Metastatic bone disease: diagnosis and treatment of secondary bone cancer
Written by:
Orthopaedic surgeon
Published: 29/05/2017
Edited by:
Metastatic bone disease, or bone metastases, is due to cancer from another part of the body that has spread to the bone. It is most commonly related to spreading from primary malignancies in the breast, lung, kidney, thyroid and prostate. It can be asymptomatic, but usually causes pain and can result in disability. Mr Ian Holloway, expert consultant orthopaedic surgeon, explains more…
Diagnosis of metastatic bone disease
Metastatic bone disease can occur anywhere in the skeleton. It tends to cause most problems when located in the long bones (femur and humerus), or in the pelvis or spine. The metastatic bone disease process tends to cause localised weakness in the bone, resulting in a risk of fracture.
Such fractures can occur with less force than would usually be required to cause the bone to break. The diagnosis is usually made on the basis of symptoms and is confirmed with X-Rays and scans. A biopsy is sometimes performed.
Treatment for bone metastases
Treatment is undertaken using a multidisciplinary team approach, with input from an oncologist, orthopaedic surgeon, specialist nurse, physiotherapist and anaesthetist. Many cases of metastatic bone disease can be treated with radiotherapy and chemotherapy alone.
Ongoing observation in the outpatient centre is required. Cases associated with a significant risk of fracture tend to need prophylactic surgery to stabilise the bone to avoid fracture, or (if fracture has already occurred), to fix the fracture. This is usually done with a device to stabilise the whole bone, called an intramedullary nail. If the metastasis is near a joint, then joint replacement is sometimes used.
Results of treatment for metastatic bone disease
Surgical treatment is not usually curative. It is designed to treat pain and improve function, and to enable subsequent radiotherapy and chemotherapy to be undertaken. Due to the multidisciplinary nature of treatment for metastatic bone disease, it is best practice for treatment to be undertaken at a specialist centre, which has the appropriate specialities represented.