakness of muscle tissues, signs of impaired sensitivity appear, and dysfunction of the pelvic localization organs and paralysis occur in the terminal stages.

If metastasis is observed in vertebral tissues, then cancer patients sometimes experience spinal compression. Usually a similar phenomenon occurs with metastasis to the thoracic vertebrae. Disorders caused by compression can develop gradually (if the metastasis is compressing) or acutely (with compression by the bone or its fragment).

Symptoms of compression occur suddenly. If such a sign is detected at its initial stage, then its reversibility (at least partial) is quite possible. If, however, the compression is inactive, then the paralysis becomes irreversible.

With timely therapeutic assistance, specialists manage to achieve a significant reduction in symptoms, although only 10% of cancer patients with paralysis can move independently after treatment.

How to identify bone metastases?

The most informative diagnostic method for detecting bone metastases is skeletal scintigraphy, which allows you to accurately determine the prevalence and degree of metastasis.

Such a procedure is able to find metastases in any part of the human skeleton. Moreover, detection of the spread of tumor cells is possible at the very initial stages, when obvious disorders in bone structures are just beginning.

With the help of X-ray examination, bone metastasis can be detected only at the stage of sufficient maturity of the secondary formation, when about half of the bone mass has already been destroyed.

Photo of metastases in the hip bones on x-ray

But on the other hand, such a diagnosis allows us to differentiate a specific type of metastatic formation. Light white spots indicate blastic metastases, and gray-white spots indicate a lytic type of metastasis.

Radioisotope diagnostics or bone scintigraphy is performed using the Rezoscan radiopharmaceutical, which is administered to a cancer patient about a couple of hours before the scan.

Also, diagnostics may include computed tomography or MRI, detection of resorption markers in urine, blood tests, etc. If metastasis is found in the cranial bones, then oncologists recommend carefully examining all organs to exclude the possibility of their damage.

Are they being treated?

Metastasis to the cranial bones is observed mainly in renal or thyroid cancer, and their treatment can be carried out by a variety of methods:

• Surgical interventions are performed during palliative therapy and are necessary for various complications (compression, fractures, etc.). After the operation, the pain syndrome is eliminated, bone marrow or limb functions are restored, etc.
• Radiation and chemotherapy for bone metastasis is used in complex conservative treatment, as well as in the preoperative or postoperative period. These techniques allow you to destroy cancer cells and prevent their growth.
• Treatment with bisphosphonates. These medications slow down the processes of disorders in bone structures.
• Radiopharmaceuticals, when administered, lead to the destruction of active cancer cells.
• Immunotherapy involves the use of special means to increase the body's resistance, so that the immune system resists the spread of a tumor throughout the body.

Video about drugs for the treatment of bone metastases:

Bisphosphonates are medications that prevent bone loss. They are designed to suppress osteoclast activity and to prevent bone destruction.

At the site of growth of a secondary tumor, bisphosphonates are absorbed by osteoclastic cells, as a result of which they slow down or stop their activity. In addition, the use of bisphosphonates prevents the synthesis of osteoclasts, which become early dying or self-destructive.

Bisphosphonates are divided into 2 groups. One group of drugs contains nitrogenous compounds and is more effective against metastatic tumors. These include drugs like Ibandronate, Alendronate, Pamidronate, etc. Another group does not contain nitrogen, for example, Clodronate, Tidronate, etc. These drugs have a lesser therapeutic effect.

Preparations of the bisphosphonate group penetrate into the bone mass, accumulate around osteoclasts and begin to inhibit them, which leads to a decrease in the destructive activity of these cells. As a result, the processes of bone destruction are suspended.

The final prognosis depends on the location of the primary cancer.

1. If bone metastases are formed from lung cancer, then the patient will live for about six months.
2. If the primary focus is located in the prostate, then life expectancy will be about 1-3 years.
3. If a cancerous tumor of the breast became the source of metastasis to bone structures, then life expectancy will be approximately 1.5-2 years.
4. Renal cancer with bone metastases leaves the cancer patient about a year of life.
5. With melanoma with bone metastasis, life expectancy will be no more than six months.
6. With thyroid cancer that has spread to the bones, life expectancy will be about 4 years.

Bone metastasis is extremely dangerous. If it is detected in a timely manner, then there is a high probability of saving the life of the cancer patient.

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Bone metastases - causes, symptoms, diagnosis and treatment

Bone metastases are secondary malignant foci in the bone tissue, caused by the spread of cancer cells from the primary tumor of another organ. Manifested by increasing pain, hypercalcemia and pathological fractures. In some cases, a dense tumor-like formation may be found in the affected area. With compression of large vessels, circulatory disorders occur, with compression of the nerve trunks - neurological symptoms. The diagnosis is established on the basis of anamnesis, complaints, objective examination data, laboratory and instrumental research. Treatment - radiotherapy, chemotherapy, surgery.

Bone metastases are damage to bone tissue as a result of the spread of malignant cells with the blood or lymph flow. Occurs in the late stages of cancer. 80% of secondary bone tumors are detected in breast cancer and prostate cancer. In addition, bone metastasis is often found in malignant neoplasms of the thyroid gland, lung cancer, malignant tumors of the kidney, sarcoma, lymphoma and lymphogranulomatosis. For other neoplasms, bone tissue damage is less typical. For ovarian cancer, cervical cancer, soft tissue tumors and gastrointestinal tract bone metastases are very rare. Treatment is carried out by specialists in the field of oncology, traumatology and orthopedics.

Types of bone metastases

The processes of resorption and bone formation are constantly taking place in the bone tissue. Normally, these processes are balanced. Malignant cells in the area of ​​metastasis upset this balance by overactivating osteoclasts (cells that destroy bone tissue) or osteoblasts (young cells of new bone tissue). Taking into account the predominant activation of osteoclasts or osteoblasts, two types of bone metastases are distinguished: osteolytic, in which the destruction of bone tissue predominates, and osteoplastic, in which there is a thickening of the bone area. In practice, pure types of bone metastases are rare, mixed forms predominate.

Most often, secondary foci are detected in bones with a rich blood supply: in the spine, ribs, pelvic bones, bones of the skull, femurs and humerus. In the initial stages, bone metastases may be asymptomatic. Subsequently, they are accompanied by increasing pain. The cause of pain is both mechanical (due to compression) and chemical (as a result of the release of a large amount of prostaglandins) stimulation of pain receptors located in the periosteum. Pain syndrome with bone metastases increases at night and after physical exertion. Over time, the pain becomes excruciating, unbearable, the condition of patients is relieved only after taking narcotic analgesics.

Sufficiently large bone metastases can cause visible deformity, be detected on palpation as a tumor-like formation, or be seen on radiographs as a site of destruction. Pathological fractures are a serious complication of bone metastases; in 15-25% of cases, they occur in the region of tubular bones, and in almost half of cases, in the region of the vertebrae. Sometimes, in the process of growth, bone metastases compress nearby large vessels or nerves. In the first case, circulatory disorders occur, in the second - neurological disorders. Severe complications of this pathology also include spinal cord compression and hypercalcemia. Local symptoms of bone metastases are combined with general manifestations of cancer: weakness, loss of appetite, weight loss, nausea, apathy, fatigue, anemia, and fever.

Symptoms of bone metastases

Hypercalcemia

Hypercalcemia is a life-threatening complication that occurs in 30-40% of patients with bone metastases. The reason for the development is the increased activity of osteoclasts, as a result of which an amount of calcium enters the blood from the destroyed bone, exceeding the excretory capacity of the kidneys. In patients with bone metastases, hypercalcemia and hypercalciuria occur, the process of reverse absorption of water and sodium in the renal tubules is disturbed. polyuria develops. A vicious circle is formed: due to polyuria, the volume of fluid in the body decreases, which entails a decrease in glomerular filtration. The decrease in glomerular filtration, in turn, causes an increase in calcium reabsorption in the renal tubules.

Hypercalcemia in bone metastases causes disturbances in the activity of various organs and systems. From the side of the CNS, there are mental disorders, lethargy, affective disturbances, proximal myopathy, confusion and loss of consciousness. From the side of the cardiovascular system, a decrease in blood pressure, a decrease in heart rate and arrhythmia are detected. Possible cardiac arrest. On the part of the gastrointestinal tract, nausea, vomiting, constipation and appetite disorders are noted. In severe cases, pancreatitis or intestinal obstruction develops.

On the part of the kidneys, polyuria and nephrocalcinosis are found. General clinical symptoms include weakness, fatigue, dehydration, weight loss, and pruritus. Hypercalcemia with bone metastases can remain unrecognized for a long time, since doctors interpret the manifestations of this pathology as signs of the progression of the underlying cancer or as side effect chemotherapy or radiation therapy.

pathological fractures

Pathological fractures occur when more than 50% of the cortical layer is destroyed. Most often detected in the vertebrae, the second most common is occupied by fractures of the femur, usually in the neck or diaphysis. Distinctive feature pathological fractures of the spine with bone metastases is the multiplicity of lesions (at the same time, a violation of the integrity of several vertebrae is detected). Usually suffers from chest or lumbar. Damage may be accompanied by compression of the nerve roots or spinal cord.

The cause of a pathological fracture in bone metastases can be a minor traumatic effect, such as a weak blow or even an awkward turn in bed. Sometimes such fractures look spontaneous, that is, occurring without any external causes. The fracture may be accompanied by displacement of fragments. Limb dysfunction in fractures of long tubular bones and neurological disorders in vertebral fractures are becoming one of the leading factors in the deterioration of the patient's quality of life.

Spinal cord compression

Spinal cord compression is detected in 1-5% of patients with metastatic spinal lesions. In 70% of cases, the cause of disorders is metastases in the thoracic vertebrae, in 20% - in the lumbar and sacral vertebrae, in 10% of cases - in the cervical vertebrae. With bone metastases, both acute (with compression by a bone fragment) and gradually progressive (with compression by a growing tumor) disorders can be detected. When compressed by a growing neoplasm, patients with bone metastases experience increasing pain. Muscle weakness develops, sensitivity disorders are detected. At the final stage, paresis, paralysis and dysfunction of the pelvic organs occur.

When compressed by a bone fragment, the clinical picture of spinal cord compression develops suddenly. In the initial stages, both types of compression are reversible (fully or partially). In the absence of timely medical care within a few hours or days, paralysis becomes irreversible. Timely adequate treatment can reduce the severity of symptoms, however, the restoration of the ability to move independently is observed in only 10% of patients with already developed paralysis.

Diagnosis and treatment of bone metastases

The diagnosis is established on the basis of anamnesis (data on the presence of a primary malignant neoplasm), the clinical picture and the results of additional studies. Lack of information about an already diagnosed cancer is not a basis for excluding bone metastases, since the primary tumor may be asymptomatic. In the presence of neurological disorders, a neurological examination is performed. At the initial stage of the examination, scintigraphy is performed. Then patients are referred for x-ray, CT or MRI of the bone to clarify the nature and extent of the lesion. To detect hypercalcemia, a biochemical blood test is prescribed.

The tactics of treatment are determined taking into account the type and location of the primary tumor, the number and location of bone metastases, the presence of metastases to other organs and tissues, the presence or absence of complications, the age and general condition of the patient. Surgical interventions are palliative in nature and are indicated in the presence of complications (pathological fractures, spinal cord compression). The goal of operations for bone metastases is to eliminate or relieve pain, restore function of the limb or spinal cord, and create a more favorable environment for patient care.

When deciding whether to perform surgery, the prognosis is taken into account. Prognostically favorable factors are the slow growth of the primary neoplasm, a long period of absence of relapses, a small single bone metastasis, the presence of radiological signs of bone sclerosis after conservative treatment and satisfactory condition of the patient. In such cases, extensive surgical interventions can be performed (installation of plates, pins, Ilizarov devices).

With aggressive growth of the primary neoplasm, frequent relapses, multiple metastases, especially with simultaneous damage to internal organs, a large size of bone metastasis, no signs of sclerosis on the radiograph, and the patient's poor condition, surgical interventions on tubular bones are not recommended even in the presence of a pathological fracture. In cases where surgical intervention is contraindicated, sparing methods of fixation are used (for example, a derotation boot for a fracture of the femoral neck).

Emergency care for bone metastases complicated by spinal cord compression includes vascular preparations, means to improve the metabolism of nervous tissue and high doses of dexamethasone. In case of compression of the nervous tissue due to the growth of a metastasis to the bone, decompressive laminectomy is performed; in case of compression of the spinal cord as a result of a pathological fracture of a vertebra, decompression and stabilization operations are performed: fixation with a plate or transpedicular fixation, restoration of the vertebrae using bone cement, auto- and allografts, etc.

Chemotherapy and radiation therapy for bone metastases are used in the process of combined conservative therapy, in preparation for surgery and in the postoperative period. With hypercalcemia, rehydration is carried out by conducting intravenous infusions saline solutions. Patients with bone metastases are prescribed " loop diuretics(furosemide), corticosteroid drugs and bisphosphonates. The effect of therapy persists for 3-5 weeks, then the course of treatment is repeated.

Forecast

The prognosis for bone metastases is more favorable than for metastases to internal organs. Average duration life is 2 years. The quality and, in some cases, life expectancy depend on the presence or absence of complications, which determines the importance of preventive measures when metastases are detected in the bones of the skeleton. With metastases to the spine, it is recommended to exclude weight lifting and rest in a supine position several times during the day. In some cases, at a certain stage of therapy, wearing a corset or head holder is indicated. If the femur is affected during the treatment period, it is advised to unload the limb as much as possible using a cane or crutches. Physiotherapy for any bone metastases is contraindicated. Patients need to undergo regular examinations for the timely detection of relapses of the disease.

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signs and symptoms, treatment and prognosis

In almost any oncology, secondary foci of pathology or metastasis appear, which can be detected in soft tissues, separate organs or in bones.

In fact, bone metastases in cancer are a repeated neoplasm of bone tissue that appears as a result of the movement of cancer cells by lymph, blood from the main focus.

Important! Bone metastases appear at the last stage of oncological disease. 80% of them occur against the background of prostate and breast cancer. They declare themselves hypercalcemia, severe pain attacks and bone fragility.

Causes and types

To begin with, it should be noted that not all bones are prone to the appearance of metastases. More often than others, large ones suffer - they have larger blood vessels. What are the types of bones?

• Ribs, bones of the skull, hands and feet undergo metastasis only in the case of local oncological formation;
• An abnormal change in the spine occurs in breast cancer;
• The humerus and tibia are practically not amenable to the secondary manifestation of oncology;
• The pelvic bone is a common site for metastasis;
• The thigh bone, due to its large size, is often affected by metastases.

Important! Before embarking on pathology therapy, you should know the reason why oncology has entered its next phase. This will help avoid unwanted complications.

If a person is healthy, then his bone tissue is constantly updated. In general, the bones are characterized by the processes of destruction, bone formation and remodeling. These processes occur due to the activity of osteoblasts and osteoclasts, which are responsible for the formation, absorption and destruction of bone tissue.

In the case when atypical cells appear in the bone structure, a violation of the functioning of the bones occurs. Healthy tissues are displaced, disruption of interactions between osteoblasts and osteoclasts begins, which leads to the separation of their functioning.

Metastasis to the bone, most often occurs with:

• prostate cancer;
• breast cancer;
• renal and pulmonary oncology;
• sarcoma;
• lymphomas;
• lymphogranulomatosis;
• ovarian and gastrointestinal cancer;
• melanoma;
• thyroid tumors.

In breast oncology, the penetration of metastases into the bones is carried out by the hematogenous and lymphogenous pathways.

Other types oncological diseases rarely involve bone tissue. This type of pathology is common. Pain with such bone metastases is very severe, the bones chest and the pelvis are prone to fractures.

Lung cancer is the most common oncological process in which metastases penetrate into the musculoskeletal system. For this reason, the examination of the respiratory organs is carried out in the first place, if the presence of metastases in the bones has been detected.

Metastases in the pelvis are indicative of prostate cancer. It is this neoplasm that leads to such a pathology.

Depending on which cells are activated, doctors distinguish two types of bone pathologies:

• osteolytic - with this type of disease, atypical cells stimulate osteoclasts, which are responsible for the destruction of bone tissues, which leads to their fragility;
• osteoplastic - in this case, osteoblast is stimulated, which promotes bone growth, resulting in protrusion and bone destruction.

Important! Most often in medicine there are mixed types of oncological pathology of bones.

Symptoms

Bone metastases have nonspecific symptoms. For this reason final diagnosis difficult to establish, it is necessary to conduct a number of additional studies. But with an increase in the tumor process, the manifestation of the disease has a certain clinical picture:

Hypercalcemia

Hypercalcemia is a dangerous complication that occurs in 40% of patients with bone metastases. The cause of the development of pathology is an increased activity of osteoclasts. In this regard, from the destroyed bones, a lot of calcium enters the blood, which negatively affects the excretory work of the kidneys.

In patients with blood metastases, due to the occurrence of hypercalcemia and hypercalciuria in the renal tubules, the process of reabsorption of water and sodium is disrupted, which leads to polyuria. It turns out a vicious circle - polyuria leads to a decrease in the volume of fluid in the patient's body and a decrease in the work of glomerular filtration, which causes calcium reabsorption in the renal canals. All this leads to disruption of the work of many systems and organs in the patient.

• From the side of the central nervous system there are mental disorders, confusion and loss of consciousness, lethargy, affective disorders.
• On the part of the cardiovascular system, hypotension, bradycardia and arrhythmia appear, cardiac arrest is possible.
• On the part of the gastrointestinal tract, nausea, vomiting, constipation, problems with appetite are observed. In more severe cases, intestinal obstruction, pancreatitis appears.
• On the part of the kidneys - nephrocalcinosis, polyuria.

Against the background of all these anomalies, weakness, dehydration, increased fatigue, weight loss, and itching appear.

Hypercalcemia remains undiagnosed for a long time, due to the fact that doctors interpret all manifestations as symptoms of an underlying cancer or the consequences of chemotherapy.

Abnormal fractures

Bone metastases can lead to pathological fractures. Such a manifestation appears if more than 50% of the cortical layer is destroyed. Most often they can be detected in the spine, in the region of the femoral neck or diaphysis.

A distinctive feature of a pathological fracture of the spine during metastasis is the simultaneous damage to several vertebrae. As a rule, the thoracic and lumbar spine suffer from this. Such injuries are accompanied by compression of the spinal cord or nerve roots.

The reason that caused the fracture can be a slight injury in the form of a weak blow, an awkward turn in bed. There are also spontaneous causes that do not carry external causes. Such pathological fractures are accompanied by displacement of debris.

Spinal cord compression

Spinal cord compression develops in 5% of patients with spinal metastases. In 10% of cases, lesions are located in the cervical vertebrae, in 20% of cases in the vertebrae of the lumbosacral region, and in 70% of cases, metastasis occurs in the thoracic region.

With a secondary cancerous tumor in the bone of the spine, acute and slowly progressive disorders are observed. To acute, include compression by bone fragments, and gradually progressive, this is compression by a growing formation.

Increasing pain in bone metastases arise from a growing tumor. In addition to the pain syndrome, muscle weakness appears, sensitivity is disturbed. In the last stages of the disease, the patient experiences cuts, paralysis, problems with pelvic functions.

With compression by bone fragments, the clinical picture of the pathology develops suddenly. At the onset of the disease, both types of compression may be fully or partially reversible. Effective Therapy helps patients greatly reduce severe symptoms, but recovery of the ability to move independently is observed in 10%.

If medical care was not timely, then in a few days, and even hours, paralysis can take severe form and the patient may remain crippled.

Important! The most important symptoms of bone metastasis are pain and bone fragility.

Diagnostics

The diagnosis of bone metastases is made after studying the data on concomitant oncology, the clinical picture and the result of the study. What will be the sentence directly depends on the type and degree of the disease.

At the first stage of the examination, the patient is given scintigraphy, followed by radiography, computed tomography and magnetic resonance imaging. To detect hypercalcemia, blood biochemistry is performed.

• Skeletal scintigraphy helps to find metastases anywhere in the human body. This examination can show the spread of cancerous tumors at the initial stage, when there are no obvious abnormalities in the bone structure.
• X-ray examination reveals bone metastasis at the stage when the secondary formation is already mature and most of the bone structure is destroyed. Such a study helps to establish a specific type of repeated oncology. Blastic metastases in the picture have a light - white appearance, the lytic appearance appears as gray - white spots.

After the examination, the doctor gives an opinion and prescribes the treatment of metastases, taking into account the type and location of the primary tumor, the presence of damage to other organs and tissues, the age and general condition of the patient. A positive prognosis depends on the timely detection of the disease and the correct treatment regimen.

Treatment

Bone metastases can be treated by various methods, there are many of them, here are some of them:

• The use of bisphosphonates, which can slow down the process of abnormal changes in the bones. These medicines treat the symptoms of the disease - reduce pain, reduce the risk of fracture, regulate the level of calcium in the blood.
• Radiation therapy is used to destroy abnormal cells.
• Chemo and hormone therapy destroys cancer cells and prevents them from growing in the future. Such treatment is necessary to reduce fractures and relieve pain.
• Special vitamins, proteins are used in immunotherapy. They reduce the spread of cancer.
• Radiopharmaceutical radiation is carried out by injecting a special drug into a vein that kills cancer cells. Treatment is carried out with strontium 89 and samarium 153.
• Surgical intervention helps to remove overgrown oncological formations that have led to negative consequences. Surgery is primarily palliative in nature.

When deciding to carry out the operation, the prognosis is taken into account. Positive factors are the slow growth of the primary tumor, as long as no recurrence was observed, small single metastases, signs of bone sclerosis and a satisfactory condition of the patient.

Surgical intervention is not permissible, with aggressive growth of the neoplasm, frequent recurrences of the disease, mass metastases, absence of bone sclerosis, and the patient's serious condition.

Emergency care for this pathology consists in the use of vascular medications, drugs that can improve the metabolism of nervous tissue and the use of large doses of dexamethasone.

With metastases in the pelvic bone, plates, pins may be needed to secure the femoral neck and other bones.

Important! In addition to the listed methods of treating bone metastasis, there are other methods, but they are less effective and safe.

Forecast

Patients diagnosed with metastases in the bone structure are wondering how much is left to live.

The final prognosis depends on the location of the primary cancer.

• Metastases in the bones formed in lung cancer - a fatal outcome occurs after six months.
• With prostate cancer, a patient can live from one to three years.
• If breast cancer became the cause of bone metastasis, then the patient lives for about 1.5 - 2 years.
• Kidney cancer with bone metastases leaves a cancer patient with a year of life.
• With melanoma and the presence of bone metastases, the patient lives no more than six months.

Only with thyroid cancer with metastasis to the bone system can a person live longer than with all other types of disease - four years.

Important! Bone metastases are extremely dangerous pathologies. But its timely detection will help save a person's life.

Read also

onkoexpert.ru

Bone metastases: causes, symptoms and treatment

Bone metastases are the most severe pathology that accompanies oncological diagnoses. Basically, this happens in the last, most severe - 4 degrees of cancer. Neoplasms are characterized by the penetration into the bone tissue of cancer-affected cells that enter there through lymphatic flows or blood.

Considered a secondary focus of a malignant tumor disease, metastases appear in every three out of four cases of oncology diagnosis. Very often, the pathology is a rather dense, large-sized formation. Up to 80% of this complication occurs against the background of breast cancer in women and prostate cancer in men.

Types

Depending on the anatomical nature and specifics of tumor cells, in oncological practice, two main types are distinguished, which are extremely rare in the pure type, mainly showing their hybrid forms:

• osteoplastic - characterized by dense bone malignant neoplasms;
• osteolytic - large tumors are absent, there is a rapid destruction of the structure of bone tissue.

Most often, metastases affect bones supplied with a large number of blood vessels- costal, humeral, large and small pelvis, external cranial. At the initial stage, they behave secretly, however, in the process of reproduction of the affected cells, a severe pain recurrence occurs.

signs

As noted, initially the metastasis behaves incubation, remains secretive and does not cause discomfort - as a rule, a person is not even aware of its existence. However, over time, there are fairly clear clinical signs and symptoms.

Most often, the fact that the body is affected by metastases is evidenced by the following manifestations:

• fractures;
• intoxication;
• compression;
• pain syndrome;
• hypercalcemia.

Fractures. They are pathological. Manifested in sharp decline the hardness of the bone material - often even minimal mechanical or physical stress is enough - and the tissue breaks.

In advanced forms of pathology, when a large tissue focus is affected by metastases, it is enough to take a deep breath or sneeze to break, for example, a rib. And with a sharp turn of the body or too low a slope, the skeletal pelvic part becomes vulnerable.

The main reason leading to this symptomatology is the leaching of the most important bone material responsible for their strength, biophosphate, as the neoplasm multiplies.

Intoxication. A very common syndrome. It manifests itself in the form of general weakness, loss of interest in food, and, as a result: a critical decrease in body weight, nausea, depression and apathy towards what is happening - up to a complete loss of interest in life. This is a non-specific manifestation of any type of cancer that increases rapidly in the process of metastasis.

Compression. Tumors that occur in hard tissue are very dense and hard in composition, capable of exerting significant pressure on the circulatory vascular system and nerve fibers.

Compressive compression of the nerve endings of the spinal cord can lead to the most critical consequences. This threatens the cancer patient with a general lesion of the nervous system, and, as a result, complete or partial paralysis of the body.

At the initial stage, the symptom manifests itself in limb dysfunction. As the disease progresses, the degree of immobility increases.

Pain. This syndrome the most frequent and most difficult to tolerate by the patient. Pain are capable of delivering severe torment and are poorly subject to correction with painkillers.

The syndrome increases, reaching its peak at night and after even minimal physical exertion in the area of ​​the lesion. Able in especially clinical forms of its manifestation to bring a sick person to suicide.

Hypercalcemia. In medical terminology, it means an increase in the percentage of calcium components in the patient's blood due to abnormal resorption of hard bone tissues.

Accompanied by intense thirst, dryness of the oral mucosa, a tendency to frequent and copious urination, sudden manifestations of nausea and severe vomiting, slow reaction, and periodic disturbances in the conscious perception of reality.

The most difficult complication that poses a serious threat to human life, since in the shortest possible time it can lead to complete dysfunction of the main organs and systems of the body's vital activity - heart failure, general dehydration, kidney disease.

Along with the listed symptoms, the following manifestations of the disease may occur:

• skin changes;
• ulcer formations;
• osteochondrosis;
• manifestations of arthritis;
• rheumatism, previously undiagnosed.

People with bone metastases should be extremely attentive to all manifestations of the disease without exception - this can be the first alarm signal that the doctor must know about. After the examination, he will also determine how severe the pathology is and how to deal with it.

Causes and development of the disease

Almost every case of oncology is associated with metastasis, but not all bones of the human skeleton are equally susceptible to this pathology. What is the risk group?

Let us dwell on the main types of bones and their propensity and this process:

• hands and feet, feet, ribs, skull - are carriers of pathology only in situations where the disease is focal malignant;
• spine - with tumors of the mammary gland;
• the pelvic part - with a close location to it of the oncological process;
• femoral - due to its impressive size, very often becomes the focus of the disease.

As a rule, the following diagnoses become the cause of bone metastasis:

• skin superficial melanomas;
• lung cancer and oncology of the respiratory tract - the most common cause of hard tissue lesions - germinate into the spine;
• prostate tumor - slowly kill the femur, lumbar region and thoracic spine;
• lymph node cancer at risk lower limbs, radial and ulnar hard tissues;
• kidney cancer - affects the spinal cord;
• formations in the thyroid gland - affects the bones of the limbs.

Diagnostics

Properly diagnosing a type of metastasis in the bones is very important - this allows you to somehow control the processes of tissue damage and destruction.

The following diagnostic methods are used:

• neurological examination - the specificity of the disease is determined, its clinical features and manifestations. On examination, it is taken into account that signs of metastasis can appear both at the same time as the development of oncology, and much later, in addition, the absence of a neoplasm is not a reason to exclude them;
• scintigraphy is one of the methods of radiation detection of the presence of the disease. Radio preparations enter the body and, based on the isotope-radiation pattern, I diagnose the disease;
• radiography is a method proven by practice and time, but in the early stages it may not reveal pathology;
• CT, MRI of the bone - indicated for the diagnosis of the spinal cord and brain;
• A biochemical blood test is a very accurate method that shows an objective clinical picture of the development of the disease. Determines the degree of damage, the internal structure of cancer cells.

Treatment

The following methods of treatment of bone metastases are practiced:

• elective surgery - justified when the process of the lesion is not too advanced. It is used in combination with other types of treatment;
• emergency intervention for spinal cord compression is a very dangerous form, any therapy other than surgery is powerless in this situation. The main task of the surgeon is to respond as quickly as possible to the growth of pathological disorders. Little time is allotted, and any delay can cost the patient his life;
• radiation therapy - used in a course for 2-3 weeks. The principle of action is based on the susceptibility of cancer cells to the effects of radio rays. As for this problem, the method is not always effective;
• chemotherapy - inhibits the further growth and spread of pathology. Works well for 1 - 2 stages of the disease;
• anesthesia - a method accompanying the main treatment. Non-steroids and potent narcotic substances are mainly used, which, when used systematically, cause dependence and reduce the effectiveness of the action.

Forecast

Metastases found in the bones, due to kidney cancer, if treatment is not carried out, give a person the opportunity to live for about a year, due to thyroid cancer - about 3-4 years, with melanoma - several months.

If you turn to a specialist in time to start therapy, the chance to live a full life is undoubtedly greater. With correctly delivered treatment, patients following all the recommendations, you can not only cope with the disease, but also return to full life.

Reviews

It is important to understand that this diagnosis is not yet a final verdict. Of course, the situation is difficult, but faith and understanding that nothing is over yet, that there is life, there are close and dear people - works no worse than medicines, and sometimes just works wonders.

In this video, the patient shares his feedback on the treatment:

If you find an error, please select a piece of text and press Ctrl+Enter.

stoprak.info

Bone metastases: life expectancy, symptoms, diagnosis

Bone metastases are an unpleasant and life-threatening situation, but they are not a final verdict.

With the timely detection of metastases in a patient, the chances of saving life and the possibility of full functioning increase.

Cancer metastases to the bone are a complication of cancer. When diagnosed, the pathology has the last stage. If the disease is in an advanced form, when metastases are deep in the bones, then the patient's life expectancy is from several months to a year.

Experts say that in most cases, bone skeletal metastases are formed as a result of cancerous neoplasms in digestive system, cervix, ovaries and soft tissues.

The process of metastasis is the penetration of cancer cells and the achievement of any organs and tissues, including bone, through the blood supply (lymphatic vessels).

Symptoms of bone metastases

In the first stages, the development of secondary bone neoplasms occurs without obvious signs. But over time, the following symptoms appear:

• hypercalcemia;
• tendency to pathological fractures;
• spinal compression.

Hypercalcemia is a dangerous complication, found in about 40% of patients with bone metastases. This condition may occur due to increased activity of osteoclasts, which increase the level of calcium in the blood, and as a result cause an abnormal increase in renal excretory abilities.

In addition to hypercalcemia, hypercalciuria can develop, and there is a violation of the reabsorption of fluid and sodium, which leads to polyuria.

Due to such changes in the patient, there is a violation of the activity of many organs and systems:

• nervous system. In the nervous system activity, there are signs in the form of lethargy and mental disorder, as well as confusion in the mind.
• Cardiovascular. The occurrence of arrhythmia and low blood pressure, a decrease in heart rate and an increased risk of cardiac arrest.
• Digestive system. There is nausea, vomiting, intestinal obstruction, lack of appetite.

In the case of bone metastasis and the destruction of more than half of the cortical layer, the formation of pathological fractures occurs. They are usually found in the bone tissue of the spine and femur. Fracture can occur even in low-traumatic situations, such as an awkward turn or a weak blow.

In most cases, these fractures are formed for no apparent external reason. With a pathological fracture, bone fragments are displaced, which leads to a violation of the functionality of the limbs (if the fracture is localized on a long tubular bone) and neurological disorders (if the localization is on the vertebral structure). All this significantly affects the quality of life of the patient.

With tumor compression, the following symptoms are observed: increasing pain, weakness in muscle tissues, impaired sensitivity, dysfunction of the organs of pelvic localization, paralysis (in the later stages).

If metastases have penetrated into the vertebral tissues, then patients sometimes experience spinal compression. A similar phenomenon is observed in metastases in thoracic vertebrae. Disorders caused by compression can develop acutely (if the bone or its fragment is compressing) or gradually (if it is compressed by a metastasis).

Signs of compression appear suddenly. If this symptomatology is found at the initial stage of development, then reversibility is possible (in most cases, partial). If you do nothing during compression, then the paralysis will become irreversible.

Diagnostics

Used for diagnosis various methods research:

• Radiography is the simplest and most affordable diagnostic method. The main disadvantage of using x-rays is the inability to detect pathology at the first stage.
• Computed tomography is a method in which a specialist receives information about the degree and boundaries of bone damage through digital processing.
• Magnetic resonance imaging - irradiation using radiological waves, in which the volume of bone tissue damage by metastases is determined.

• Scintigraphy is a study that allows you to establish the localization of metastases.
• A biopsy with subsequent histological examination is a method as a result of which it is possible to determine whether the bone tissue belongs to a certain type. Thanks to this study an accurate diagnosis is made.

Treatment of bone metastases

If the treatment of metastases is done on time, then malignant foci are formed less frequently, which increases the patient's survival.

Also, skeletal complications such as pain, pathological fractures, spinal cord compression and hypercalcemia are less frequent and the patient's life becomes much easier, which is an important achievement.

Systemic drug therapy includes anticancer treatment (the use of immunotherapy and hormone therapy) and maintenance therapy (the use of bisphosphonates and analgesics). It is also possible to treat a local nature with the help of radiation therapy, surgery, radiofrequency ablation and cementoplasty.

The tactics of treating patients with bone metastases is determined on an individual basis. The choice depends on the course of the disease, the age of the patient and the location of metastases.

Treatment with bisphosphonate drugs

Bisphosphonates are medications that prevent bone loss. They are prescribed to suppress osteoclast activity and prevent bone destruction.

At the site of development of a secondary neoplasm, bisphosphonates are absorbed by osteoclastic cells, which stops or slows down the activity of malignant cells. Bisphosphonates also prevent the synthesis of osteoclasts.

Bisphosphonates are divided into two groups. The first group contains a nitrogenous compound and is the most effective in relation to metastatic neoplasms (drugs: Ibandrotan, Alendronate, Pamidronate). The second group does not contain nitrogen and has a lesser therapeutic effect (drugs: Clodronate, Tidronate).

Prognosis and life expectancy

Specialists determine the frequency of occurrence of metastases in the skeletal system in patients suffering from cancer, according to it:

1. In lung cancer, metastasis occurs in 30-40% of cases, the survival rate is about six months;
2. In breast oncology, metastases form in 60-70% of cases, survival after the detection of metastasis is from one and a half to two years;
3. In prostate cancer, the frequency of metastasis varies in 50-70% of cases, the survival rate is about three years.
4. In kidney oncology, the frequency of metastasis formation is 20-25%, the survival rate is about one year;
5. With oncology of the thyroid gland in 60-70% of cases, the meridian of survival is four years;
6. With melanoma, the formation of metastases is 15-45%, the survival rate is not more than six months.

Prevention

Key point in prevention this disease- This is a timely diagnosis of a primary neoplasm. This allows you to start treatment on time and stop the process of reproduction of malignant cells and their damage to other systems and organs.

Plays an important role right choice treatment, which is aimed at destroying cancerous foci and increasing the body's resistance to diseases.

To reduce the risk of developing bone metastases, it is necessary to strictly follow all the recommendations of the attending physician regarding physical activity, diet, intake medicines etc.

Bone metastases are a serious complication of oncology, accompanied by unpleasant symptoms. With timely diagnosis, the quality and life expectancy of the patient increases.

wmedik.ru

Bone metastases - prognosis, treatment and symptoms in grade 4 cancer

Bone metastasis is a severe cancerous complication with severe pain symptoms, meaning the transition of cancer to stage 3, 4. The prognosis of treatment and life expectancy are significantly reduced, how long they live with bone metastases depends on the therapy used and the aggressiveness of the primary focus

The process of metastasis is a terrible complication that always occurs with cancer if the disease is not detected in time and its treatment is not started. Usually metastases are formed in soft tissues, organs, but sometimes bones are also affected by them. Metastasis in bone structures should be considered as another episode of cancer, when abnormal cells from the primary tumor, moving through the body, are deposited in the elements of the skeleton.

Bone metastases appear in the late stages of pathology development, in 4 out of five cases the primary tumors are breast cancer for women and prostate cancer for men. This situation does not have a good prognosis, the patient suffers from symptoms severe pain, weakened bones break even with a slight impact. The primary oncological lesion of the kidneys and thyroid gland leads to metastasis in the structures of the skull.

Causes

In addition to the listed types of cancer, metastasis to bone tissue suffers from malignant tumors of the lungs, kidneys, ovaries in women, sarcoma, lymphoma, and damage to the organs of the gastrointestinal tract. In severe cases, there is a migration of atypical cells from other affected organs.

Photo 1. Destruction of bone metastasis

The appearance of severe signs and symptoms of the disease is associated with a violation of the constant renewal of bone tissues that exists in healthy person. Normal cellular interaction, the elements of which are resorption, remodeling and bone formation, is disrupted, since osteoblasts and osteoclasts responsible for this functionality are blocked by cancer. As a result, in the bone there is a displacement of healthy and useful tissues, the place of which is occupied by metastasis.

Mammary cancer common cause bone metastasis. With such a female disease, malignant structures, through lymphogenous or hematogenous movement, move and accumulate in the bones, mainly the pelvis and chest.

The course of the disease is accompanied by intense pain, which contributes to regular fractures. This usually means grade 4 cancer, in which life expectancy is short.

Types of bone metastases

Based on the type of activation of oncology, several types of them are distinguished:

• Osteoplastic refers to the situation of the formation of dense areas embedded in the bone.
• Osteolytic refers to the process of destruction of bone tissue.

Any case of a disease is a combination of the two indicated pathological processes. Most often, metastases occur in bones that are actively fed by blood, they form in:

1. shoulder area
2. ribs
3. Skull, spine elements

In the early stages of formation, they have no signs, later symptoms of pain and other manifestations appear.

Symptoms of bone metastases

The early degree of metastasis is asymptomatic, but as it grows, the effect of oncology on the bone becomes more pronounced, and the first signs appear:

• Hypercalcemia. This is the name of the consequence of bone metastases, which occurs in more than a third of patients. Pathology causes increased activity osteoclasts, causing a sharp increase in calcium in the blood. This leads to an increased load on the kidneys, which threatens to reverse absorption and excessive urine output.
• pathological fractures.
• Spinal compression for a tumor in the spine.

As a result of hypercalcemia and clamping of the spinal canals, a person develops the following symptoms:

1. On the part of the nervous system, a cancer patient with bone metastases suffers from lethargy, an unbalanced psyche, confusion, and affective disorders.
2. The heart and blood vessels begin to function incorrectly, which ends with arrhythmia, reduced blood pressure, low heart rate. All this borders on heart failure and instant death.
3. Possible renal failure due to intense load on them
4. The gastrointestinal tract suffers from disorders, the patient often feels nauseous, there is no appetite, constipation leads to intestinal obstruction, etc.

In conditions where metastases in bone tissues destroy more than 50% of the cortical layer, the likelihood of fractures increases sharply. This affects the bones of the spinal column in the lower back or thoracic region and hips. A slight excess of the load ends with bone fractures and symptoms of severe pain.

Due to metastases in the bones, they are so weakened that they often break on their own. In this case, due to the relative displacement at the fracture site, the functionality of the limb or bone element is completely lost. Not having time to grow together, another scrapping occurs and so on. As a result, a person is practically immobilized and is threatened with disability with the need for constant pain relief.

Further growth of a malignant tumor leads to compression by broken bones of soft tissues located nearby. This threatens with constant severe pain, muscle weakness, impaired sensitivity. Life expectancy with such complications is very short, the terminal stage leads to paralysis and failure of the pelvic organs.

In such conditions, life with bone metastases becomes a serious test. There is no longer any talk of a cure, the task of physicians is to improve the conditions of existence.

With metastasis of the bones of the spine, there is a risk of spinal compression. Often this phenomenon is observed when localized in the thoracic part of the spinal column. Symptoms are formed sequentially, as pressure increases on the spinal cord, passing through a special spinal canal. A sharp appearance of signs occurs with a fracture of the vertebral element.

If you notice and start treating spinal compression in time, then its consequences are reversible, in the later stages the signs of paralysis will become more and more obvious, despite treatment.

Statistics show that only every tenth cancer patient is able to move independently after the development of paralysis.

Diagnostics

Reliable and informative diagnosis of bone metastasis is possible with the help of skeletal scintigraphy. The method allows you to understand how widespread education is, and at what degree it is.

This procedure finds metastases in any bones of the human trunk and limbs. Even the initial stages of the disease are effectively detected, when the symptoms are not yet manifested. The result of treatment at this stage will be a significant improvement in prognosis and life expectancy.

Photo 2. View of the pelvic bones on x-ray

A more accessible and non-contact method is X-ray. However, it reveals only a mature secondary metastasis, when a significant amount of bone has already undergone destruction. The advantage of radiology is the possibility of differentiating a secondary neoplasm based on its type. The different coloring of the spots in the photo will indicate their different nature.

At later stages of diagnosis, to clarify the diagnosis and method of treatment, the following are used:

1. CT and MRI
2. Radioisotope diagnostics
3. Osteoscintigraphy
4. Urine and blood tests

Treatment

What and how to treat bone metastases will depend on the location of the pathology, the degree of its development and the parameters of the original cancer. We list the main methods of treatment:

• Operations are used in the framework of palliative care, when it is impossible to improve the prognosis of recovery and the patient is already incurable, but it is necessary to extend life as much as possible and improve its quality. Thanks to the surgical removal of tumors, it is possible to reduce the compression of the nerve endings of the spinal cord, and reduce the likelihood of bone fractures. All this significantly reduces pain and partially returns the lost anatomical functionality.
• The use of radiation and chemotherapy is used to prepare the patient for surgery, or after it, as well as self-treatment. By chemical or radiation destruction of cancer cells, it is possible to stop the growth of bone metastases.
• Taking bisphosphonates. These are special drugs that inhibit the destruction of bone tissue.
• For some types of cancer, the use of radiopharmaceuticals is effective.
• Activation immune system allows you to extend the lifespan of a person. Due to the activation of its own forces, the body begins to fight the malignant spread better, helping external radiation from the inside.

Bisphosphonate drugs

This is the name of drugs that protect bone structures from destruction. They are indicated for osteoclastic pathology to compensate for the harmful effects of metastases.

Due to the absorption of basphosphonate in the place where metastasis has occurred, negative activity slows down or stops altogether. In addition, the drug inhibits the production of osteoclasts, which quickly die or are destroyed on their own. The mechanics of action is to accumulate active substance around education. When the required mass is gained, a positive effect on the suppression of the destructive function begins.

There are two types of bisphosphonates. The former consist of nitrogenous compounds and are more effective against bone metastases. The second group is deprived of such compounds and treatment with its help is less effective. What exactly to prescribe will depend on the financial capabilities of the patient and the stage of development of the neoplasm.

Prognosis and life expectancy

How long exactly patients with bone metastasis live is impossible. This can only be roughly done by looking at the medical history. For an accurate prognosis, the doctor needs to analyze a lot of information about metastasis and other cancers.

Here are the numbers for how long people with bone metastases live, depending on the primary oncology:

1. Metastasis of lung cancer and melanoma gives a life expectancy of about 6 months.
2. Prostate - 1-3 years
3. Breast cancer - 18-24 months
4. Kidneys with bone metastasis give a person up to 12 months of life
5. The best prognosis for malignant lesions of the thyroid gland. With the complications discussed in the article, people live up to 4 years.

103med.ru

Bone metastases: symptoms, prognosis and treatment

Cancer is one of the worst most dangerous diseases that threaten humanity. Oncological pathologies are numerous, they develop suddenly, sometimes without any previous signs. It is also important to remember that cancer at certain stages can spread throughout the body, and this is how bone metastases appear.

In such situations, we must not forget that the skeletal system plays a crucial role in human body. Bones are responsible not only for musculoskeletal functions, they are the focus of the accumulation of minerals, etc. Metastasis to bone structures is one of the most severe forms of cancer, in order to resist pathology, you need to know as much as possible about it.

What it is?

To get an answer to this question, you need to understand the nuances of what the process of metastasis itself is.

So, the term metastasis in medicine refers to a secondary tumor that originated from the primary focus of a malignant tumor. Metastases can spread throughout the body, affecting nearby or distant organs, as well as entire systems, including bone structures.

It is important to understand that bone metastases are precisely a tumor of the secondary type, since the primary neoplasm is the one that originally appeared and grew in the bones. Metastases enter the bone structures and affect them due to the spread throughout the body of malignant blood cells that circulate through the lymphatic or bloodstream (lymph and blood flow).

The process of metastasis occurs mainly in the last and most severe, that is, the fourth stage of cancer. Moreover, according to statistics, about 80% of all cases of bone metastasis occur due to cancer of the breast, prostate, lung, etc.

In other words, it is the listed types of oncological pathology that in most cases give metastases, which subsequently affect the skeletal system and lead to bone cancer.

Causes and types

As mentioned above, the main cause of metastasis and secondary bone cancer lies in the oncology of any organs. In most cases, the development of pathology occurs with cancer of the following localization:

• with breast cancer;
• thyroid gland;
• lungs;
• kidneys;
• with an increased likelihood of bone metastases in prostate cancer;
• organs of the gastrointestinal tract, mainly the stomach;
• ovaries, etc.

These types of cancer are more likely to metastasize to the bones, but this does not mean that other types of cancer are not capable of causing bone cancer.

In addition, some scientists argue that not all bones are affected by metastases. The formation of neoplasms occurs mainly in large bone structures and hollow bones. In general, a comparative characteristic can be given by comparing the formation of a tumor and the likelihood of metastasis. This feature is as follows:

• With breast cancer, that is, the mammary glands, metastasis occurs more often in the bone structures of the spinal column.
• Metastases in the ribs, hands, feet, and also in the bones of the skull appear mainly with global oncological lesions in the late stages of the oncological process.
• Another "favorite" site of metastasis lesions are the bones of the acetic region and thighs. This is explained by the fact that the bone structures in these parts of the skeleton are very massive.

If we talk about the causes and types of bone metastasis, we cannot fail to mention the division of bone metastases into two main types:

1. Osteoblastic metastases - their characteristic feature is the fact of the formation of seals directly on the surface of bone structures.
2. Osteolytic metastases - this case is fundamentally different from the previous one, since the bone tissue and the bone itself destroys, the pathological process occurs from the inside.

Taking into account the two types of metastases described, one more cause of bone oncology can be identified. To do this, you need to know that in the body of a healthy person, bone tissues are continuously renewed, processes of resorption, bone formation, and remodeling take place. The functioning of renewal processes depends on the activity of certain cell units - osteoclasts and osteoblasts.

In patients with metastases, pathological cells penetrate into the cellular structure of the bones, the work of osteoblasts and osteoclasts is disrupted. As a result, regular regulation of the processes of formation, absorption and destruction of bone tissues is disrupted, healthy cells are replaced by pathogenic ones. A particularly severe pathological process is diagnosed when metastases enter the bone marrow.

A separate cause of the development of oncology, which is important to mention, are bone fractures. Most physicians agree on the theory that fracture sites, even after decades, are more likely to become the site of localization of cancerous tumors. According to this theory, the chance of bone metastases is higher in the place where the fracture was once localized.

In addition, in addition to the increased likelihood of large bone metastases, bone structures with an abundant blood supply also fall into this category.

Symptoms and characteristic signs

The process of formation of metastases in the bone has different symptoms, in some cases the clinical picture depends on where exactly the tumor is located and grows. We are talking about the fact that in some cases, in the general symptoms, atypical clinical signs appear, characteristic of the manifestation of cancer in certain parts of the skeleton.

But before moving on to such features and particular cases, it is worth considering the overall clinical picture in patients with metastases. To begin with, it is worth saying that the first stages of the development of bone metastases are completely asymptomatic. The only symptom that also does not appear in everyone is increased fatigue and general malaise. As the pathology develops and the tumor grows, the following symptoms appear:

• Pain in bone metastases is the main and most striking symptom, which is present in 98% of cases. The pain syndrome is localized mainly in the place where the malignant neoplasm was localized. By the nature and specifics of the pain is constant, tends to intensify during physical exertion, in motion, and also during a night's sleep with muscle relaxation.
• With the development of the tumor process, edema appears. Puffiness also has a clear localization, it encircles the tumor. This means that if we are talking about a neoplasm of the hip in the hip joint, the swelling will be around this area. The exception is the defeat of deep bone structures, then the edema may be hidden.
• Distortion or deformation of the affected area. In this case, the tumor grows and protrudes, forming a kind of bump or bump. The size of the deformed area depends on the size of the neoplasm itself.

In the general clinical picture, there are also signs of causeless weight loss, constant subfebrile temperature, lethargy, drowsiness, loss of strength, loss of appetite and excessive sweating. All these clinical signs are invariably present at the stages of metastasis, because in this case we have to talk about severe progression of oncology. In addition, metastasis of bone structures is accompanied by atypical symptoms, the following disorders occur:

• Pathological fractures - clinical sign comes into force at that stage of the oncological process, when more than 50% of the cortical layer of bone structures is destroyed in the patient. In such cases, the bones become brittle, the joints are fragile. The spine, pelvic bones, central parts of the tubular bones suffer the most. A fracture can occur from a minor blow or even from an unsuccessful movement;
• Spinal cord compression - mainly manifestations of compression affect the thoracic spine. Less commonly, it is the lumbosacral region, and in only 10% of cases it is cervical. Apart from pain, compression is accompanied by a gradual loss of musculoskeletal functions, paralysis of the limbs and parts of the body, which are controlled by nerves in the corresponding section of the spine. There is a violation of blood circulation, as well as the functioning of the nervous system;
• Hypercalcemia - develops due to excessive activity of osteoclasts, due to which calcium is “washed out” from damaged bones into the blood, which negatively affects kidney function. As a result, the patient develops polyuria, as one of the complications, serious disorders of various body functions begin. As a result, there are disturbances in the work of the nervous and cardiovascular systems, kidneys, organs of the gastrointestinal tract.

How to determine?

With the appearance of the corresponding symptoms and suspicions of the formation of metastases in the bones, it is necessary to consult an oncologist. To confirm the diagnosis, the specialist must prescribe a series of diagnostic measures to the patient.

As part of the diagnostic examination, the following are required:

• Radiography in traumatology is the very first and main procedure, which is distinguished by its availability and simplicity. But the x-ray has one significant drawback - small tumors are not visible in the picture, that is, this method is ineffective in the early stages;
• MRI or magnetic resonance imaging - obtaining a general picture of the disease, including the ability to determine the extent of damage to bone tissues by metastases;
• A blood test for biochemistry - is carried out mainly in order to detect excessive amounts of calcium in the blood, which indicates hypercalcemia;
• Tumor biopsy - taking tissue samples of the neoplasm for the purpose of further cytological and histological examination. This examination is necessary to determine the type of tumor, establish a diagnosis, and then plan treatment.

How to treat?

Bone metastases are a disappointing diagnosis, but it is not a reason to refuse treatment. Even if therapy does not guarantee recovery, adequate treatment of bone metastases significantly alleviates symptoms, improves the quality of life of the patient, and also increases life expectancy.

In general, with bone metastases, the treatment regimen involves an integrated approach, which includes:

• Medical therapy The patient is prescribed a course of bisphosphonates. Preparations of this group stimulate regenerative processes in bone tissues. They suppress the activity of osteoclasts and level the loss of bone mass;
• Chemotherapy for prostate cancer with bone metastases and other types of metastasis is one of the main methods of treatment. In this case, cytostatic drugs are used that can slow down or even stop the progression of the pathological process. In some cases, there is even a decrease in tumor growth;
• Radiation therapy - it is based on the method of intense irradiation with x-rays, which contributes to the destruction of neoplasms. In some cases, this method is very effective, perhaps even transferring oncology into a state of remission.

Treatment involves the mandatory involvement of an oncologist. It is highly not recommended to resort to folk remedies to fight cancer, since such an effect can only aggravate the patient's condition and provoke the progression of the disease.

How many live?

Bone metastases are a disappointing diagnosis, because in this case we are talking about a severe stage of oncology progression. At the same time, it is very difficult to predict life expectancy, because here it is necessary to take into account a lot of different factors.

Despite this, most doctors agree that with such a diagnosis, a person lives from 3 months to a year and a half. But even such figures should not be demoralizing, because modern methods of cancer treatment, provided they are timely, the desire to live, and a number of individual factors can increase life expectancy. In addition, there is always a place for a miracle and the onset of remission.