Bone metastasis

Diagnosis 

The following diagnostic tests may be done to detect bone metastasis:

• X-ray
• Bone scan (bone scintigraphy)
• Computerized Tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)
• Biopsy

Treatment

Medications

The following treatment may be used for bone metastasis:

• Bone-building medications. Bone metastasis may be treated with the same medications taken for osteoporosis in order to strengthen the bones and alleviate the pain which lessen the chance of taking strong pain relievers. It also helps to avoid new bone metastasis build up. This medication may be administered orally or intravenously but some do have side effects such as short-term bone pain, kidney issues and even a rare but serious jawbone degeneration (osteonecrosis).
• Intravenous radiation.  Radiopharmaceuticals (a form of radiation) are injected in people with multiple bone metastasis. It has a low level radioactive substance that attracts the bones and releases radiation on the affected bone once administered for pain management.
• Chemotherapy. Chemotherapy is prescribed to eradicate cancer cells that has metastasized to multiple bone areas. It may be administered orally, intravenously or both. The side effects depend on the chemotherapy medications used. Chemotherapy is the most recommendedtreatment for metastasized cancers that are responsive to it.
• Hormone therapy. Hormone suppression treatment may be effective for cancers that react to certain hormones such as breast and prostate cancer.
• Pain reliever. Over-the-counter or prescription pain medications may be taken to alleviate the pain.
• Steroids. Steroids can quickly reduce inflammation and swelling on the location of cancer which results to pain relief. But, it should be utilized cautiously due to some serious long-term side effects.
• Targeted therapy. The drugs used in targeted therapy focus on certain cancer cell abnormalities. They hinder the abnormalities which kills the cancers cells. Specific types of cancer can be very reactive to this treatment such as HER2 positive cancer cells.

External radiation therapy

Strong energy beams involving x-rays and protons target cancer cells to die. It may be used if your bone metastasis pain is not responding to pain medications or the pain is at a few locations in the body. It may be administered in a single large dose or at a fewer dosage over several days. The side effect depends on the location and size of the affected part.

Surgery

The goal of performing surgery is to avoid fracture or fix the fractured bone.

• Surgery to stabilize the bone.  Metal hardware (plates, screws and nails) are used to stabilize the bones called orthopedic fixation. It alleviates the pain and enhance functionality of the bone area. Radiation is often done after surgery to eradicate tumor cells.
• Surgery to inject a bone with cement.  Bone cement can be injected on broken or destructive bone metastasis areas (e.g., pelvic bones and spinal bones) where metal hardware are hard to install to alleviate the pain.
• Surgery to repair a broken bone.  Metal hardware are used to repair and stabilize the broken bones. Furthermore, hip replacement is also an alternative choice.

Heating and freezing cancer cells

The procedures may be helpful in patients who have one or two sites of bone metastasis which other treatments are not helpful. Heat and cold utilization to target cancer cells may be able to manage the pain.

Radiofrequency ablation uses a needle with an electric probe and inserts it into the bone tumor directly which heats up the tissues around it. Once the tissue cools down, the same process can be done repeatedly.

Cryoablation is another procedure that freezes the tumor and then thaws it. The procedure is also done repeatedly for a couple of times.

The use of heating and freezing method can have side effects such as damage to the nerves of the nearby tissues or damage to the bones causing fracture.

Physical therapy

The purpose of physical therapy is to alleviate pain and improve bone strength and motility. The physical therapist will help you plan your exercises, physical rehabilitation and may recommend assistive devices such as crutches, braces, a can or a walker to avoid weight bearing on the affected bone area. Hence, it will improve your stability while walking.