Metastatic Bone Disease

 MBD

Cancer that arises in an organ, such as the lung, breast, prostate, kidney, thyroid and others, and subsequently spread to the bone as bone metastases (MBD). More than 1.2 million new cancer cases diagnosed each year, and about 50 percent of these tumors can spread or metastasize to the skeleton.
Living with improved medical treatment of many cancers, especially breast cancer, lung cancer, prostate cancer and the patients longer. However, these patients develop bone metastases.

Anatomy and pathophysiology

How does cancer spread to bone from an organ? Two important theories are still holding. In 1889 Sir James Paget developed, English surgeon, and his "seed and soil" theory by studying the medical records of 735 patients with breast cancer. The majority of metastases were found to occur in the liver and brain. Dr. Paget realized there was a discrepancy between the blood supply and the incidence of metastases in different organs. It stipulates that local factors have organ implantation to favor certain Web sites. He did not feel that metastases was associated in the blood supply to certain organs, such as skeletal muscle and spleen have a rich blood supply, but not often targets for metastasis. Dr. Paget felt maintain that it is not simply that the cancer cells' ability to survive and spread to a new Web site (seed), but was that the local environment will lead to further tumor growth (bottom) had. Only two factors could occur successful metastasis.

In contrast, beat James Ewing, MD, an American pathologist, his theory of transport in 1928. He suggested that tumors of certain organs due to the routes of blood flow carrying tumor cells from the primary site populated. He thought organs passive vessels for tumor cells with no capacity to explain were targeting to specific sites.

The venous blood of the body, that part of the circulation is responsible for returning the blood to the heart, includes a complex network that might have guessed he change for the distribution of metastasis of cancer. The most common sites of metastases for all cancers (not just those who go to the bone) is the lung and liver, where the venous system is quite prominent. The venous system around the spine by Oscar Batson, MD, describes proposed to explain why prostate cancer cells spread, preferably the pelvis and spine. This plexus contains a long series of veins that are parallel to the spine and allow more feedback to the central system to get around. Seventy years later, these two theories are not mutually exclusive. The blood flow can help dictate the course of the tumor cell to travel but intrinsic properties of tumor cells and place of the propagation environment can facilitate the growth.

Disease progression
The skeleton is the third most common site of spread of cancers arising from organs or carcinomas. Metastases in lungs and liver are often only detectable late in the course of the disease because patients experience no symptoms. On the contrary, bone metastases are usually painful when they occur.

The vast majority of bone metastases from cancers of the breast, lung and prostate, which are followed by the thyroid gland and kidney. The most common sites of spread of the skeleton, the spine, pelvis, ribs, skull, arm and leg long bones. Interestingly, these sites to areas of the bone marrow, the high production evidence of red blood cells, the cells responsible for transporting oxygen to the tissues in the body.

Patients with bone metastases require a team approach to care. An oncologist should be very closely with an orthopedic surgeon very familiar with bone metastases, and a radiation oncologist. Pain management specialists and social workers are also highly recommended. Planned follow-up or surveillance zone should be with each of these individuals by the medical oncologist and / or surgeon fixed.

Symptoms

Patients with bone metastases may have marked pain in the spine, pelvis and extremities, because the bone is weakened by the tumor. This pain can with radiation, analgesics, or new, minimally invasive surgical techniques such as radiofrequency ablation are relieved. Patients can sometimes be at risk for the development of a break in the bone that can not walk or perform normal daily activities. In such cases, surgery is usually necessary to repair the bone. The surgical techniques in these cases usually are different from those used for patients who get a broken bone from an injury (ie, not because of cancer of the bone to the point where it breaks weakened).

Patients with cancer that has spread to the spinal bones can nerve damage that can lead to paralysis or loss develop the use of the legs and / or arms. Sometimes the bones are not broken, but so weak that a break is imminent. Such scenarios are called "threatening fractures." Patients with impending or actual fractures can be forced to bed rest for a long time, the possible chemical imbalances in the blood such as increased calcium levels (hypercalcemia) can lead you to stick to.

Anemia (decreased production of red blood cells) is a common abnormality of blood for these patients. The major concern for patients with bone metastases is the general loss of quality of life.

Every cancer patient should discuss their risk for developing bone metastases with her oncologist. Some cancers do not readily spread to the bone while doing another.

The most common cancers that comprise the organs and bones caused spread:


    * Breast

    * Lung

    * Thyroid

    * Kidney

    * Prostate

When a cancer patient experiences no pain, especially in the back, legs and arms, they should tell their doctor immediately. Pain, which is also no activity (ie, walking or lifting an object) is particularly concerning. If the pain is getting worse, the patient should not delay in seeking medical attention.