According to Carol Porth in "Essentials of Pathophysiology," metastatic bone disease is cancer that originated in another body part and traveled to settle in the bone. Bone metastasis is the most common bone malignancy and occurs most often in the femur, ribs, proximal humerus, skull and spine. Porth estimates that over 85 percent of bone metastasis derives from tumors in the breast, prostate or lungs.
Tumor Treatment
Earnest Conrad asserts that biopsies are typically the initial treatments for bone tumors in his book "Orthopaedic Oncology." Conrad indicates that there are two different types of biopsy treatments: open biopsy, by which a surgeon cuts into a patient to remove a tumor manually; and a closed biopsy, by which a clinician inserts a needle to remove the cancerous tissue internally. Open biopsies remain the standard; only doctors with sarcoma experience should perform them. A surgeon with experience with oncologic principles of flap development, amputation and coverage can plan a procedure that includes limb salvaging. Needle biopsies may be optimal for situations such as the instance of a deep pelvic tumor, but are not safe for children. Moreover, an incorrectly executed closed biopsy could result in deep contamination and bleeding.
Fracture Treatment
Radiation therapy, or chemotherapy, typically applies to reducing pain and preventing fractures in reference to metastatic bone disease. Once a fracture occurs, doctors usually treat them with bracing, spine stabilization or intramedullary femur nailing. Bone stabilization may include medical cement, most often methylmethacrylate, since diseased bone is hard to stabilize using only bracing and nails. Biophosphonates, which decrease issues associated with osteoporosis, can strengthen bones afflicted with metastatic cancer, particularly those that originate in the prostate and breast, thus effectively preventing fractures. Doctors should treat patients with metastatic bone disease with biophosphonates indefinitely.
Hormone Therapy
As a preventative measure, doctors may use hormone therapy to control certain types of metastatic breast cancers to prevent metastatic bone cancer, according to Doyle, Hanks, Cherny and Calman in the book "Oxford Textbook of Palliative Medicine." Alternately, the authors warn that such treatments are effectively only to treat metastatic cancer before it afflicts the bones, otherwise it can potentially exacerbate the condition. In the event that a patient receives hormone therapy after the onset of metastatic bone disease, tumor flares leading to hypercalcaema could result. Moreover, if metastatic bone disease occurs despite hormone therapy following the onset of breast cancer, then hormone-resistant chemotherapy is necessary to treat the disease effectively.
References
- "Essentials of Pathophysiology: Concepts of Altered Health States"; Carol Porth; 2007
- "Orthopaedic Oncology: Diagnosis and Treatment"; Earnest U. Conrad; 2008
- "Oxford Textbook of Palliative Medicine"; Derek Doyle, Geoffrey Hanks, Nathan I. Cherny and Sir Kenneth Calman; 2005
