Bone metastasis is a common complication of advanced tumors
Bone metastasis refers to certain malignant tumors that originated from other than bone tissues, which metastasize to bone tissue through blood, causing diseases with bone damage and pain as the main manifestations. It is a common complication of advanced malignant tumors, which can be divided into three types: osteolytic, osteogenic, and mixed. Generally speaking, the metastasis of breast cancer and lung cancer is mainly osteolytic metastasis, and the main metastasis of prostate cancer is osteogenic metastasis. Bone metastases mostly occur in the spine, pelvis, ribs, etc., which can cause bone pain, pathological fractures, hypercalcemia, etc. Spinal metastases can also cause spinal cord compression and even paraplegia. Although bone metastasis itself generally does not directly pose a life threat, its symptoms often make patients extremely painful and seriously affect the quality of life.
The occurrence of bone metastasis is a relatively complicated process: after tumor cells reach the bone marrow with the bloodstream, they destroy the bone tissue through interaction with osteoblasts, osteoclasts, and bone stromal cells, and release many kinds of storage in the bone tissue. Growth factors make tumor cells continue to proliferate to form metastases. Almost all malignant tumors can have bone metastasis in the advanced stage. Among them, breast cancer, lung cancer, prostate cancer, multiple myeloma and other patients have the highest probability of bone metastasis. However, because some cancers are insidious and the early symptoms are not obvious, the phenomenon that bone metastasis has occurred is not known. Clinically, patients like Mr. Li are not uncommon. Some patients go to the orthopedics department for neck, shoulder, waist and leg pain. After some diagnosis and treatment, it is discovered that the culprit is tumor. It was osteoporosis. After some examination, it was discovered that he had cancer and bone metastases had occurred. Therefore, if there is inexplicable shoulder pain, back pain, or numbness of the limbs, you must pay attention to the real cause behind it.
Bone pain is a common first symptom
Patients with early bone metastases may not have any symptoms, but as cancer cells spread, the tumor will destroy the bones, causing a series of symptoms such as pain, hypercalcemia, and pathological fractures.
1. Pain
The pain caused by bone metastasis is a typical representative of cancer pain, and it is also one of the common symptoms of tumor bone metastasis. Pain includes local bone pain, radiating pain, angulation pain, compressive neuralgia, sympathetic nerve-related pain, muscle spasm pain and related myofascial pain, etc., presenting intermittent pain or continuous pain, which worsens day by day, and is compared at night. Heaviness is the characteristic, and it is often aggravated during activity and load-bearing.
I met a patient before, he is a veteran. He was not afraid when lung cancer was detected, nor was he afraid when bone metastases were detected. At first he said to me: "Doctor, I heard that pain relief is for bad health, so I don't want to fight, I can bear the pain." But after only a month, he said that he could not bear the pain and begged to let me. Give him an injection for pain relief. It can be seen how "unforgettable" the pain of bone metastasis is for the patient. Of course, not all pain represents bone metastasis. However, if cancer patients have multiple, fixed and persistent pains, they need to be vigilant and must go to the hospital for examination in time.
2. Hypercalcemia
After the cancer cells have transferred to the bones, the spread of cancer cells will destroy the bones, and calcium will leak from the bones into the bloodstream, causing hypercalcemia. Hypercalcemia affects the function of multiple organs and can cause many pathological changes, which is more life-threatening than the tumor itself. It can reduce the excitability of nerves and muscles, and cause neurological symptoms such as lethargy, unresponsiveness, and lack of energy, as well as fatigue, muscle fatigue, hypotonia, etc.; digestive system symptoms include nausea, anorexia, vomiting, etc.; and kidney function Damage etc.
3. Pathological fracture
Unlike general fractures, pathological fractures have no obvious history of trauma. Primary or metastatic bone tumors are the most common causes of pathological fractures. Cancer cells metastasize to bone tissue, causing erosion and destruction, leading to bone loss and fragile bones. Minor trauma or coughing can cause pathological fractures, even some simple daily activities, such as Mr. Li just swiping mosquitoes can cause fractures.
4. Compression symptoms
Bone metastasis not only affects the bone tissue, but may also endanger the surrounding nerves. For example, cancer cells transferred to the spine will damage the nerves and compress the nerve roots or spinal cauda equina, causing patients to experience hypoesthesia, radicular neuralgia, dysfunction, paralysis, and severe paralysis.
In addition, bone metastases can also cause systemic symptoms such as anemia, fatigue, loss of appetite, and malnutrition. In the later stage of bone metastasis, the patient needs to stay in bed for a long time because of his weakness, and may also have atelectasis, pressure sores, and thrombosis.
Bone metastasis does not mean that there is no cure
Many patients and their families believe that once cancer metastases to bone, it means that the patient is sentenced to death and there is no cure. This view is wrong. Patients with prostate cancer, breast cancer and other tumors generally have a longer survival period after bone metastasis. If they can receive reasonable treatment, they can survive for a long time. Therefore, for malignant tumors that are prone to bone metastasis, regular inspections should be performed to assess the condition in time.
At present, the clinical principle for the treatment of bone metastases from malignant tumors is to rationally apply various existing treatment methods, such as surgery, radiotherapy, chemotherapy, interventional therapy, and biological therapy, to control tumor progression, relieve bone metastasis pain, and prevent and Treat pathological fractures, improve the quality of life of patients, and prolong the survival time of patients.
1. Medication
Various analgesic drugs are commonly used clinically to reduce the pain of patients and improve the quality of life. Under the guidance of a doctor, drugs for treating osteoporosis can also be rationally used to strengthen bones, reduce the pain caused by bone metastasis, and reduce the amount of analgesic drugs.
2. Local radiotherapy
External radiotherapy can improve local bone pain and diffuse bone pain, and effectively prevent paraplegia in patients with severe vertebral bone metastases. The use of the radionuclide strontium-89 is an important method for the treatment of bone metastases, which can relieve bone pain and improve the quality of life of patients. However, radiotherapy cannot repair damaged bone.
3. Surgical treatment
The purpose is to prolong life, relieve symptoms, improve quality of life, prevent or treat pathological fractures, and relieve nerve compression, including minimally invasive and vertebroplasty treatments.
To sum up, bone pain is the first symptom of bone metastasis of malignant tumors, or the first signal of clinical suspicion of bone metastasis. It is often misunderstood as a common problem in orthopedics and ignored in clinical practice. The symptoms have been repeatedly ignored, but the damage to bone by cancer cells has never stopped. If things go on like this, the patient's physical function declines, which seriously affects the standard of living, and at the same time affects the effect of anti-tumor therapy, leading to an increased risk of death. Therefore, if cancer friends find bone pain, they must pay attention to it.
