Metastasises in a bone
Metastasises in a bone – the secondary malignant centers in a bone tissue caused by distribution of cancer cells from primary tumor of other body. Are shown by the accruing pains, a giperkaltsiyemiya and pathological changes. In some cases in the struck area dense opukholevidny education can be found. At a sdavleniye of large vessels there are blood circulation violations, at a sdavleniye of nervous trunks – neurologic symptomatology. The diagnosis is established on the basis of the anamnesis, complaints, the given objective survey, results of laboratory and tool researches. Treatment – radiotheraphy, chemotherapy, surgeries.
Metastasises in a bone
Metastasises in a bone – damage of a bone tissue as a result of distribution of malignant cages with current of blood or a lymph. Arise at late stages of an oncological disease. 80% of secondary tumors of a bone tissue come to light at a breast cancer and a prostate cancer. Besides, metastasis in a bone quite often meets at malignant new growths of a thyroid gland, lung cancer, malignant tumors of a kidney, sarcoma, a lymphoma and a limfogranulematoza. Damage of a bone tissue is less characteristic of other new growths. At ovarian cancer, uterus neck cancer, tumors of soft fabrics and digestive tract metastasises in a bone are diagnosed very seldom. Treatment is performed by experts in the field of oncology, traumatology orthopedics.
Types of metastasises in a bone
In a bone tissue constantly there are processes of a resorption and kosteobrazovaniye. Normal these processes are balanced. Malignant cages in the field of a metastasis break this balance, excessively making active osteoklasta (the cage destroying a bone tissue) or osteoblasts (young cells of a new bone tissue). Taking into account primary activization of osteoklast or osteoblasts allocate two types of metastasises in a bone: osteolytic at which destruction of a bone tissue and osteoplastic at which consolidation of the site of a bone is observed prevails. In practice pure types of metastasises in a bone meet seldom, the mixed forms prevail.
Most often the secondary centers come to light in bones with rich blood supply: in a backbone, edges, pelvic bones, skull bones, femoral and humeral bones. At initial stages metastasises in a bone can proceed asymptomatically. In the subsequent are followed by the accruing pains. (At the expense of a sdavleniye), and chemical (as a result of allocation of a large amount of prostaglandins) stimulation of the pain receptors located in a periosteum becomes the reason of pains both mechanical. The pain syndrome at metastasises in a bone amplifies at night and after physical activities. Over time pains become painful, intolerable, the condition of patients is facilitated only after reception of narcotic analgetics.
Rather large metastasises in a bone can cause visible deformation, come to light at a palpation in the form of opukholevidny education or be looked through on roentgenograms in the form of the site of destruction. A serious complication of metastasises in a bone are the pathological changes in 15-25% of cases arising in tubular bones, almost in half of cases – in vertebras. Sometimes in the course of growth metastasises in a bone squeeze nearby large vessels or nerves. In the first case there are blood circulation violations, in the second – neurologic frustration. The compression of a spinal cord and a giperkaltsiyemiya are also among heavy complications of this pathology. Local symptoms of metastasises in a bone are combined with the general displays of an oncological disease: weakness, appetite loss, decrease in body weight, nausea, apathy, bystry fatigue, anemia and temperature increase of a body.
Symptoms of metastasises in a bone
Giperkaltsiyemiya – the life-threatening complication which is coming to light at 30-40% of patients with metastasises in a bone. Hyperactivity of osteoklast as a result of which the amount of calcium exceeding secretory abilities of kidneys comes to blood from the destroyed bone becomes the reason of development. Patients with metastasises in a bone have a giperkaltsiyemiya and a giperkaltsiuriya, process of the return absorption of water and sodium in kidney tubules is broken. The polyuria develops. The vicious circle is formed: because of a polyuria liquid volume in an organism decreases that involves decrease in a glomerular filtration. Decrease in a glomerular filtration, in turn, causes increase in the return absorption of calcium in kidney tubules.
Giperkaltsiyemiya at metastasises in a bone causes violations of activity of various bodies and systems. From TsNS mental disorders, block, affective violations, a proximal myopathy, confusion of consciousness and loss of consciousness are observed. From cardiovascular system the lowering of arterial pressure, reduction of heart rate and arrhythmia come to light. Cardiac arrest is possible. From digestive tract nausea, vomiting, locks and violations of appetite are noted. In hard cases pancreatitis or intestinal impassability develops.
From kidneys are found a polyuria and . The general clinical symptomatology includes weakness, increased fatigue, dehydration, loss of body weight and a skin itch. Giperkaltsiyemiya at metastasises in a bone can remain long time not distinguished as doctors treat displays of this pathology as signs of progressing of the main oncological disease or as side effect of chemotherapy or radiation therapy.
Pathological changes arise at destruction more than 50% of a kortikalny layer. Most often come to light in vertebras, the second place on prevalence is taken by femur fractures, usually – in a neck or a diaphysis. Distinctive feature of pathological spinal fractures at metastasises in a bone is plurality of defeat (violation of integrity of several vertebras at the same time comes to light). As a rule, the chest or lumbar department suffers. Damages can be followed by a compression of nervous backs or a spinal cord.
The insignificant injuring influence, for example, light blow or even awkward turn in a bed can become the reason of a pathological change at metastasises in a bone. Sometimes such changes look spontaneous, that is, arisen without any external reasons. The change can be followed by the shift of otlomk. Dysfunction of extremities at fractures of long tubular bones and neurologic frustration at spinal fractures become one of the leading factors of deterioration of life of the patient.
Compression of a spinal cord
The compression of a spinal cord comes to light at 1-5% of patients with metastatic damages of a backbone. In 70% of cases metastasises in chest vertebras, in 20% - in lumbar and sacral vertebras, in 10% of cases – in cervical vertebras become the reason of violations. At metastasises in a bone can come to light as sharp (at a sdavleniye a bone fragment), and gradually progressing (at a sdavleniye the growing tumor) frustration. At a sdavleniye the growing new growth of patients with metastasises in a bone the accruing pains disturb. Muscular weakness develops, sensitivity violations come to light. At a final stage there are paresis, paralyzes and malfunction of pelvic bodies.
At a sdavleniye a bone fragment the clinical picture of a compression of a spinal cord develops suddenly. At initial stages both types of a compression are reversible (in whole or in part). In the absence of timely medical care within several hours or days paralysis becomes irreversible. Timely adequate treatment allows to reduce expressiveness of symptoms, however restoration of ability to independent movement is noted at only 10% of patients with already developed paralysis.
Diagnostics and treatment of metastasises in a bone
The diagnosis is established on the basis of the anamnesis (data on existence of primary malignant new growth), a clinical picture and results of additional researches. Lack of information on already diagnosed oncological disease is not the basis for an exception of metastasises in a bone as primary tumor can proceed asymptomatically. In the presence of neurologic violations perform neurologic inspection. At the initial stage of inspection carry out a stsintigrafiya. Then patients are directed to a X-ray analysis, by bone KT or MPT for specification of character and prevalence of defeat. For identification of a giperkaltsiyemiya appoint biochemical blood test.
Tactics of treatment is defined taking into account type and localization of primary tumor, quantity and an arrangement of metastasises in a bone, existence of metastasises in other bodies and fabrics, existence or lack of complications, age and the general condition of the patient. Surgical interventions have palliative character and are shown in the presence of complications (pathological changes, a compression of a spinal cord). The purpose of operations at metastasises in a bone is elimination or easing of pains, restoration of function of an extremity or spinal cord and creation of more favorable conditions for care of the patient.
At making decision on performing surgery consider the forecast. Predictively favorable factors are the slow growth of primary new growth, the long period of lack of a recurrence, a small single metastasis in bones, existence of radiological signs of a sclerosis of a bone after conservative treatment and satisfactory condition of the patient. In similar cases extensive surgical interventions (installation of plates, pins, Ilizarov's devices) can be carried out.
With an aggressive growth of primary new growth, a frequent recurrence, multiple metastasises, especially – with simultaneous damage of internals, the big size of a metastasis in a bone, lack of signs of a sclerosis on the roentgenogram and an unsatisfactory condition of the patient surgical interventions on tubular bones it is not recommended even in the presence of a pathological change. In cases when surgical intervention is contraindicated, use the sparing fixing methods (for example, a derotatsionny boot at a hip neck fracture).
Emergency aid at the metastasises in a bone which were complicated by a compression of a spinal cord includes vascular medicines, means for improvement of metabolism of nervous tissue and high doses of dexamethasone. At a sdavleniye of nervous tissue owing to growth of a metastasis in a bone carry out a decompressive laminektomiya, at a compression of a spinal cord as a result of a pathological fracture of a vertebra carry out the decompressive stabilizing operations: fixing by a plate or transpedikulyarny fixing, restoration of vertebras with use of bone cement, auto-and allotransplantat etc.
The chemotherapy and radiation therapy at metastasises in a bone are used in the course of the combined conservative therapy, during preparation for surgery and in the postoperative period. At a giperkaltsiyemiya carry out a regidratation, carrying out intravenous infusions of salt solutions. The patient with metastasises in a bone appoint "loopback diuretics" (furosemide), kortikosteroidny medicines and bisfosfonata. The effect of therapy remains within 3-5 weeks, then the course of treatment is repeated.
The forecast at metastasises in a bone is more favorable in comparison with metastasises in internals. Average life expectancy makes 2 years. Quality, and in certain cases and life expectancy depend on existence or lack of complications that causes importance of preventive actions at detection of metastasises in skeleton bones. At metastasises in a backbone recommend to exclude a raising of weights and several times during the day to have a rest in lying situation. In certain cases at a certain stage of therapy carrying a corset or headholder is shown. At damage of a femur during treatment advise as much as possible to unload an extremity, using a cane or crutches. Physiotreatment at any metastasises in a bone is contraindicated. Patients need to have regularly examinations for timely identification of a recurrence of a disease.