Bone metastases

Metastases in the bone are formations that are secondary to such malignant tumors as: myeloma, breast cancer, prostate, lung, kidney, thyroid, non-Hodgkin's lymphoma.

Oncologists say that most often the formation of metastases in the bone skeleton is observed with the development of malignant formations in the gastrointestinal tract, ovaries, cervix, soft tissues

The process of metastasis is the penetration of malignant tumor cells and the achievement of any organs and tissues, as well as bone tissue through circulation in blood and lymphatic vessels.

When the patient is in a healthy state, the bone tissue is renewed in his body. It is characterized by cyclic resorption and bone formation. This process is caused by two kinds of cells: osteoclasts, which perform the function of destruction or absorption of bone tissue, and osteoblasts responsible for its formation.

It is hardly worthwhile for anyone to prove the importance and role of bones and bone tissue in the human body for a long time, but it is possible to outline several of their main purposes:

• function of the framework in the human body;
• function of storage of minerals necessary for an organism - calcium, magnesium, sodium, phosphorus;
• with the help of bone marrow produced and stored most of the blood cells (red blood cells, white blood cells, platelets).

With the penetration of cancer cells into bone tissues, there is an effect on the functioning of bones, the healthy cells are displaced, the interaction between such components as osteoclasts and osteoblasts is broken, thereby their work is disunited. Depending on the pathogenesis, the division of metastases into bones occurs in the form of osteolytic (osteoclasts are activated, nothing happens with the osteoblasts, which causes pathological resorption of the bones) and osteoblastic (osteoblasts are activated, and pathological bone formation occurs). With mixed metastases, both osteoclasts and osteoblasts are activated simultaneously.

[1], [2], [3], [4]

Symptoms of cancer metastases in the bone

The main symptoms of cancer metastases in the bone are:

• presence of pain in the bones;
• limited mobility in the metastasized area.

In addition, spinal cord compression often occurs, causing limbs and abdominal region to numb, often patients complain of having problems with urinary function, signs of hypercalcemia increase, which causes the patient to have attacks of nausea, thirst, appetite, fatigue. The pathogenesis of bone metastases can be completely different, because in some cases, clinical manifestations may even be absent.

Metastases in the bone with kidney cancer

When a patient is diagnosed with kidney cancer, bone metastases manifest themselves as pains, where the affected bone is projected. In addition, in addition to all the appearance of pathological bone fractures, the spinal cord is compressed, palpation detects formation.

Metastases in the bones of lung cancer

Lung cancer is often complicated by metastases in the bone, and especially in the spine. The blood supply to the body greatly affects the bone tissue, as the blood flow brings to the bone various trace elements, including tumor cells, which when introduced into bone tissue in the near future begin to destroy it. The destruction of bone tissue makes it fragile, because so often the presence of fractures.

Metastases in the bone usually occur where there is a good blood supply: these are the areas of the ribs, humerus and costal bones, cranial, pelvic and vertebral. The most dangerous thing about this is that there are no symptoms at first, and when pains already occur, then it may be too late. Metastases in the bones of lung cancer are mainly manifested by the symptom of hypercalcemia, then the patient exhibits dry mouth, nausea, vomiting, excessive urine formation, in which consciousness is disturbed.

Breast cancer and bone metastases

Using as a path lymph and blood vessels cancerous cancer metastasizes to various organs, including various bone areas.

Bone tissues are the place where metastases in breast cancer occur quite often, along with such zones as the ovaries, lungs, brain, liver, etc.

[5], [6], [7], [8], [9], [10], [11]

Prostate cancer and bone metastases

One of the most common localizations of cancer, due to which metastases are formed precisely in the bones - the prostate gland. However, primary metastases in bones from prostate cancer are extremely rare. Metastasis due to prostate cancer occurs when there is already a late stage of a tumor disease.

Metastasis due to a prostate cancer usually affects the femur, lumbar spine, thoracic spine, pelvic bones, etc.

Metastases in the bones of the spine

If there was a lesion metastasized in the bones of the spine, then any physical activity is contraindicated, it is strictly forbidden to lift heavy, rest is needed several times a day.

Metastases in the hip bone and pelvis

When metastases were formed in the femoral, pelvic bone, it is necessary to avoid the load of the leg that was affected. It is good to use a cane or crutches during this period.

Metastases in many cases are localized in the pelvic bones and hip joints. This zone occupies the second place after the spine, where bone metastases are formed. When the patient is diagnosed with a cancerous prostate cancer, first of all, sometimes even before the defeat of the spine, under the impact of metastases, pelvic bones fall. Metastasis from such forms of cancer as cancer of the breast, malignant formations of the thyroid and parathyroid glands, cancer of the prostate, lungs, liver, lymph nodes, kidneys, uterus and organs of the urinary system falls into this zone.

Metastases in the limb bones

The extremities are the third zone in the rating where the cancer tumor of various forms metastasizes. Shoulder divisions most often affects the cancer of the thyroid gland and malignant formations of the breast, cancer of the lungs, colon and rectum, cancer of the liver and bile ducts. If there is a pathological fracture in the humerus, then this may be the first "bell" of the aforementioned ailments. Also, the humerus can be metastasized when the patient is ill with melanoma, urinary cancer, malignant chemodectomy (paraganglioma), and lymphogranulomatosis.

Radial, ulna is mostly affected when a cancerous tumor of the chest, lungs, and kidneys is diagnosed. The brush can be metastasized when the thyroid and mammary glands, the large intestine, the kidney, the liver, the prostate gland, the bladder are affected by a cancerous tumor. In addition, melanoma, lymphogranulomatosis, malignant hedecoctoma, primary periosteal sarcoma (which comes from the jaws, to be more precise, the lower part), liposarcoma in soft tissues can cause such metastasis.

The tibia is mostly affected by a cancerous tumor of the lungs, fibular - when the large intestine, the prostate gland is affected. Breast cancer can be metastasized in the bones of the foot.

Metastases in the skull bones

When there is metastasis in the skull, it is mostly affected by its arch and base, often in the presence of damage to the bones of the face. Very often detection of metastases occurs even before the primary malignant tumor has been detected. In most cases, this happens when the kidney cancer is subsequently diagnosed.

Metastases in the bones of the arch and base, using the hematogenous pathway, usually causes malignant tumors of the mammary glands, thyroid and parathyroid gland cancer, colon, prostate, lungs, as well as the presence of sympatoblastoma, retinoblastoma in the patient.

When a single metastasis is diagnosed in the cranial bones, experts strongly recommend the examination of other organs to immediately rule out the likelihood that they were also affected. If by that time it is still unknown which location was affected by the primary malignant tumor, it is first suspected that the kidney, milk, thyroid gland, liver are affected by cancer. If a similar situation happened to a child, then he is suspected of retinoblastoma and medulloblastoma.

When metastases are formed in the osseous parts of the facial part, the paranasal sinuses, the upper and lower jaw, and the orbit are affected. Metastasis of the paranasal sinuses is most often due to kidney cancer.

Metastases of the cranial region may also appear in the upper jaw, two jaws are most often not affected at the same time.

The ophthalmic can fall under the impact of metastases due to breast cancer, kidney, thyroid gland, adrenal gland, melanoma. When carrying out an X-ray, the appearance of such metastases usually resembles a retrobulbar tumor.

Diagnosis of cancer metastases in bone

In order to diagnose cancer metastases in the bone, their prevalence and the level of neglect of the case, conduct skeletal scintigraphy. Thanks to her, bone metastases can be found in any corner of the human skeleton. In addition, such a study is effective and at a very short time, at a time when there are not very many metabolic abnormalities in the bones. Therefore, bisphosphonates can be prescribed on time, and even in advance, because scintigraphy plays an unusually important role.

As for the X-ray study, the initial stages of the appearance of metastases will not give enough information. Determine the size of the focus and its precise localization in the bones becomes possible only when the metastatic formation ripens, and this occurs when the bone mass is already destroyed by half.

X-ray examination of metastases in the bone makes it possible to differentiate the types of metastases in diagnosis. The presence of dark spots (loosened zones), which has a gray-white bone tissue, indicates the presence of lytic metastases. With white spots on the pictures, which are somewhat lighter in tone than the bone tissue (with a dense or sclerotic region), one can conclude that we are dealing with blastic metastases.

When conducting a radioisotope study of the bones of the skeleton (osteoscintigraphy), the gamma camera performs the study of the entire body surface. Two hours before this, a specific osteotropic radiopharmaceutical Rezoscan 99m Tc was administered. With the help of this diagnostic technology, pathological foci of hyperfixation of this drug in the bones are determined. It is also possible to visualize how widespread or isolated the metastatic process is and to ensure the presence of dynamic control, how much treatment is carried out using biophosphonates.

In addition, for the diagnosis of metastases of cancer in the bone using a computer tomography. By CT a CT biopsy is performed, but with it only osteolytic foci can be found.

Also for the detection of cancer metastases in bone, the practice of magnetic resonance imaging is practiced.

With the help of laboratory testing, it is possible to determine the markers of bone resorption in the urine (how the urinary N-terminal telopeptide and creatinine are correlated), in what quantities the serum contains calcium and alkaline photostatic.

[12], [13], [14], [15], [16]

Treatment of cancer metastases in bone

If bone metastases are treated in a timely manner, new foci of bone metastasis occur less frequently, and the survival of patients increases. Since skeletal complications (pain syndrome, pathological fractures, spinal cord compression, hypercalcemia) occur less often, it becomes much easier for them to live, which is also an important achievement.

Systemic drug therapy includes antitumor therapy (use of cytostatics, hormone therapy, immunotherapy) and maintenance therapy - treatment with biophosphonates and analgesics. Locally, bone metastases are treated with radiotherapy, surgical treatment, radiofrequency ablation, cement plasty.

Patients who have metastases in their bones are treated with completely different methods, one universal does not exist. Each patient is assigned his own treatment, paying attention to how the disease proceeds and where exactly the metastases are located.

The use of physiotherapy procedures is not practiced. Exceptionally, in those cases when the doctor approved, it is permissible to perform physical exercises.

Anesthesia with cancer in bone metastases

When the bone tissue of one or two regions contains metastases in the bone, the most effective method of treatment, which has the same effect of anesthesia, is radiotherapy. Eighty-five percent of cases when radiotherapy was applied are characterized by the effect of anesthesia, which takes place for a sufficiently long time. In addition, when metastases are found in the bones, how anti-inflammatory and opioid agents prove to be very effective.

[17], [18], [19], [20], [21], [22]

Chemotherapy for metastases in the bones

Chemotherapy with metastases in the bones, hormonal therapy, targeted therapy - all these methods are also characterized by a positive effect. Also, experts recommend combining these methods, using in addition radiation exposure, under which usually one or more metastases in the bone, differing in causing the greatest soreness. Radiation therapy can also be carried out in such a way that radioactive strontium-89 is injected intravenously, in which case bone metastases begin to absorb it. The use of drugs such as "Zometa" and "Aredia" also well anesthetize the metastasis of cancer in the bone by improving the bone structure. Practice such a method as immobilize (immobilize) a sick limb.

[23], [24], [25]

Treatment of metastases in the bone with biophosphonates

In the treatment of bone metastases, the use of bio-phosphonates intravenously and orally is used. To drugs that are administered intravenously, include a drug such as Zometa (zoledronic acid) and Bondronate (ibandronic acid). Orally take the drug Bonefos (clodronic acid) and Bondronate in tablets.

Treatment of bone metastases in the bone with Zometa

Zometa - the most effective preparation of groups of biophosphonates, is an intravenous nitrogen-containing biophosphonate of the third generation. He is active in the presence of any of the known types of metastasis: in the presence of lytic, blastic, mixed metastases in the bone. Also, Zometa has an effect in patients who have hypercalcaemia due to tumor development, as well as osteoporosis

Zometa has a selective effect, which is "felt" by bone metastases. Zomet is characterized by penetration into bone tissue, concentration near osteoclasts, causing their apoptosis, a decrease in secretion, which occurs due to lysosomal enzymes. Due to the effect of the drug, adhesion of tumor cells in bone tissue is disrupted and tumor resorption in the bone is disrupted. An important difference from other biophosphonate discharges is that Zometa causes oppression of neoplasm of vessels in tumor cells (the presence of an anti-yeagenic effect), and also because of their apoptosis.

Zometa is usually presented as a concentrate for infusions. One bottle usually contains four milligrams of the active substance (zolendronic acid). This is the dose that is administered at a time. Before you enter the patient, practice diluting the concentrate in one hundred milliliters of saline. Intravenous infusion occurs within fifteen minutes. If the solution is prepared in advance, but not used, then for twenty-four hours it can be stored at a temperature regime of +4 - + 8 ° C. The frequency and severity of side effects of Zometa is similar to other intravenous biophosphonates, that is, the entire drug group is characterized by similar undesirable phenomena. When using Zometa in rare cases, the temperature may rise, muscles and back may ache. The presence of the flu-like syndrome is noted during the first two days after the Zometa infusion was performed. But it can easily be quenched if you take nonspecific anti-inflammatory drugs. The gastrointestinal tract can respond to Zometa, causing nausea and vomiting. Redness and swelling in the place where Zometa was injected intravenously, were observed in very rare cases, the symptoms were gone for one or two days.

Metastases in the bone - the diagnosis in which such a drug as the Zometa is one of the most widely used. It gives good results not only when there are observed lytic and mixed metastases, but also in the case when we are dealing with blastic foci.

Zometa is prescribed immediately after bone metastases have been detected. Apply this drug for a long time, usually combining with other methods of treatment of metastases in the bone - chemotherapy, hormone therapy, radiation therapy.

The course of treatment with Zometa recommended by the American Society of Clinical Oncologists is:

• two years when there is prostate cancer with bone location;
• one year with breast cancer with bone metastasis, and also if multiple myeloma is observed;
• nine months if bone metastases are caused by various other significant tumors.

Intravenous infusions of Zometa in the amount of 4 mg are carried out every 3-4 weeks.

Effects that are observed due to the use of Zometa:

• anesthesia;
• Increase the amount of time that passes before the first bone complication appears;
• decrease in the frequency of complications in bone tissues and the likelihood that they will occur;
• lengthening the interval between how, after the first complication, the second will occur;
• The anti-resorptive properties of Zometa and its ability to enhance the effect of antineoplastic drugs increase the duration and improve the quality of life of patients experiencing bone metastasis.

Treatment of bone metastases in bone with Bondronate

Bondronate (ibandronic acid) is a preparation belonging to the category of biophosphonates, by means of which patients with a problem of localization in bone tissue are treated due to the development of malignant tumors. Along with Zometa and Bonefos is one of the most widely used drugs used in this diagnosis. An important advantage of Bondronate in comparison with other biophosphonates is the ability to use it both intravenously and orally.

Bondronate is prescribed when the patient has a metastatic bone lesion in order to reduce the risk that hypercalcemia will occur, pathological fractures; also in order to reduce pain, reduce the need for radiotherapy if there is pain and a threat of fractures; the presence of hypercalcemia in malignant tumors.

Bondronate exists in two forms - it is administered intravenously and taken orally. With intravenous injection, drip infusions are practiced in a hospital. Bondronate is bred, obtaining a special solution. To make it, you need 500 ml of a 0.9% solution of sodium chloride or a 5% solution of dextrose, in which Bondronat concentrate is diluted. Infusion is carried out an hour or two after the preparation of the solution.

If we are dealing with Bondronate tablets, they are taken half an hour before meals or drinks, as well as other medications. Tablets should be swallowed whole, washed down with a glass of water, and it is necessary that the patient stay in the "sitting" or "standing" position, and then an hour after that did not take a horizontal position. Chewing and resorption of tablets is contraindicated, since oropharyngeal ulceration can occur. Also, these tablets can not be washed down with mineral water, which contains calcium in large quantities.

If Bondronate is used for metastatic bone damage during breast cancer, this drug is most often used as an infusion, injecting 6 mg intravenously for fifteen minutes every three to four weeks. Concentrate for the preparation of solution for infusion is diluted in 100 ml of 0.9% solution of sodium chloride or 5% solution of dextrose.

To treat hypercalcaemia in cancerous tumors, intravenous infusions are performed for one two hours. Therapy with Bondronate begins after adequate hydration with 0.9% sodium chloride solution. The severity of hypercalcemia determines the dose: with its severe form, 4 mg of Bondronate is administered, moderate hypercalcemia requires 2 mg. Maximal for once the patient can enter 6 mg of the drug, but increasing the dose does not increase the effect.

The main difference from Zometa and an important advantage over this drug lies in the absence of negative influence of Bonnronate on the kidneys.

Treatment of bone metastases in bone Bonefos

Bonefos is an inhibitor of bone resorption. It allows inhibition of bone resorption in the tumor process and metastasis in the bone. It helps suppress the activity of osteoclasts, decrease the calcium content in blood serum. In patients with the problem of metastases in bone, the severity of the pain syndrome decreases, the progression of the metastasis process is delayed, new metastases to the bone do not develop. Bonefos can be caused by osteolysis caused by malignant tumors: myeloma (presence of multiple myeloma), cancer metastasis in the bone (cancer of the breast, cancer of the prostate, cancer of the thyroid gland), hypercalcemia in cancerous tumors.

Bonefos is a powerful tool for the treatment of metastasis in cancerous tumors of the mammary glands. Bonefos helps reduce bone pain; reduce the likelihood that severe hypercalcemia will develop. Bonefos is characterized by good gastrointestinal tolerance and lack of nephrotoxicity.

With hypercalcemia due to tumor processes, Bonefos is administered intravenously with the help of infusions in an amount of 300 mg throughout the day. To do this, prepare a special solution from the contents of the ampoule and 500 ml of a 0.9% solution of sodium chloride or 5% glucose solution. Infusion is performed daily for two hours for five days, but not more than a week.

After the level of calcium in the blood serum is normalized, Bonefos is taken orally at 1600 mg per day.

When hypercalcaemia is treated with Bonefos tablets or capsules, the therapy usually begins with large doses of the order of 2400-3200 mg per day and gradually the doctor reduces the daily dose to 1600 mg.

In the case of osteolytic bone changes caused by the appearance of malignant tumors without hypercalcemia, the specialist selects Bonefos dosage individually. They usually start with 1600 mg orally, sometimes the dose is gradually increased, but it is calculated so that it does not exceed 3600 mg per day.

Capsules and tablets of Bonephos 400 mg swallow without chewing. Tablets 800 mg can be divided into two parts to swallow them became easier, but crush and dissolve them is not recommended. 1600 mg of Bonefos is taken in the morning on an empty stomach, the tablets should be washed down with a glass of water. For two hours from the time of taking the drug, you should refrain from eating and drinking, as well as taking other medications. In the case of a dose exceeding 1600 mg, it is divided into a two-time dose. The second dose follows between meals to allow two hours after eating or an hour to an hour. Milk, as well as food containing calcium or other divalent cations that interfere with the absorption of clodronic acid - the main substance of the drug - is strictly prohibited. If the patient suffers from kidney failure, the daily oral dose of Bonephos should not exceed 1600 mg.

Prognosis for bone metastases

There is a table of the frequency of metastases in the bone in patients who suffer from various tumors. According to it:

• with breast cancer, the incidence of metastatic development is 65-75%, the survival rate from the moment when bone metastases are detected is from nineteen to twenty-five months;
• when the patient is diagnosed with prostate cancer, metastases can develop in 65-75%, the patient can live for another year to thirty-five months;
• with lung cancer, thirty to forty percent of cases develop metastases, the survival rate from the time of their detection is six to seven months.

Duration of life with bone metastases

• the metastases in the bone, identified due to kidney cancer, lead to the patient having to live about a year, the incidence of metastases in this form of cancer is twenty to twenty five percent;
• metastases to the bone in thyroid cancer occur in sixty percent of cases, in this situation, the patient's median survival is forty-eight months;
• the frequency of development of metastases in the blood with melanoma ranges from fourteen to forty-five percent, the median survival from the moment of establishing the presence of metastases in the bone is six months.

Cancer metastases in the bone - an unpleasant and life-threatening situation, but not the final sentence. The main thing with metastases in the bone is the understanding that this is not the end. If they are found in time, it is possible to preserve the cancer and life, and the ability to fully function, work, etc. If you completely trust the doctor and observe all that he prescribes. Timely use of prescription drugs, compliance with sleep, eat correctly.

[26], [27], [28], [29], [30], [31], [32]