Metastatic Bone Disease

Metastatic bone disease refers to cancer which has spread (metastasised) to the bones from a primary cancer elsewhere in the body. It is a common complication in cancer patients, particularly if the disease is in the advanced stages. It differs from primary bone cancer in that it develops from the spread of a tumour elsewhere in the body rather than originating from the bone itself; primary bone cancer is significantly rarer than metastatic bone disease.

Cancer can cause destruction to the bone as it spreads (osteolysis). This results in small holes in the bone (osteolytic lesions) which cause pain and weakness, increasing the risk of fracture and other problems. As cancer spreads to the marrow of the bones and affects the production of blood cells and platelets, it becomes more difficult for the body to remain healthy.

Symptoms may vary depending on the type of cancer that disease has metastasised from. All patients suffering from an existing cancer (particularly a late-stage type) are encouraged to learn the symptoms of bone metastasis and report them to their GP or oncologist if they appear.

Signs to look out for include:

·       Pain in the bone and joints that cannot be relieved by over-the-counter medication

·       Weakened bones and resulting fractures

·       Nerve problems (including numbness and urinary and bowel incontinence)

·       High levels of calcium in the blood (hypercalcemia), which may cause nausea, vomiting, constipation, and confusion.

·       Anaemia or persistent infections

·       Bruising or abnormal bleeding

The presence of these symptoms does not necessarily mean you have metastatic bone disease, although they should not be ignored. If you have any concerns, speak to your GP or oncologist.

Bone metastasis occurs when cancer cells break from an existing tumour elsewhere in the body, spread to the bones, and begin to multiply.

Nearly all types of cancer can metastasise in the bone, although some types are more prone to spreading than others. Breast, lung, prostate, kidney, and thyroid cancers are particularly prone to metastasising in the bone, especially if they remain untreated for an extended period before diagnosis or reach the advanced stages. Myeloma (a type of blood cancer) can also cause bone pain and weakening of the bones.

Early diagnosis of metastatic bone disease ensures the best possible outcomes for treatment. Although metastatic bone disease cannot be cured, prompt diagnosis can increase life expectancy.

If metastatic bone disease is suspected, your doctor will often order a blood test to examine the level of calcium and alkaline phosphate in your blood. A simple x-ray examination will often reveal the location of the metastasis and how much of the bone is involved. As pain may refer from other areas (knee pain coming from the hip or back, for example), your doctor will often order x-rays which extend beyond the area of pain. Your doctor may also order MRI, CT, PET scans, or a bone biopsy to gain further information.

As metastatic bone disease cannot be cured, the aim of treatment is to prevent further spread of the disease, reduce pain, and prolong life. Your own course of treatment will depend on the bones involved, the stage of your cancer, your overall health, and the type of primary cancer that you have. If the primary cancer that your bone disease has metastasised from is not known, other tests will be performed to locate it.

After the initial diagnosis has been made and tests performed, your case will often be discussed by a multi-disciplinary team of specialists who will work together to develop a treatment plan. This team may include primary care physicians, oncologists (cancer specialists), orthopaedic surgeons, physical therapists, and other specialists who can lend valuable input.

Your treatment for metastatic bone disease will likely include a range of therapies. These may include:

• Surgery to stabilise bones, repair fractures, or reduce pain. Sometimes, a portion of the diseased bone next to a joint may need to be replaced by a big joint replacement called a megaprosthesis.
• Chemotherapy or radiation therapy.
• Physical therapy to assist with mobility and muscle strength.
• Painkillers or steroids to provide pain relief.

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