Bone metastases is a severe pathology that accompanies cancer diagnoses. This mainly occurs in the last, most severe - grade 4 cancer. Neoplasms are characterized by the penetration of cancer-affected cells into the bone tissue, which enter it through lymph flows or blood.

Considered a secondary focus of a malignant tumor disease, metastases appear in every three out of four cases of oncology diagnosed. Very often, the pathology is a rather dense, large-sized formation. Up to 80% of this complication - against the background of breast cancer in women and prostate- in men.

Depending on the anatomical nature and specificity of tumor cells, in oncological practice there are two main types of them, which are extremely rare in the pure type, mainly showing their hybrid forms:

• osteoplastic- are characterized by dense bone malignant neoplasms;
• osteolytic- large tumors are absent, a rapid destruction of the structure of the bone tissue occurs.

Most often, metastases affect bones that are supplied with a large number of blood vessels – costal, humeral, large and small pelvis, external cranial... At the initial stage, they behave covertly, however, in the process of reproduction of the affected cells, a severe pain relapse occurs.

Signs

As noted, metastasis initially behaves incubation, remains secretive and does not cause discomfort - as a rule, a person is not even aware of his existence. However, over time, rather clear Clinical signs and symptoms.

Most often, the following testifies to the fact that the body is affected by metastases their manifestations:

• fractures;
• intoxication;
• compression;
• pain syndrome;
• hypercalcemia.

Fractures. Wear pathological character... It manifests itself in a sharp decrease in the hardness of the bone material - often even minimal mechanical or physical stress is enough - and the tissue breaks.

With advanced forms of pathology, when a large focus of tissue is affected by metastases, it happens inhaling too deeply or sneezing is enough to break, for example, a rib. And when a sharp turn of the body or too low an inclination - the skeletal pelvic part becomes vulnerable.

The main reason leading to this symptomatology is the leaching of the most important bone material, which is responsible for their strength, biophosphate, as the neoplasms multiply.

Intoxication. A very common syndrome. It appears as general weakness, loss of interest in food, and as a result: a critical decrease in body weight, nausea, depression and apathy to what is happening - up to a complete loss of interest in life. This is a non-specific manifestation any type of cancer, which rapidly increases in the process of metastatic lesions.

Compression. Tumors that arise in hard tissue are very dense and hard in composition, capable of exerting significant pressure on the blood vascular system and nerve fibers.

The most critical consequences can be caused by compression squeezing nerve endings spinal cord ... It threatens a cancer patient common defeat nervous system, and, as a result - complete or partial paralysis of the body.

At the initial stage, the symptom manifests itself in limb dysfunction... As the disease progresses, the degree of immobility increases.

Pain. This syndrome is the most common and most difficult to tolerate by the patient. Painful sensations are capable of delivering severe torment and are poorly subject to correction with painkillers.

The syndrome grows, reaching its peak at night and after even minimal physical activity in the area of ​​the lesion. Capable of especially clinical forms its manifestations bring a sick person to suicide.

Hypercalcemia. In medical terminology, means an increase in the percentage calcium components in the patient's blood due to abnormal resorption of hard bone tissue.

Accompanied by intense thirst, dry mucous membranes oral cavity, a tendency to frequent and profuse urination, sudden manifestations of nausea and severe vomiting, slowness of reaction, and periodic violations of the conscious perception of reality.

The most difficult complication that poses a serious threat to human life, since in the shortest possible time it can lead to complete dysfunction of major organs and systems vital functions of the body - heart failure, general dehydration, kidney disease.

Along with the listed symptoms, there may be the following manifestations diseases:

• skin changes;
• ulcerative formations;
• osteochondrosis;
• manifestations of arthritis;
• rheumatism not previously diagnosed.

People with metastases in the bones should be extremely careful about all manifestations of the disease, without exception - this may become the first alarm signal that the doctor must necessarily learn about. After the examination, he will determine how severe the pathology is, and how to deal with it.

Causes and development of the disease

Almost every case of oncology is associated with metastasis, but not all bones of the human skeleton are equally susceptible to this pathology. What is the risk group?

Let's dwell on main types of bones and their tendencies and this process:

• hands and feet, feet, ribs, skull- are carriers of pathology only in situations where the disease is of a focal malignant nature;
• spine- with breast tumors;
• pelvic part- if the oncological process is close to it;
• femoral- due to its impressive size, it very often becomes a focus of the disease.

As a rule, the following diagnoses become the cause of bone metastasis:

• cutaneous superficial melanomas;
• lung cancer and oncology respiratory tract - the most common cause of hard tissue lesions - they grow into the spine;
• swelling of the prostate- slowly kill the femur, lumbar region and the thoracic spine;
• lymph node cancer- threatened by lower limbs, radial and ulnar hard tissues;
• kidney oncology- affects the spinal cord;
• education in thyroid glands s- affects the bones of the limbs.

Diagnostics

It is very important to correctly diagnose a type of bone metastasis - this allows you to somehow control the processes of damage and destruction of tissues.

The following diagnostic methods are used:

• neurological examination- the specificity of the disease is determined, its clinical features and manifestations. On examination, it is taken into account that signs of metastasis can appear both at the same time with the development of oncology, and much later, in addition, the absence of a neoplasm is not a reason for their exclusion;
• scintigraphy- one of the methods of radiation determination of the presence of the disease. Radio preparations enter the body and on the basis of the isotope pattern - radiation, I diagnose the disease;
• radiography- a method proven by practice and time, but for early stages may not reveal pathology;
• CT, MRI bone- indicated for the diagnosis of the spinal cord and brain;
• Blood chemistry- a very accurate method, it shows an objective clinical picture of the development of the disease. Determines the degree of damage, the internal structure of cancer cells.

Treatment

The following methods of treating bone metastases are practiced:

• elective surgery- justified when the process of defeat is not too started. It is used in combination with other types of treatment;
• emergency intervention for spinal cord compression- a very dangerous form, any therapy, except for an operation, is powerless in this situation. The main task of the surgeon is to react as quickly as possible to the growth of pathological disorders. There is little time allotted, and any delay can cost the patient his life;
• radiation therapy- used by the course for 2-3 weeks. The principle of operation is based on the susceptibility of cancer cells to the effects of radio beams. As for this problem, the method is not always effective;
• chemotherapy- inhibits further growth and spread of pathology. Works well for stages 1 - 2 of the disease;
• anesthesia- accompanying the main treatment, method. Mainly used are non-steroids and potent narcotic substances, which, when used systematically, cause dependence and reduce the effectiveness of the action.

Forecast

Bone metastases due to cancer kidneys, if treatment is not carried out, they give the person the opportunity to live about a year due to cancer thyroid - near 3-4 years, at melanoma – several months.

If you turn to a specialist in time to start therapy, the chance to live a full life is undoubtedly greater. With the correct treatment, the patients adhere to all recommendations, it is possible not only to cope with the disease, but also to return to a full life.

06.04.2017

They arise against the background of a secondary focus of malignant tumor formation in bone tissues.

Tumor cells spread from the primary foci of neoplasm of other organs.

The disease manifests itself painful sensations, the level of calcium in the blood plasma rises, the bones become brittle. In most situations, when diagnosing a disease, doctors find a dense neoplasm.

The tumor presses on large vessels, while they are closely adjacent to each other, and as a result, blood circulation is impaired. If the tumor compresses the nerve trunks, then neurological symptoms are observed. The diagnosis is made on the basis of the history of the disease, external examination, laboratory and instrumental research.

First, bone tissue is affected due to the rapid distribution of cancer cells along circulatory system and lymph nodes. As a rule, the presence of metastases is already the last stage in the development of a malignant neoplasm. 85% of metastases are a sign of stage 4 breast and prostate cancer.

They appear as a result of malignant neoplasms in the thyroid gland, kidneys, sarcoma, lymphogranulomatosis. Rarely enough, bone metastasis is diagnosed with tumors of the ovaries, cervix, soft tissues, gastrointestinal tract.

Patients diagnosed with bone metastases are treated by oncologists and an orthopedic traumatologist.

Bone metastases and their types

Malignant neoplasm starts metastases in two forms, and it is according to them that the appropriate treatment is determined.

1. Osteolytic form. Tumor cells cells damage the bone and its tissues, and over time it is completely destroyed. There is a stimulation of osteoclasts, cells that completely destroy the structure of the bone.
2. Osteoplastic form. Tumor cells stimulate osteoblasts. They lead to rapid bone growth. Because of this, the tissue is destroyed, and the bone itself begins to move to the side (bulge).

Etiology

Metastasis in bone tissue begins as a result of cancer of the lungs, kidneys, breast, prostate, as well as as a result of a malignant neoplasm in the ovary, gastrointestinal tract, lymph nodes and sarcoma.

Other cancers develop stage 4 metastases, but this is less common.

When a person is completely healthy and there are no violations in the body, the bone tissue is periodically renewed.

Bone tissue has its own characteristics and processes:

• resolves as a result of exposure to osteoclasts;
• after the destruction of bone tissue, bone is formed to keep the skeleton in balance;
• bone formation.

These processes are carried out by cellular activity, which involves osteoblasts and osteoclasts. It is they who are responsible for how bone tissue is formed, absorbed and destroyed.

The bone begins to malfunction if the wrong cells penetrate into its structure, displacing healthy ones. Because of this, osteoblasts and osteoclasts stop interacting with each other.

Symptoms

Like all cancers, bone metastases have their own symptoms:

• Bones ache. This is one of the most common and dire symptoms. The most acute pain begins when the process of damage to bone tissue begins, sometimes it becomes unbearably painful. Sometimes pain pills don't help. The pain syndrome is growing. becomes stronger at night and after exertion. There were cases when the patient could not cope with the pain and laid hands on himself.
• Compression. Bone neoplasm has a dense structure and when it begins to increase in size, the vessels and nerve trunks are compressed. The situation worsens - compression of the spinal roots or spinal cord. Then the patient has a dysfunction of the nervous system, sometimes transverse paralysis occurs.
• Local changes. Seals of a dense focus appear on the affected areas.
• Pathological fracture. If the bone is slightly loaded, then it begins to collapse. A rib may break if you sneeze. The symptom of such fractures is manifested due to 60% of the erosion of the upper layers. The spine is often affected, less often the femur. Fracture spinal occurs as a result of the violation of the integrity of some parts of the spine. Basically, the sections of the sternum and lower back are affected. Squeezing is also noticed nerve root and the spinal cord. The smallest injury (impact or sharp turn) can result from these fractures.
• Increased blood calcium levels. Hypercalcemia occurs due to the destruction of bone tissue. This complication is considered the most dangerous and, in some cases, is fatal. Elevated level calcium can cause irregular heartbeats, dehydration, and kidney failure.
• Intoxication. Appetite decreases, weakness, nausea appear, the patient loses weight, which further leads to anorexia.

Due to these phenomena, in patients with metastasis, dysfunction of organs and systems is noticed:

• Nervous system - the patient becomes inhibited, psycho-emotional disorder, consciousness is impaired;
• Cardiovascular system - low blood pressure, heart rate slows down, which can lead to complete cardiac arrest;
• Kidneys - salt and calcium are deposited in the tissues of the kidneys, the volume of urine increases;
• Gastrointestinal tract - regular constipation, nausea, accompanied with gag reflexes, regular constipation, loss of appetite, intestinal obstruction, pancreas becomes inflamed.

Methods for the diagnosis of bone metastases

• To diagnose metastases in bone tissues, specialists carry out:
• Radiography. This is a simple form of diagnosis. With the help of X-rays, it is possible to accurately determine the diagnosis only at the third and fourth stages of the development of oncology, since in the first stages, the oncological disease does not start metastases.
• Computed tomography. The obtained results of the X-ray image are processed using digital devices. After treatment, the doctor will see the degree of tissue destruction and the boundaries of its erosion.
• Magnetic resonance imaging. This method is carried out by irradiation. For irradiation, a radiological wave is used. Tomography determines the volume of the affected areas in the bone tissue.
• Scintigraphy. Determine how much the radioactive isotope is filled with tumor cells. Scintigraphy allows you to pinpoint the location of metastases.
• Biopsy. This research technique is the most accurate of all to make a diagnosis, since it determines the belonging of bone tissues to certain types. To take material for biopsy examination, the patient is injected local anesthesia... The material is sent to study the functionality of cells and the structure of tissues.
• Biochemistry blood test. The analysis will determine the excess calcium in the circulatory system.

How are bone metastases treated?

After the diagnosis has been made - bone metastases, the treatment begins immediately. With this diagnosis, the patient dies within 4 to 10 months.

But this does not mean that there is no need to treat the disease.

1. Surgical treatment. this type of therapy is used to ensure that the patient lives a little more normal life. Pathological fractures are treated, thin bones are fixed, and more.
2. Radiation therapy. If the focus of a malignant tumor is irradiated, the patient will be able to live longer. This method of treatment is effective because the tumor cell is more sensitive to radiation than bone tissue.
3. Chemotherapy. Anticancer drugs are given intravenously and kill tumor cells. Cytostatics are highly toxic, because of this, there are many side effects.

All of these treatments are used in combination.

Concomitant treatment

• eliminate pain in bone metastases. This is the most important goal of therapy. Doctors on the means drugs that relieve pain, fever and inflammation, and morphine is also prescribed.Some countries allow marijuana to be used at the last stage of cancer development. As you know, it relaxes the patient and relieves pain.

• drugs that reduce the risk of pathological fractures and prevent complete erosion of bones.Patients ask themselves: “how can bone metastases be treated? folk methods? ”. The answer to this is categorical -treatment with folk remedies is strictly prohibited. None of folk remedies will not help you get rid of the malignant tumor, but will only aggravate the situation. The treatment is exclusively carried out by an oncologist.

Purpose of treatment

Front complex therapy there are four main goals:

1. Reduce pain syndrome.
2. destroy tumor cells and prevent them from multiplying.
3. Rid the body of toxic substances.
4. Treat concomitant diseases.

Treatment of metastases necessarily includes a set of measures to remove the primary foci of a malignant tumor.

Prognosis for bone metastases

The prognosis directly depends on where the primary focus of the malignant tumor is.

1. If bone metastases are the result of a lung tumor, then the patient is predicted to live no more than six months.
2. The result of a prostate malignant neoplasm, the patient will manage to live up to three years.
3. When bone metastases are the result of breast cancer, the prognosis is 2 years.
4. A patient with metastases of a renal tumor will live for one year.
5. Melanoma with bone metastases gives the patient six months to live.
6. Thyroid cancer that has metastasized to the bone tissue is the most benign. Patients live for four years.

Treatment and prevention of bone metastases is a difficult and long process. If diagnosed in time, it is possible to give the patient a chance for life.

Bone metastasis is a severe cancer complication with severe pain symptoms, which means the cancer progresses to stages 3 and 4. The prognosis of treatment and life expectancy are significantly reduced, how long they live with bone metastases depends on the therapy used and the aggressiveness of the primary focus

The process of metastasis is a terrible complication that always occurs with cancer, if the disease is not detected in time and its treatment is not started. Usually metastases form in soft tissues, organs, but sometimes bones are also affected. Metastasis in bone structures should be considered as another episode of cancer, when abnormal cells from the primary tumor, moving through the body, are deposited in the elements of the skeleton.

Bone metastases appear at the later stages of the development of pathology, in 4 out of five cases, primary tumors are breast cancer for women and prostate cancer for men... This situation does not have a good prognosis, the patient suffers from symptoms of severe pain, weakened bones break even with a slight impact. Primary cancer of the kidneys and thyroid gland, leads to metastasis in the structures of the skull.

Causes

In addition to the listed types of cancer, metastases to bone tissues are affected by malignant tumors. lungs, kidneys, ovaries in women, sarcoma, lymphoma and lesions of the gastrointestinal tract... In severe cases, there is a migration of atypical cells from other organs affected by the disease.

Photo 1. Destruction of bone tissue by metastasis

The appearance of severe signs and symptoms of the disease is associated with a violation of the constant renewal of bone tissue, which exists in healthy person... Normal cellular interaction, the elements of which are resorption, remodeling and bone formation, is impaired, since osteoblasts and osteoclasts responsible for this functionality are blocked by cancer. As a result, in the bone is observed crowding out healthy and useful tissues, which are replaced by metastasis.

Mammary cancer common reason bone metastasis. With this female disease malignant structures, through lymphogenous or hematogenous movement, move and accumulate in the bones, mainly the pelvis and chest.

The course of the disease is accompanied by intense pain, which is contributed by regular fractures. This usually means grade 4 cancer, which has a short life expectancy and survival.

Types of bone metastases

Based on the type of oncology activation, there are several types of them:

• Osteoplastic call the situation of the formation of dense areas embedded in the bone.
• TO osteolytic include the process of destruction of bone tissue.

Any case of the disease is a combination of the two indicated pathological processes. Most often, metastases occur in bones that are actively nourished by blood, they are formed in:

1. Shoulder area
2. Ribs
3. Skull, elements of the spine

In the early stages of education, they do not have any signs, later symptoms of pain and other manifestations appear.

Symptoms of bone metastases

The early degree of metastasis is asymptomatic, but as it grows, the effect of oncology on the bone becomes more pronounced, and the first signs appear:

• Hypercalcemia... This is the name of the consequence of bone metastases, which occurs in more than a third of patients. Pathology causes increased activity of osteoclasts, due to which the calcium in the blood rises sharply. This leads to increased stress on the kidneys, which threatens with impaired reabsorption and excessive urine output.
• Pathological fractures.
• Spinal compression with a tumor in the spine.

As a result of hypercalcemia and clamping of the spinal canals, a person develops the following symptoms:

1. From the side nervous system A cancer patient with bone metastases suffers from lethargy, unbalanced psyche, confusion, and affective disorders.
2. Heart and blood vessels begin to malfunction, which ends with arrhythmia, low blood pressure, low heart rate. All this borders on heart failure and instant death.
3. Probably renal failure due to the intense load on them
4. Gastrointestinal tract suffers from a disorder, the patient is often nauseous, lack of appetite, constipation leads to intestinal obstruction, etc.

In conditions when bone metastases destroy more than 50% of the cortical layer, the probability of fractures... This affects the bones of the spinal column in the lower back or thoracic region and the thigh. A slight excess of the load ends in bone fractures and symptoms of severe pain.

Due to metastases in the bones, they become so weak that they often break down by themselves. At the same time, due to the relative displacement at the site of the fracture, the functionality of the limb or bone element is completely lost. Not having time to grow together, another scrapping occurs, and so on. As a result, the person is practically immobilized and is threatened with disability with the need for constant pain relief.

Further growth of a malignant tumor leads to squeezing of the soft tissues adjacent to the broken bones. This threatens with constant severe pain, muscle weakness, impaired sensitivity. Life expectancy with such complications is very short, the terminal stage leads to paralysis and failure of the pelvic organs.

In such conditions, life with bone metastases becomes a serious challenge. There is no longer any talk of cure, the task of physicians is to improve the conditions of existence.

With metastasis of the bones of the spine, there is a risk spinal clamp... Often this phenomenon is observed when localized in the thoracic part of the spinal column. Symptoms develop sequentially as the pressure on the spinal cord increases, passing through a special spinal canal. A sharp appearance of signs occurs with a fracture of the vertebral element.

If you notice and begin to treat spinal compression in time, then its consequences are reversible; in the later stages, the signs of paralysis will become more and more obvious, despite treatment.

Statistics say that only every tenth cancer patient is able to move independently after the development of paralysis.

Diagnostics

Reliable and informative diagnosis of bone metastasis is possible with the help of skeletal scintigraphy... The method allows you to understand how widespread education is, and to what extent it is.

This procedure finds metastases in any bones of the human body and limbs. Even the initial stages of the disease, when the symptoms have not yet been manifested, are effectively detected. The result of treatment at this stage will be a significant improvement in prognosis and life expectancy.

Photo 2. View of the pelvic bones on x-ray

A more accessible and non-contact method is x-ray... However, it reveals only a mature secondary metastasis, when a significant amount of bone has already been destroyed. The advantage of radiology is the ability to differentiate a secondary neoplasm, based on its type. A different color of spots in the photo will indicate their different nature.

At later stages of diagnosis, to clarify the diagnosis and method of treatment, the following are used:

1. Radioisotope diagnostics
2. Osteoscintigraphy
3. Urine and blood tests

If a tumor is found in the skull, additional examinations are carried out to exclude damage to neighboring organs.

Treatment

What and how to treat bone metastases will depend on the localization of the pathology, the degree of its development and the parameters of the original cancer. Let's list the main methods of treatment:

• Operations are used in the framework of palliative care, when it is impossible to improve the prognosis of recovery and the patient is already incurable, but it is necessary to prolong life as much as possible and improve its quality. Thanks to the surgical removal of tumors, it is possible to reduce the compression of the nerve endings of the spinal cord, and to reduce the likelihood of bone fractures. All this significantly reduces the pain syndrome and partially returns the lost anatomical functionality.
• Application radiation and chemotherapy used to prepare the patient for surgery, or after it, as well as self-treatment... By chemical or radiation destruction of cancer cells, it is possible to stop the growth of bone metastases.
• Reception bisphosphonates... These are special drugs that inhibit the destruction of bone tissue.
• For some types of cancer, it is effective to use radiopharmaceuticals.
• Revitalization immune system allows you to extend the life span of a person. By activating its own forces, the body better begins to fight against malignant spread, helping external radiation from the inside.

Bisphosphonate drugs

This is the name of drugs that protect bone structures from destruction. They are indicated in osteoclastic pathology to compensate for the harmful effects of metastases.

Due to the absorption of basphosphonate in the place where metastasis occurred, negative activity slows down or stops altogether. In addition, the drug inhibits the production of osteoclasts, which quickly die or self-destruct. The mechanics of action consists in the accumulation of the active substance around the formation. When gaining the necessary mass, a positive effect begins to suppress the destructive function.

There are two types of bisphosphonates. The former consist of nitrogenous compounds and are more effective against bone metastases. The second group is devoid of such compounds and treatment with it is less effective. What exactly to appoint will depend on the patient's financial capabilities and the stage of development of the neoplasm.

Forecast and life expectancy

How long patients with bone metastasis live exactly is impossible. You can roughly do this by looking at the medical history. To accurately predict survival, the doctor needs to analyze a lot of information about metastasis and other cancers.

Here are the numbers how many live people with bone metastases, depending on the primary oncology:

1. Metastasis of lung cancer and melanoma gives a life expectancy of about 6 months.
2. Prostate - 1-3 years
3. Breast cancer - 18-24 months
4. Kidneys with bone metastasis give a person up to 12 months of life
5. The best prognosis for malignant thyroid disease. With the complications considered in the article, people live up to 4 years.

One of the complications cancer is that may spread to soft tissue and distant organs.

Metastasis also occurs in the bones. In fact, bone metastases are secondary cancerous tumors of bone tissue, formed as a result of the transfer of atypical cells from the main focus with blood and lymph flow.

Usually, bone metastases occur already at the last stages of oncopathology. Moreover, about 80% of cases of bone metastasis occurs against the background of and. Such formations are manifested by severe pain, frequent fractures and hypercalcemia.

Causes of occurrence

Most often, metastasis to bone structures occurs with and, prostatic and breast cancer, malignant formations in and gastrointestinal structures, and.

They metastasize to bone tissue and other malignant neoplasms, only much less frequently.

When a person is healthy, his bone tissues are constantly renewed. In general, bone structures are characterized by the processes of resorption, remodeling and bone formation. These processes are carried out due to the cellular activity of osteoblasts and osteoclasts. These cellular structures are responsible for the formation, absorption and destruction of bone tissue.

If atypical cells penetrate into the bone structures, then bone dysfunction occurs. Healthy cells are displaced, the processes of interaction of osteoblasts with osteoclasts are disrupted, which leads to dissociation of their activities.

For breast cancer

Metastasis to bone structures in breast cancer occurs in a lymphogenous and hematogenous way. Such localization of metastases in breast cancer is quite common.

Cancer with such metastases is characterized by severe pain and an excessive tendency to pathological fractures, especially in chest and pelvic bones.

Types

Depending on the type of cell activation, oncologists distinguish several types of bone metastases:

1. Osteoplastic- accompanied by the formation of seals on the bones;
2. Osteolytic- when there is a predominant destruction of bone structures.

Pure types in medical practice are relatively rare, their mixed forms are much more common.

Bones with a rich blood supply are most susceptible to metastasis, i.e., in the humerus and femurs, ribs and vertebrates, cranial and pelvic bones. At first, bone metastases do not manifest themselves in any way, but over time they become the cause of intense pain, which is associated with the stimulation of periosteal pain receptors.

Symptoms of bone metastases

At first, secondary bone tumors develop asymptomatically, but with the development of the tumor process, a definite clinical picture is formed:

• The presence of hypercalcemia;
• Tendency to pathological fractures;
• The presence of spinal compression.

Hypercalcemia is a life-threatening complication that is found in about 30-40% of cancer patients with bone metastasis.

A similar condition occurs due to the excessive activity of osteoclasts, leading to an increase in the level of calcium in the blood, which in turn causes a pathological increase in renal excretory abilities.

As a result, in cancer patients with metastatic foci in the bones, in addition to hypercalcemia, hypercalciuria develops, the reabsorption of fluid and sodium is impaired, leading to polyuria.

As a result of such changes in cancer patients, the activity of many systems and organs is disrupted:

1. In the nervous system activity, there are signs such as lethargy and mental disorders, confusion and disorders of an affective nature;
2. In cardiovascular activity, there are deviations such as arrhythmias and low blood pressure, a decrease in heart rate, while the risk of cardiac arrest is high.
3. The kidneys are affected by nephrocalcinosis and polyuria;
4. In the gastrointestinal area, nausea-vomiting syndrome, frequent constipation and lack of appetite are observed, or pancreatitis may develop.

If during bone metastasis more than half of the cortical layer is destroyed, then pathological fractures appear. They are usually found in the bones of the spine (lumbar or thoracic region) and femurs. A fracture can occur even in minor traumatic situations such as an awkward turn or weak hit.

Often, these fractures appear without visible external cause... With a pathological fracture, displacement of bone fragments can occur, which leads to functional impairment extremities (if the fracture is localized on the long tubular bone) and neurological disorders (if the fracture is localized on the vertebral structures), which significantly impairs the quality of life of the patient.

Growing tumors and debris can compress adjacent tissues.

With tumor compression, the oncopatient develops increasing pains, worries about the weakness of muscle tissues, signs of impaired sensitivity appear, and at the terminal stages, dysfunctions of the pelvic organs and paralysis occur.

If metastasis is observed in vertebral tissues, then spinal compression sometimes occurs in cancer patients. Usually, a similar phenomenon occurs with metastasis to the thoracic vertebrae. Compression disorders can develop gradually (if the metastasis is compressed) or acutely (when compressed by a bone or a fragment of it).

Compression symptoms appear suddenly. If such a sign is identified at its initial stage, then its reversibility (at least partial) is quite possible. If you do not act during compression, then the paralysis becomes irreversible.

With timely therapeutic assistance, specialists manage to achieve a significant reduction in symptoms, although only 10% of cancer patients with paralysis can move independently after treatment.

How to identify bone metastases?

The most informative diagnostic method for detecting bone metastases is skeletal, which allows you to accurately determine the prevalence and degree of metastasis.

A similar procedure is able to find metastatic formations in any part of the human skeleton. Moreover, the identification of the spread of tumor cells is possible at the very initial stages, when obvious violations in the bone structures are just beginning.

With the help of X-ray examination, bone metastasis can be detected only at the stage of sufficient maturity of the secondary formation, when about half of the bone mass has already been destroyed.

Photo of metastases in the hip bones on x-ray

But on the other hand, such a diagnosis makes it possible to differentiate a specific type of metastatic formation. Light white spots indicate blastic metastases, and gray-white spots indicate a lytic type of metastases.

Radioisotope diagnostics or bone scintigraphy is performed using the radiopharmaceutical Rezoscan, which is administered to a cancer patient about a couple of hours before scanning.

Also, diagnostics can include either MRI, identification of resorption markers in urine, blood tests, etc. If metastasis is detected in the cranial bones, then oncologists recommend a thorough examination of all organs to exclude the likelihood of their damage.

Are they treated?

Metastasis to the cranial bones is observed mainly with renal or thyroid cancer, and their treatment can be carried out by a variety of methods:

• Surgical interventions are performed with palliative therapy and are necessary for all sorts of complications (compression, fractures, etc.). After the operation, elimination occurs pain syndrome, bone marrow or limb functions are restored, etc.
• and for bone metastasis it is used in complex conservative treatment, as well as in the preoperative or postoperative period... These techniques allow you to destroy cancer cells and prevent their growth.
• Treatment with bisphosphonates. These medications slow down the processes of disorders in bone structures.
• When administered, radiopharmaceuticals lead to the destruction of active cancer cells.
• involves the use of special means to increase the body's resistance, so that the immune system resists the spread of the tumor throughout the body.

Video about drugs for the treatment of bone metastases:

Treatment with bisphosphonate drugs

Bisphosphonates are medications that prevent bone loss. They are intended to suppress osteoclastic activity and to prevent bone destruction.

At the site of secondary tumor growth, the absorption of bisphosphonates by osteoclast cells occurs, as a result of which they slow down or stop their activity. In addition, the use of bisphosphonates prevents the synthesis of osteoclasts, which become early dying or self-destructing.

Bisphosphonates are classified into 2 groups. One group of drugs contains nitrogenous compounds and is more effective against metastatic tumors. These include drugs like Ibandronate, Alendronate, Pamidronate, etc. Another group does not contain nitrogen, for example, Clodronate, Tidronate, etc. These drugs have less therapeutic effect.

Preparations of the bisphosphonate group penetrate into the bone mass, accumulate around osteoclasts and begin to suppress them, which leads to a decrease in the destructive activity of these cells. As a result, the processes of bone destruction are suspended.

Forecast and life expectancy

The final prognosis depends on the location of the primary cancer.

1. If bone metastases are formed from lung cancer, then the patient will live for about six months.
2. If the primary focus is located in the prostate, then life expectancy will be on the order of 1-3 years.
3. If a breast cancer has become the source of metastasis to the bone structures, then the life expectancy will be approximately 1.5-2 years.
4. Renal cancer with bone metastases leaves a patient with about a year of life.
5. With bone metastasis, life expectancy will not exceed six months.
6. When it spreads into bone tissue, life expectancy will be about 4 years.

Bone metastasis is extremely dangerous. If it is detected in a timely manner, then the probability of saving the patient's life is high.

People with cancer are very likely to develop metastases in the bones and ribs. Cancer cells break away from the primary focus and spread throughout 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, femur, and humerus bones.

In the bone tissue, there is a continuous process of resorption and bone formation due to the cells of osteoblasts and osteoclasts. The former form bone tissue, the latter dissolve it. Getting into the bloodstream Bone marrow, cancer cells affect 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 a 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, leukocytes, platelets).

4. Maintaining the mineral composition of the body (store a 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 bone tissue are provoked by cancer of the prostate, breast, thyroid glands, lungs, kidney, plasmacytoma (plasma cells), melanoma (cancer of pigment cells). Less commonly - cancer of the cervix, soft tissues, gastrointestinal tract, ovaries.

Bone metastases on initial stages are asymptomatic, therefore, all patients with primary lesions are subject to careful examination for secondary lesions. The emergence secondary symptoms in a person with an undetected primary focus indicates neglect of the disease and brings the greatest suffering to cancer patients, since it can be accompanied by following symptoms:

Bone pain (intraosseous pressure);

Numbness of the limbs;

Problems with urination;

Restriction of activity;

Hypercalcemia (an increase in calcium in the blood), observed most often with osteolytic metastases, is manifested by a violation heart rate, general and muscle weakness, nausea, vomiting, decreased blood 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 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 has been 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. Only pregnancy is a contraindication, and in some cases exceptions are allowed.

Often to obtain a more complete clinical picture, determining the exact diagnosis and prescribing the optimal treatment requires additional examinations and tests:

· Radiography does not give good results. 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 symptomatology. 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 alleviate symptoms and morally support a person.

High performance efficiency drug treatment give bisphosphonates, also called bisphosphonates or diphosphonates. 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 antitumor 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 suppressed 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 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 possible symptoms complications and promptly inform your doctor about them, since no one can feel the changes taking place in your body better than you.

Expert editor: Mochalov Pavel Alexandrovich| d. m. n. physician

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "General Medicine" in 1991, in 1993 " Occupational diseases", in 1996" Therapy ".