Bone and rib metastases
People with cancer are very likely to develop metastases in the bones and ribs. Cancer cells break away from the primary focus and spread through the body by blood (hematogenous pathway) or lymph (lymphogenous pathway), attaching in a new place, they grow, forming metastases. Bone tissue is constantly renewed, thereby increasing the likelihood of secondary infection by the hematogenous route. Bones with the greatest blood supply are especially susceptible to infection, namely the spine, skull, ribs, as well as the pelvic, thigh, and humerus bones.
In the bone tissue, a continuous process of resorption and bone formation occurs due to the cells of osteoblasts and osteoclasts. The first ones form bone tissue, the second ones dissolve it. Getting into the bone marrow with the blood flow, cancer cells act on osteoclasts or osteoblasts, depending on the type of primary focus, and disrupt the interaction between them, and hence the normal development of bone tissue.
Bones perform important biological and mechanical functions in the human body:
1. Support (bones make up the frame for internal organs and soft tissues).
2. Protection of internal organs from damage.
3. Hematopoiesis (bone marrow is responsible for the production of red blood cells, white blood cells, platelets).
4. Maintaining the mineral composition of the body (store the supply of calcium, phosphorus, sodium and magnesium).
When osteoclasts are activated, the process of bone destruction is triggered, causing osteolytic metastases, which leads to thinning of bones and frequent fractures, even with minor loads. The activation of osteoblasts leads to osteoblastic metastases, and, as a consequence, to bone growth. There are also mixed secondary foci. The type of metastases is determined by the ratio of the activity of osteoplasts and osteoblasts.
Tumors with an undetected primary focus often metastasize in the bones. In most cases, secondary foci in the bone tissue are provoked by cancer of the prostate, breast, thyroid glands, lungs, kidneys, plasmacytoma (plasma cell cancer), melanoma (pigment cell cancer). Less commonly - cancer of the cervix, soft tissues, gastrointestinal tract, ovaries.
Bone metastases in the initial stages are asymptomatic, so all patients with primary foci should be carefully examined for secondary foci. The appearance of secondary symptoms in a person with an undetected primary focus indicates the neglect of the disease and brings the greatest suffering to cancer patients, since it may be accompanied by the following symptoms:
- bone pain (intraosseous pressure);
- frequent fractures;
- numbness of the limbs;
- problems with urination;
- limitation of activity;
- hypercalcemia (an increase in calcium in the blood), observed most often with osteolytic metastases, manifests itself as a violation of the heart rhythm, general and muscle weakness, constipation, nausea, vomiting, depression, decreased pressure, mental disorders,
- myelophthisis (violation of the process of hematopoiesis);
- swelling;
- compression of the spinal cord (constant increasing back pain, neurological deficit).
Cancer patients should be especially attentive to the above symptoms and promptly report them to the doctor, which will help to preserve the patient's quality of life, increase his survival rate and prevent the spread of secondary foci. The frequency of complications depends on the intensity of treatment, as well as on whether the primary focus is identified and what is the nature of the neoplasms. Patients with secondary bone lesions have an average of four complications per year.
When diagnosing bone metastases, the most complete and detailed information is provided by scintigraphy - radionucleide diagnostics, which makes it possible to recognize foci anywhere in the skeleton, even at the earliest stages. This fact significantly increases the patient's chances of recovery. In addition, this method is completely painless and harmless to humans. Examination of the entire skeleton takes about 50 minutes. Of the contraindications, only pregnancy, and then in some cases exceptions are allowed.
Often, additional examinations and analyzes are required to obtain a more complete clinical picture, determine an accurate diagnosis and prescribe the optimal treatment:
· Radiography does not give good results. Tumors up to 1 cm in diameter are practically invisible, only mature neoplasms are visible;
· Computed tomography can detect only osteolytic foci;
· Magnetic resonance imaging does not require instrumental intervention, does not expose the patient to radiation;
· Laboratory tests determine the level of alkaline phosphatase and calcium in the blood, examine bone tumor markers;
· Blood test.
Treatment depends on the nature of the primary focus, if identified, and on the symptoms. The methods can be divided into three groups: radiation therapy, drug treatment, and surgery. Usually a combination of methods is used simultaneously or sequentially. Not all bone metastases can be cured; in some cases, only palliative treatment is appropriate to help smooth the symptoms and morally support a person.
Bisphosphonates, also called bisphosphonates or diphosphonates, are highly effective in drug treatment. This is a class of drugs that interfere with the resorption process, which means the development of hypercalcemia. They also reduce pain, prevent fractures, and have an anti-tumor effect. They only act on osteoclasts, without harming other cells.
Bisphosphonates are easily tolerated by patients, since they have practically no side effects. Sometimes flu-like symptoms, shortness of breath, weakness may appear. But they are quickly stopped without medication. They can be combined with radiation and chemotherapy, since they do not increase toxicity. The ability of bisphosphonates to reduce the incidence of secondary foci in breast cancer and myeloma has also been noted.
Among other things, traditional methods are widely used in the treatment of bone metastases:
· Chemotherapy is effective, but has a large list of side effects;
· Radiation therapy is appropriate for non-widespread foci, requires careful calculation of the radiation dose;
· Hormone therapy;
· Immunotherapy is aimed at maintaining your own immune system;
· Palliative care;
· Surgical intervention.
For the success of treatment, it is important to listen to your body, independently study the possible symptoms of complications and inform your doctor about them in a timely manner, since no one can feel the changes taking place in your body better than you.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
