When Cancer Spreads to the Bone: Surgery for Metastatic Bone Disease
Last updated Thursday, December 13, 2007
Management and treatmentTreatment Patients usually
receive some combination of surgical, medical, and radiation treatment for
metastatic bone disease. While this treatment is not curative, it may help
improve the patient’s quality of life by reducing pain, making it easier to
move around, and preventing or fixing bone fractures.
Surgical treatment usually consists of implants
of metal rods or plates to stabilize fractured bone or bone about to fracture.
Surgery may also sometimes be performed to reduce compression on the spinal
cord, if that is occurring and is causing pain, numbness, loss of bowel or
bladder control, or difficulty walking or using the arms.
Radiation therapy is directed at killing the
cancer locally and at improving localized pain control in affected parts of the
body.
Medical treatment may include different forms of
chemotherapy. A class of drugs called bisphosphonates act by decreasing bone
destruction and thereby reducing pain. This class of drugs is similar to those
used to treat osteoporosis, a form of non-cancerous bone loss common in
postmenopausal women or in younger adults who diet and exercise in the extreme.
Patients will also receive medications to boost their comfort, such as
narcotics or other pain treatments.
Surgery usually needs to be performed only once,
radiation therapy usually takes a number of treatment sessions over several weeks,
and medication of some sort usually continues for the rest of the patient’s
life. After treatment, many patients go back to their regular lifestyle, and
their primary-care doctor or oncologist at home manages their medications for
them. At the UW and the Seattle Cancer Care Alliance, and at many other widely
respected cancer treatment centers, every effort is made to keep the patient’s
primary care physician and local oncologist informed on their patient’s
clinical course.Self-management Any cancer patient
should see their doctor early on if they are experiencing new pain, and not
wait to schedule an appointment. Patients should keep their diagnostic and
treatment appointments, and follow the course of treatment he or she has agreed
upon with his or her cancer treatment team. Patients should take their
medications as prescribed, or report intolerable medication side effects to
their physician and not simply stop taking the medication without consulting a
doctor or pharmacist.Health care team Health professionals
involved in treating or managing metastatic bone disease may include medical
oncologists, radiation oncologists, radiologists, orthopedic surgeons,
hospitalists, pharmacists, nurses, rehabilitation medicine specialists,
physical therapists, social workers, and others as needed for the patient’s
individual concerns. The patient’s primary-care physician will also continue to
be involved in the patient’s care before and after treatment at a specialized
medical center, and may be consulted during the course of specialized
treatment.Pain and fatigue Radiation therapy can
usually help reduce localized pain. Surgery can sometimes help prevent or
reduce pain from fractures or stabilize bones that are at risk for fracture.
Medications, such as narcotics, can also help in pain reduction. If anemia is a
cause of fatigue, it can sometimes be treated. Adequate pain control can often
prevent or relieve sleep problems and the daytime fatigue that results from
repeated nighttime awakenings. Comfort items, such as a favorite chair; soft,
easy fitting clothing; and a good mattress and pillows, can help to promote
rest by reducing pressure on achy parts of the body.Diet No, diet has not yet
been shown to help treat metastatic bone disease. Nonetheless, appropriate
calcium and vitamin D supplementation can help maintain a healthy skeleton.Exercise and therapy Exercise can increase
overall well being and keep bones healthy, but it should not be attempted until
after the bones have received appropriate treatment and the patient has checked
with his or her doctor before starting an exercise routine.Medications Patients may be given
various forms of chemotherapy for the recurrence of their cancer. They may also
receive medications similar to those given for osteoporosis (bone loss) to
improve the quality of their bone tissue. They can also be given medications,
such as narcotics, to control their pain. Other medications, such as treatments
for anemia, may be prescribed as necessary to control other conditions that may
accompany or occur coincidentally with metastatic bone disease.Surgery While not curative,
surgery can help prevent or manage some of the problems associated with
metastatic bone disease, and can prevent the bone from fracturing (breaking) or
treat the fracture if it already has occurred. Rods, plates, joint
replacements, and some types of cementing treatments may be employed surgically
to strengthen weak bones or to prevent or fix fractures.Joint aspiration Neither joint
aspiration nor injection is used in the management of metastatic bone disease.Splints or braces In selected cases, if
a bone is broken or if a patient elects not to have bone surgery, splints or
braces may be employed.Alternative remedies Alternative remedies
for metastatic bone disease are directed at increasing patient comfort, not at
treatment or cure. Some patients may try non-medical modalities or non-Western
medical therapies in addition to their medical treatment to improve their sense
of well being. These may include acupuncture, herbs, massage, and meditation.
Some patients believe in the metaphysical nature of certain places to help them
feel better. Patients should tell their physician about any herbal medicines
they plan to take, because some may interact unfavorably with their other
treatments. Some patients find that complementary, non-medical modalities such
as meditation can be helpful, but it is very important also to seek
conventional treatment for metastatic bone disease.Long-term management There needs to be
continual monitoring of the original cancer that now has spread to the bone.
Any musculoskeletal complaints from a patient need to be taken seriously by the
patient and his or her physician. Depending on the type of cancer, many
patients with metastatic bone disease will be on chronic medication management.Unproven remedies People need to
realize that the treatment of metastatic bone disease is not curative. Many
people think that if their bone disease is cared for, then they are cured. This
is not true. Some patients also have a fear of radiation treatment, but today
radiation therapy has evolved so the side effects are fewer and those that do
occur are managed more effectively than they were 20 or 30 years agoSurgery for Metastatic Bone Disease at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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