How does a tumor affect bone?
Bone is constantly renewed: some cells destroy old tissue, others build new one. Tumor cells, once in the bone marrow, secrete substances that shift this balance. With the osteolytic type, destruction predominates, and cavities form in the bone - it becomes fragile. With the osteoblastic type, characteristic of prostate cancer, bone tissue is formed in excess, but it is defective and also breaks down. Mixed variants are often found, and when the bone is destroyed, excess calcium is released into the blood.
- Osteolytic lesions - bone destruction
- Osteoblastic lesions - excessive compaction
- Mixed type of lesion
- Most common locations: spine, pelvis, ribs, hips
- Sources: mammary and prostate glands, lungs, kidneys, thyroid gland
Symptoms
The leading symptom is pain in the bone, which differs from the usual muscle or joint pain: it is constant, gradually increases, intensifies at night and at rest, and is poorly relieved by conventional means. If the spine is affected, the pain may surround the chest or radiate to the leg. An alarming situation is compression of the spinal cord by a tumor or a displaced vertebra: weakness in the legs, numbness, urinary retention or incontinence. This condition requires immediate help, otherwise the changes will become irreversible.
- Constant pain that gets worse at night
- Local pain when pressed
- Fracture with minimal load
- Decreased height and spinal deformity
- Weakness and numbness in the legs
- Disorders of urination and stool
- Thirst, nausea, confusion with high calcium
Diagnostics
Radiography reveals only fairly large lesions, so if suspected, more sensitive methods are used. Bone scintigraphy shows the condition of the entire skeleton in one study, CT is good at assessing the degree of destruction and the risk of fracture, and MRI is indispensable for damage to the spine and suspected compression of the spinal cord. Blood tests can help detect elevated calcium and alkaline phosphatase levels. If the primary tumor is unknown, a biopsy of the lesion is required: the choice of treatment depends on its result.
- X-ray of the affected area
- Skeletal osteoscintigraphy
- CT scan to assess fracture risk
- MRI of the spine for neurological symptoms
- PET-CT according to indications
- Calcium, alkaline phosphatase, complete blood count
- Biopsy of a lesion for an unknown primary tumor
Treatment
Treatment is always two-level. The first direction is therapy for the main tumor: drug, hormonal, targeted or immunotherapy, selected by an oncologist. The second is the effect on the bone lesion itself. Radiation therapy effectively relieves pain, often after just a short course. Drugs that inhibit bone destruction reduce the risk of fractures and correct calcium levels; they are prescribed with mandatory monitoring of the condition of the teeth. If there is a threat of a fracture of a large bone or instability of the spine, strengthening operations are performed.
- Systemic treatment of the main tumor
- Radiation therapy to a painful lesion
- Drugs that strengthen bone tissue
- Surgical fixation in case of risk of fracture
- Decompression for spinal cord compression
- Correction of high calcium in the blood
- Sanitation of the oral cavity before starting bone therapy
Pain relief and quality of life
Pain from bone metastases is controllable and does not need to be tolerated. The doctor selects a regimen in stages: from non-steroidal anti-inflammatory drugs to strong prescription painkillers, with regular doses taken by the hour, rather than on demand. Additionally, radiation therapy, corsets and orthoses, gentle exercise regimen and physical therapy under the supervision of a specialist help. Prevention of constipation, drinking enough fluids, vitamin D and calcium as prescribed by a doctor, and working with a psychologist are also important.
- Regularly taking painkillers according to your doctor’s regimen
- Radiation therapy for pain relief
- Corset or cane for unloading
- Avoid heavy lifting and twisting
- Vigorous activity and therapeutic exercises
- Prevention of constipation during pain relief
- Psychological support for patient and family
