About Metastatic Bone Disease
There are two types of bone cancer – primary and secondary, also known as metastatic. The most frequently occurring of the two is metastatic bone disease (MDB), which is cancer that has spread to the bone from a primary site. Approximately 1.2 million cases of new cancer are diagnosed each year in the United States with total cases numbering more than five million. Many of these cancers end up spreading to the bone with an estimated prevalence of 500,000 metastatic bone cases at any given time and 170,000 new cases each year.
Earlier detection and improved treatments from bone cancer specialists like Dr. Daniel C. Allison are helping patients with metastatic bone disease to live longer than ever. Los Angeles’s Dr. Allison is a recognized leader in orthopedic oncology, and limb preservation. He treats patients for all benign and malignant problems of the musculoskeletal system, including soft tissue and primary sarcomas of the bone, metastatic bone cancer, and invasive skin cancers of the pelvis, shoulder girdle, back, and extremities.
If you or a loved one is suffering from metastatic bone cancer, call (310) 730-8008 to learn more and schedule an appointment today.
Systems & Diagnosis
People often do not experience any signs or symptoms of bone cancer, however, when they do occur, symptoms can cause:
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- Bone pain
- Broken bones
- Leg or arm weakness
- Urinary incontinence
- Bowl incontinence
Additionally, high levels of calcium in the blood can induce nausea, vomiting, constipation and confusion.
Keeping in mind these signs and symptoms of bone cancer could indicate another health condition, you should consult with your doctor to discuss your concerns and schedule an examination. Consider meeting with an expert like Dr. Allison, located in Los Angeles, CA, who specializes in this type of cancer and knows the best diagnostic methods for an accurate diagnosis. Especially for individuals who had cancer in the past, you want to discuss your medical history and symptoms with a specialist experienced in metastatic cancers and their characteristics.
If MBD is suspected, a surgical biopsy is standard practice to confirm the diagnosis; however, in cases of a known history of cancer combined with symptoms of metastatic disease, your medical history, physical exam and imaging may be sufficiently conclusive. Otherwise, bone cancer diagnostics could be performed including MRI of the entire bone, chest x-ray, CT scan of the chest, abdomen, pelvis, bone scan, and labs (CBC, PSA, ESR, CRP, Alk Phos, Ca, LDH, SPEP, UPEP, UA).
Overview
Most cancer types are capable of spreading from a primary site to the bones. Some of the more common types that are known to spread include lung, breast, prostate, kidney and thyroid cancers. Though bone metastasis can occur in any bone, it frequently appears in the spine, pelvis and thigh. Some individuals may not know they have cancer until the disease metastasizes to bone or perhaps metastasis doesn’t occur until years after primary cancer treatment.
Though technically there is no cure for metastatic bone disease, patients are moving toward a situation of living with bone cancer rather than dying from it. Indeed, in a study recently published from our institution, more than half of our patients with metastatic bone cancer to the proximal femur were alive after one year from initial surgery, and over 10% were still alive after 5 years [Harvey et al.]
Treatment
Treatment of metastatic bone disease is aimed toward alleviating pain, restoring function, and preventing disability. Though there is no cure for metastatic bone cancer yet, current advanced diagnostic and treatment regimens extend life – in some cases fulfilling a patient’s normal life span. The attitude has changed to living with disease rather than dying from it.
Treatment should be performed with potential longevity in mind, and may include chemotherapy, surgery, and radiation – either alone or in combination.
Radiation
Radiation therapy is a relatively non-invasive, effective means to treat metastatic cancers. Areas that are painful or symptomatic can sometimes be controlled with radiation alone. Areas that have been treated surgically are also usually supplemented with radiation. Doses are usually lower than doses for other primary tumors and side effects are less severe.
Chemotherapy
Chemotherapy is considered a “systemic” treatment, meaning it reaches throughout the entire body, in contrast to surgery or radiation, which treat only one location. Since metastatic bone disease is a systemic process, systemic chemotherapy is therefore an important supplementary treatment. Chemotherapy may range from intravenous cytotoxic therapy with notable side effects to oral, non-toxic therapy with minimal side effects.
Surgery
Surgery for MBD usually aims to prevent or treat fracture. Sometimes painful lesions not responsive to chemotherapy or radiation may be treated surgically. If metastasis is limited to only one location, surgery could be more aggressive with curative intent. Surgery often involves careful, conservative removal of the tumor with preservation of normal tissues with additional “adjuvant” therapies like cryoablation (freezing of tissue), cementation (with cement heating to temperatures that also kill surrounding cells), and postoperative radiation.