CONDITIONS AND TREATMENTS

Metastatic Bone Disease

Cancer that arises in an organ and then spreads to bone is termed metastatic bone disease (MBD). The majority of MBD originates from cancers of the breast, lung, and prostate, followed by the thyroid and kidney. The most common sites of spread include the spine, pelvis, ribs, skull, upper arm, and leg long bones.

More than 1.2 million new cases of cancer are diagnosed each year. Approximately 50 percent of those cases can spread or metastasize to the skeleton. Improved medical treatment of many cancers means patients are living longer, however many of these patients can go on to develop bone metastases.

Every cancer patient should discuss his or her risk for developing metastatic bone disease with their oncologist.

Symptoms

Patients with MBD may have marked pain in the spine, pelvis, or extremities because the bone is weakened by tumor. Pain that occurs even without activity (e.g. walking or lifting an object) is particularly concerning. If the pain worsens, the patient should immediately seek medical attention.

Diagnosis

After collecting a thorough medical history, your physician will perform a physical examination concentrating on any painful areas. When metastatic bone disease is suspected, a radiographic examination will be ordered. Because some pain can be referred from other areas (e.g. knee pain may be arising in the hip), your doctor may order radiographs that look beyond the areas where you are experiencing discomfort. The radiographic examination can tell your oncologist a great deal of information about if and how much bone is involved.

Osteolytic MBD occurs when the bone is destroyed in a particular area. This is commonly seen when cancer spreads to the bone from the lung, thyroid, kidney, or colon.

Osteoblastic MBD occurs when new bone forms in response to the spread of cancer and is frequently seen with prostate, bladder, and stomach cancer.

Some cancers can result in a mix of osteolytic and osteoblastic MBD, as is the case with breast cancer.

Treatment

Patients with MBD require a team approach to care. A medical oncologist, radiation oncologist, and an orthopedic surgeon familiar with MBD should work together. A pain management specialist and social worker are also strongly recommended.

Nerve damage that can lead to paralysis or loss of the use of legs and/or arms is also a concern. Pain caused by MBD can be relieved with radiation treatments, pain medication, and newer, minimally invasive surgical techniques. Non-operative treatments include:

  • Radiation Therapy
    • Local field radiation
    • Hemibody Irradiation
    • Radioisotope Therapy
  • Medical Treatment
    • Chemotherapy
    • Endocrine Therapy
    • Bone-Specific Therapy
    • Bisphosphonates

Patients are at increased risk for bone fractures that can impact mobility and one’s ability to perform typical daily activities. Impending fractures, where a break is imminent because the bone is weakened, are also common. Long periods of bed rest may be prescribed. It is also well established that patients who undergo surgical intervention to prevent a fracture fair better than those who require surgery to treat a fracture. Surgery is considered after a careful assessment by your orthopedic surgeon.