Treating metastatic bone cancer with drugs

There are several treatments for cancer with metastatic bone such as radiation therapy, burning the tumor, using drugs or surgery. When treating bone metastatic cancer with drugs, the doctor will prescribe the drug that is right for the patient's condition and needs.

1. What is metastatic bone cancer?

Bone metastasis occurs when cancer cells from a tumor elsewhere in the body travel through the blood or lymphatic system to the bone and become metastatic cancer cells. Bone metastases can occur in any bone in the body, but are most common in bones near the center of the body such as the spine, pelvis, etc. Bone metastases can be part of the late stage cancer. Bone metastases are common in breast and prostate cancers. Bone metastases can cause symptoms including severe pain, fractures, life-threatening electrolyte imbalances, and compression of nerves that can cause pain and/or weakness. Pain and nerves not working properly can be difficult to treat and affect quality of life.
Bone metastases can be divided into 2 types: osteonecrosis or bone-stimulating metastases. The difference between these 2 types of bone metastases is as follows:
Osteolytic: The tumor has caused the bone to break or thin. Calcium is being released from the bones into the bloodstream. On x-rays we can see holes called "lucencies". This type of bone metastasis is commonly seen in multiple myeloma, but can be present in patients with other types of cancer such as breast cancer. Osteoblastic (metastasis that stimulates bone growth): This type of metastasis has the potential to increase bone production. The tumor signals the bone to make more new bone cells, leading to the formation of hard, thick, and inflexible bone. This type of metastasis is most commonly seen in prostate cancer.

2. Why does cancer metastasize to bones?

Bone is a common site of metastasis for many solid tumors. The 3 reasons for this are blood flow, adhesion molecules and growth factors.
Blood flow: Blood flow to the bones and bone marrow is usually quite high. Once cancer cells enter a blood vessel, they can travel throughout the body and travel to where blood flow is highest. Adhesion molecules: Tumor cells secrete adhesion molecules that can bind to bone marrow and bone. This interaction can cause the tumor to signal for bone destruction and more tumor growth in the bone. Growth Factors: Bones are a rich source of growth factors. These growth factors signal cells to divide, grow, and mature. When cancer attacks bone, these growth factors are released and stimulate tumor cells to grow. This leads to a self-generated growth cycle.

3. What are the signs to recognize bone metastases?

Signs of bone metastasis can be caused by many other health problems. Common signs to recognize bone metastases are:
Bone pain; Non-traumatic or traumatic fracture. Fractures are more common in bone metastases than in osteoblastic metastases; Numbness and tingling in the feet and legs; Bowel and bladder problems such as ataxia of urine and/or stools, severe constipation, and urinary retention. Leg weakness and difficulty moving the front leg. This means that there is a tumor pressing on the spinal cord, damaging the nerves that control these functions. This is called spinal cord compression and is considered an emergency requiring immediate medical attention. A less common sign of bone metastases is elevated calcium levels in the body. High calcium can cause constipation, abdominal pain, nausea, loss of appetite, thirst, frequent urination, and fatigue. If calcium levels become very high, confusion and altered mental status may occur.

4. Diagnosis of bone metastatic cancer

When a patient has any signs of bone metastases, tests can be done to find the real cause. In some cases, bone metastases can be found before symptoms begin. X-rays and MRIs are used to diagnose bone metastases. X-rays are particularly helpful in looking for osteolytic lesions. They usually show up as "holes" or black spots in the bone on X-rays. Bone metastases usually do not show up on plain radiographs until they have progressed to an advanced stage.
In contrast, bone tomography can detect bone metastases very early. Sometimes infections, arthritis, and old fractures can appear as dark spots on bone scans and are difficult to distinguish from actual cancer. Bone tomography is also used to monitor patients with known bone metastases. In some cases, CT scans can show whether cancer has spread to the bones. An MRI is most useful when examining nerve roots that are suspected of being compressed by a tumor or of bone fragments destroyed by the tumor.
There is currently no blood test used to diagnose bone metastases. However, there are a number of blood tests that can suggest the presence of bone damage, but the diagnosis depends on a combination of X-ray results, symptoms, and the type of primary cancer (whether it is cancer that usually metastasizes to bone. Your doctor may also order a biopsy to determine the exact type of cancer and the stage of the tumor. A biopsy is a procedure in which part or all of a tumor is removed and examined under a microscope. The type of biopsy used depends on where the tumor is found.

5. How is metastatic bone cancer treated?

The best treatment for bone metastases is to treat the primary cancer. Therapies may include chemotherapy, hormone therapy, radiation therapy, immunotherapy, or monoclonal antibody therapy. Pain is usually treated with pain relievers. Physical therapy may be helpful, and surgery may be important if the cancer is leading to the fracture. Here are some commonly used drugs in the treatment of bone metastases:
5.1. Bisphosphonates drug treatment of bone metastatic cancer Treatment of bone metastases with Bisphosphonates helps relieve pain for patients and supports stronger bones. Bisphosphonates are synthetic compounds based on a natural compound called pyrophosphate that prevent bone breakdown. They are used to treat or prevent osteoporosis and to treat other bone diseases (such as Paget's Disease), as well as in the treatment of high blood calcium. This drug blocks the breakdown of bone caused by osteoclasts and may indirectly stimulate bone-forming cells (osteoblasts) to make new bone. Increased bone formation and pain relief have made bisphosphonates a good treatment for metastatic bone cancer. Bisphosphonates can be given orally or intravenously. The two most commonly used in cancer treatment are pamidronate (Aredia) and zoledronic acid (Zometa). Typical side effects are a flu-like reaction in the first 48 hours after infusion, nausea, low calcium levels, kidney failure, and osteonecrosis of the jaw with long-term use.
5.2. Treatment of bone metastases with the drug Denosumab Suppressors of bone cells can also be achieved with a drug called denosumab (monoclonal antibody). This drug works a little differently than a bisphosphonate, it works by targeting a specific protein needed for bone destruction. By inhibiting this protein (RANKL), denosumab prevents bone breakdown and thus reduces the risk of fracture in the affected bone. It has the same side effects as bisphosphonates, but is more likely to cause hypocalcemia. Therefore, patients are required to take calcium and vitamin D supplements during treatment.
5.3. Radioactive drugs These drugs carry radioactive elements that can kill cancer cells. They are put into a vein and move to the cancer areas in the bone. There they emit radiation that kills cancer cells. Radiation is given out over a period of time, so the treatment is done once, but the effect can last for several months. Examples of radioactive drugs are Strontium-89, Samarium-153, and Radium-223. These agents work best on trophoblast regions. This treatment may make the pain worse at first, but the symptoms will gradually subside. The main side effect of this treatment is a decrease in blood cells, so it is used with caution in people with low red blood cell counts.
Bone metastasis is one of the causes of cancer patients' pain and rapid decline in quality of life. To prevent bone metastasis, the most important thing is to detect and treat the primary cancer in time. When the body has abnormal symptoms for a long time, the patient should go to a medical facility to diagnose the cause and treat it soon.
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Reference source: oncolink.org

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