Yuan Ting
Doctor of Orthopedics / Master Supervisor of Shanghai Jiao Tong University
Department of Orthopaedic Oncology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University
Bone tissue is the third most likely organ for metastasis of various cancers, after the lungs and liver. After bone metastasis occurs, the most direct feeling of most patients is: pain! pain! pain! More patients have pain when they are active, pain when they are resting, pain during the day, and pain at night. Metastatic cancer can also lead to pathological fractures as they grow up, causing patients to suffer more and making treatment more difficult. Many patients abandon themselves as soon as they hear about bone metastases and choose to rely on painkillers to survive, thus missing the best period of treatment to control bone metastases.
For bone metastasis, early detection and early treatment are the "king".
1. What are the early symptoms of bone metastasis?
Bone metastases are insidious in the early stages and are difficult for patients to detect, manifesting only as mild pain or discomfort. However, if the pain or discomfort is mainly at night, or if the pain is obviously worse than that during the day, it is necessary to be vigilant and go to the top three hospitals in time for examination. Many patients do not find bone metastases until the fracture, and it is too late!
Regular review is the best approach.
For cancer patients at high risk of bone metastasis, a bone scan or pet-ct should be done once a year.
2. What is the step-by-step treatment of bone metastases?
Treatment of bone metastases is broadly divided into the following stages:
Prevention - drug control - minimally invasive surgery - salvage surgery
Prevention: Prevention is always the most important part of any disease. The treatment and control of primary tumors is always the most important means of prevention. Whether it is surgical resection, radiation therapy, chemotherapy, immunotherapy, or targeted drugs, bone metastases can be prevented by controlling the primary lesion.
In addition, anxiety and depression can affect a person's immunity, so it is necessary to maintain a positive and optimistic attitude.
Drug control: There are many drugs that are thought to help control the further exacerbation of bone metastases that have occurred. Among them, the most classic is bisphosphonate (a new class of drugs used for various bone diseases and calcium metabolic diseases. It can specifically bind to hydroxyphosphine in the bone, inhibiting osteoclast activity, thereby inhibiting bone resorption). For example, the latest authoritative guidelines released by NCCN (National Comprehensive Cancer Network) also propose that for early bone metastases, early intervention with bisphosphonates is recommended.
Minimally invasive surgery: patients often require further evaluation if the drug is poorly controlled. Minimally invasive surgery is the best option for patients with a high risk of fracture (e.g., thoracolumbar spine, pelvis, femur, etc.) and unbearable pain. Bone cement tamponade after various ablation surgeries can effectively control pain and delay the occurrence of fractures. Sometimes even a few millimeters of needle hole can be achieved.
Salvage surgery: for patients who progress further after minimally invasive surgery and miss the best time for treatment. Traumatic rescue surgeries such as amputations and joint replacements are the last line of defense to guard the lives of patients.
To sum up, bone metastasis ≠ advanced, but only aggressive treatment can prolong life and improve quality of life!