How to live with bone cancer metastasis?
Introduction
Bone cancer metastasis are the most common consequences of cancer development. Very frequently they cause significant suffering that disturbs the life of a patient. However, today with the use of available treatment, we can effectively help many of those suffering patients.
The informations here should help the patients to recognize and to better understand the causes of frequent appearances of bone cancer metastasis. We have shown the most common disease symptoms, possibility of treatment and methods to palliate the sufferings. One should remember, that the informations included in this article cannot substitute a visit to a specialist, who knows the patient and the case history as well as is able to apply appropriate treatment.
What are metastasis?
Cancer metastasis is recognized when a group of cancer cells grows in a certain distance, in a different organ than the primary cancer focus. The appearances of metastasis, often called a dissemination, are the reason for patients deterioration.
Metastasis can spread through the circulatory or the lymphatic systems, through the implantation or partial growth. During migration through the blood vessels, the cancer cells within the blood stream are reaching capillary vessels. After halting the migration, the cancer cells adhere to vessel walls and through invasing the vessel walls, infiltrating the tissues and organs. Metastasis which spreads through the lymphatic vessels, extend within successive group of lymph nodes and often through their enlargements, signalize the progress of the illness.
How bone cancer metastasis is formed?
For the formation of bone cancer metastasis, responsible are active osteoclasts, distructive cells inside a bone. Bone metastasis are found mostly in bones that are rich in bone marrow (backbone, pelvis, hip and shoulder bones) and show good vascular supply of circulation.
What are the symptoms of bone cancer metastasis?
Bone metastasis could be a reason for persistent pain, pathological fractures with spinal cord compression, limbs paralysis as well as hypercalcaemia.
Pain is the most frequent symptom of cancer bone dissemination. The reason for pain is compressure or infiltration of nerves, muscular spasm reflex, pathological fractures with nerve compression and agitation of the nerves receptors caused by prostaglandin. In some cases pathological fracture is the first symptom which indicates the presence of bone metastasis. This fractures often occurs in long and exposed to load bones ( hip and shoulder bones ) and vertebras. The result of fracturing vertebras (spine bones) is often compression of spinal cord. Over all, the consequence of bone fracture is movement difficulty or patient immobilization.
Hypercalcaemia is a condition where level of calcium in blood serum has considerably increased. Symptoms of hypercalcaemia are: nausea and vomiting, constipations, weakness, weight loosing, frequent urination. Abdominal pain can occur as well as renal calculosis and renal failure.
Diagnostic investigations
Basic investigations are radiological examinations, skeleton scintigraphy, computer tomography and in - some cases - nuclear magnetic resonance. Basic blood cell count tests are necessary as well as calcium level and alkaline phosphatase level.
Treatment possibility
Treatment of bone metastasis includes the use of analgesics (pain killers), bone calcification drugs ( biphosphonians ), cytostatics, radiotherapy and surgical treatment.
A. System treatment with biphosphonians
Biphosphonians are drugs of choice used in hypercalcaemia and in suppression of osteoclasts activity in cancer. These compounds has selective relationship with bone tissue. In case of simultaneous treatment of biphosphonians and cytostatics or radiotherapy and hormones, activity of these drugs are far more effective. Application of biphosphonians allows to decrease the doses of narcotic drugs, until complete elimination. Doses of another kind of pain killers are also being redused.
All doctors, not only oncologists have the capability of prescribing biphosphonians. These medicines are safe and well tolerated; they improve comfort of live of a patient and his general well-being. Drugs can be administrated in outpatient clinic, which makes the treatment more comfortable.
B. Other systematic treatment
Systematic treatment with the use of cytostatics, shows good results in case of chemosensitive cancers like Hodgkin's disease, non - Hodgkin lymphoma, undiferrentiate embryonale neoplasms. In bone metastasis of breast cancer, chemotherapy allows to get up to 30% of positive answers. In other types of cancer metastasis, chemotherapy is not that effective and administrated only occasionally.
Application of radioisotopes is a rare method of treatment in Poland. The isotopes are selectively accumulated in bones and on account of affinity with phosphorus compound, they destroy metastasis cancer cells by radiation.
C. Local therapy
Radiotherapy and surgery are the local treatments. Radiotherapy of bone metastasis is considered as effective therapy and its administrated in pain distress, pathological fractures, in case of spinal cord compression and nerve roots. Prophylactic radiation of bones is applied in possible danger of pathological fractures as well as a prevention against neurological symptoms. The palliative effect is expected at up to 85% of patients.
Orthopedic equipment involves large scale of procedures; starting from preparation of a corset and ending on instalation of complicated implants that stabilize the bones. The main therapeutic indications are pathological fractures and instability of spine as a result of vertebras infiltration. In some instances, bone metastasis are removed by surgery. The treatment is effective only within 6-8 hours from the appearance of first symptoms.
D. Symptomatic treatment
The main aim of symptomatic treatment is palliation of symptoms, associated with bone cancer metastasis as well as hypercalcaemia. Main reason for symptomatic treatment is acute, constant pain and his negative effect on patients life. It is very important to follow the doctors instructions and to receive medications at right time, usually every 4 houres. The analgetics (pain killers) are administrated along with adjuvant drugs such as antiswelling drugs ( steroids ), antiemetic drugs, laxatives, tranquilizers and antidepresants. Narcotic analgesics are perfectly safe to use and drugs such as morphine or buprenophine do not cause drug dependence if used in correct doses.
Professional psychological advice and proper use of relaxing techniques could be great help in symptomatic treatment. Significant role in patients therapy are appropriate beds and antidecubital mattresses. This equipment allows for comfortable positioning of a patient and for performing prescribed physical rehabilitation, which is advisable in every stage of cancer.
What is the influence of bone cancer metastasis on daily life?
Bone cancer metastasis therapy is a long term treatment and often last until the end of life. Accepting own state of health is one of the main conditions for successful and effective therapy. Most common problem is the necessity of resignation from previous way of living, including the job. The change in way of living is often a powerful experience, especially for active people. For them the vision of living life in bed is difficult and sometimes impossible to accept. Resignation from the treatment and giving up to fight for own health and life, will not give back the previous state of health. One should try to enjoy every day, especially that we are not able to predict the course of illness. It is important to remember about appropriate nutrition, adequate fluids intake and if the organism permits to enjoy the favourite food.
The vital role of family and friends
The role of family and friends is difficult to overestimate. However, very often the help of family in patients care is insufficient and underestimated. A patient, surrounded by loving care of family, is more likely to accept the illness and better tolerates the treatment. Members of family are able to notice problems that the doctor is unaware of. But sometimes even the family need psychological support, in order to support the patient further. Over all, the help of family and friends in daily care of suffering patient cannot be replaced by anything.
Document summary
The appearance of bone cancer metastasis should not be always associated with the loss of hope to regain health. Appropriate care of oncological doctor, fast diagnosis and correct treatment - in many cases - elevate the chance of health improvement and even total cure. Important is not to overlook the first symptoms, that could indicate malignant lesions in bones. Our health should be in hands of specialists. And over all, we should take good care of our health, promote healthy life style (proper diet, no smoking, exercising etc.) in order to increase the chance of avoiding cancer.
Janusz Skowronek MD, PhD, Ass. Prof.
Janusz Skowronek MD, PhD, Ass. Prof.