What is bone metastasis?
Bone is the third most common location where cancer cells metastasize after liver and lung. Once cancer has spread to bone it rarely can be cured. Doctors treat the disease to slow its growth and focus on controlling the symptoms of the disease.
The majority of cancer involving the bones is metastatic disease from other remote cancers (most commonly breast, prostate and lung). Primary bone cancer is much less common with 2-3000 cases reported per year. Primary bone tumors occur most commonly in children and adolescents and are less common in adults.
What are the symptoms of bone metastasis?
- Pain affects the majority of patients with bone metastasis.
- Pain may occur with weight bearing or at rest.
- Bone loss from tumor can result in fracture.
- Tumors within the vertebrae can cause spinal cord compression resulting in numbness or weakness.
What imaging is done to diagnose bone metastasis?
Bone tumors are most commonly discovered during work up or treatment of primary cancers. Multiple imaging exams including X-Rays, CT, MRI, PET and bone scan may be used to identify tumors. Your physician may also request an image guided biopsy of the tumor.
What interventions/treatments can be performed for bone metastasis?
Standard therapies for bone metastasis include medical, surgical, radiation and minimally invasive interventional procedures. Ultimately, a combination of these therapies will likely be used to treat the disease as well as the pain related to the tumors.
Surgery: Metastatic disease to bone is most likely treated with surgery in the case of recent or impending pathologic fracture. For primary bone cancer the goal of surgery is usually to remove the entire tumor and a surrounding area of normal bone.
Medical: Many patients with metastatic disease to bone will be treated with chemotherapy or hormonal therapy. Chemotherapy is used to kill cancer cells throughout the body and is common for treatment for metastatic disease. These treatments vary based on tumor type. Bisphosphonates are used to treat pain and reduce bone loss from tumors. They also help reduce the incidence of fracture from tumors.
Radiation: Radiation is the standard treatment for painful bone metastasis. The radiation is delivered in numerous doses or “fractions” to reduce damage to the surrounding tissues.
Minimally invasive therapies: Various treatments are administered by interventional radiologists to treat painful bone metastasis. These treatments are usually performed as outpatient procedures with short recovery time.
- Ablation: Percutaneous ablation is performed with small needles placed through the skin into bone tumors that create heat or cold to kill tumor cells. This treatment is usually prescribed for painful bone tumors that did not improve or minimally improved after radiation. Patients usually experience rapid pain relief within 1 week of ablation.
- Stabilization: Bone tumors can cause the bones to become weak resulting in pain or fracture with weight bearing. Stabilization can also be performed in the pelvis and peripheral bones to treat pain from instability.
- Vertebral augmentation. The majority of bone metastases occur in the spine. Vertebral augmentation can be used in conjunction with ablation and involves injecting bone cement to fill the weakened bone after the tumor has been killed.
- Nerve blocks or Neurolysis: Tumors may compress nerves resulting in pain. Nerve blocks or neurolysis (destruction of the nerve) are performed with tiny needles under local anesthesia to treat pain.