09 May 2022, Monday
Bone Metastases from Breast Cancer
Bone Metastases from Breast Cancer occur when cancer originating from the breast tissue has spread to the bones. Breast cancer is very common in females, but it can also affect males.
Bone metastases are also called ‘bone mets’, which occur in nearly 70% of women with metastatic breast cancer, signifying that cancer has returned. Bone metastases can happen before even knowing that you have breast cancer. It can be treated but can’t be cured fully.
Also, the diagnosis of it can be concerning as well as you can face some side effects of the medicines. Sometimes metastatic cancer in the bones can be fatal. However, some people continue their life after the diagnosis as well.
All pains and aches are not cancer. But it would be best if you were very careful when some of the symptoms discussed below are seen.
1. Bone pain
Bone pain is the first and most common symptom of bone metastases. At first, the pain can come and go, but it can be worst at night. Later, it may become worse while physical activity. It can become constant as well. If the pain occurs due to cancer, then your bone can become weak and enhance the risk of bone fracture. This can be treated if found early.
2. Broken bones
Bone metastases generally eat away the areas of bones which can cause weak and unstable bones and make them more likely to get fractured. A fracture can happen during your everyday activities. So, if you are facing severe pain in the bones, it can be a sign of bone fracture.
3. Compression of spinal cord
When cancer spreads to the bones of your spine, it squeezes your spinal cord. It can cause different types of symptoms like:
- weakness in the legs
- numbness in the legs and belly
- difficulty in urinating
So, if you have any of those, consult with your cancer doctor, as it may lead to serious complications such as paralysis.
4. Loss of appetite and extreme thirst
These are the signs that you have a high calcium level in your blood, which causes ACS. It can happen due to bone metastases that release calcium into your bloodstream. If you are experiencing any of these symptoms, consult with medical experts. If it is left untreated, it can lead to a coma.
Bone metastases generally occur when the cancer cells break away from the original tumour and spread to your bones. When this happens due to breast cancer, this causes the tumour cells grow that disruptive form structures in the bones; when new bone tissues replace the old bone tissues to keep our body strong, bone remodelling.
Bone Metastases affect the process of bone remodelling. When cancer develops in the bones can be osteolytic, which means it reduces the bone tissue. It can cause an overproduction of bone.
Breast cancer cells in the bone will speed up breaking down the normal bone tissue, which weakens the bones. The cancer cells can also overstimulate new bone production, leading to large and rigid growths called osteoblastic metastases.
Once the cancer cells have reached the bones, it provides fertile ground to grow the cancer cells. It happens as bones have the areas of constant cell turnover and growth. Somehow cancelled cells release some substances which cause faster cancer growth.
These cancer cells always attach to bones more than other substances in our body. Cancer cells may go anywhere, but they usually go to the bones along with the greatest blood supply, which includes bones in the:
- Upper arms
The diagnosis of bone metastases includes blood tests to know if your blood has alkaline phosphatase or calcium. Either of them can be elevated in bone metastases. But an alone blood test cannot confirm metastatic breast cancer in the bones.
Often, an x-ray can tell whether you have bone metastases or not. But sometimes, the doctor has also asked for more tests to look for the signs that cancer has gone to the bones. Those other tests include:
1. Bone scan
It is a nuclear medicine test. Before doing the scan, doctors usually inject a small amount of radioactive substance into your vein. They do it as cancer will show up as dark areas on the scan after this.
2. CT (Computerized Tomography) Scan
A CT scan combines computer technology and x-ray, which provide cross-sectional images. It generally highlights the inside picture of the areas of bones.
3. MRI (Magnetic Resonance Imaging) Scan
Here, it uses a magnetic field and radio waves to see detailed pictures of the specific bone.
4. PET (Positron Emission Tomography) Scan
It is also a nuclear test. Here, radioactive tracers are used, allowing cancer cells to appear on the scan as bright spots.
Doctors sometimes do bone biopsies to get more cancer information. Metastatic cancer in the bones might have different characteristics. So, this test will help doctors determine which treatment will be effective for the patient.
When breast cancer spreads to the bones, it can not be cured but can be treated. The treatments include:
- Pain relief
- Localized Treatment
- Systemic Treatment
1. Pain Relief
Your doctor will give medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), depending on the pain level. They can prescribe narcotics as well for your pain.
2. Localized Treatment
This treatment depends on which bones are affected and how weak they have become. The treatments include:
- Radiation Therapy
This therapy is generally used to destroy cancer cells. It is usually given as a single dose or several doses for a few days.
Though surgery won’t cure the bone metastases from breast cancer but can be a part of the treatment, this treatment mainly helps stabilize the fractured bone that has become weakened due to cancer.
- Bone-strengthening Medicines
These drugs include denosumab and bisphosphonates to strengthen the bones. It reduces skeletal injuries like spinal cord compression, fracture, or other complications.
3. Systemic Treatment
The systemic treatments vary on the characteristics of cancer. It includes the hormone and the HER2 receptor status and other specific tumour markers. The treatment may include:
- Hormone therapy like tamoxifen and fulvestrant or aromatase inhibitors
- Chemotherapy like mitotic inhibitors, anti-tumour antibiotics, topoisomerase inhibitors, and corticosteroids
- Anti-HER2 drugs like trastuzumab, pertuzumab, etc.
- Immunotherapy like pembrolizumab or atezolizumab in combination with chemotherapy.
- Targeted Therapy like PAPR inhibitors, CDK4/6 inhibitors, and many more.
Bone Metastases from Breast Cancer
The bone is the most common site of breast cancer metastases. When this breast cancer reaches the bone, it is called bone metastases. But remember that bone metastases are not bone cancer.
Though cancer is in the bone, it still is breast cancer. Bone metastases can be treated with breast cancer drugs, not bone cancer drugs. So, you can have bone metastases during breast cancer diagnosis, or the breast cancer can spread to the bones later.
What to expect from your doctor?
If you go to the doctor with any symptoms, the doctor will do a physical examination first. Then, he will do a blood test and a bone scan to examine whether you have bone metastases or not.
Depending on this result and the pain in the bones, he will go for an x-ray, PET scan, or CT scan. Sometimes he can go for a tissue biopsy to confirm the diagnosis.
A tumour mainly refers to a solid mass of tissue. It generally forms when abnormal cells group together.
Bone cancer can start inside any bone, but it is most often detected in the hip and long bones (arms and legs). Bone cancer is very rare, making up less than 1% of all cancers. Moreover, noncancerous bone tumors are significantly more common than cancerous ones.
The phrase “bone cancer” refers to various malignancies that grow in the bones. The type of bone cancer depends on the type of cell and tissue where it starts. The development of cancer cells affect bone tissues and cause complications.
Pain is one of the most common and troubling symptoms of bone cancer, be it primary bone cancer (sarcoma)…
Stage 4 bone cancer is an advanced stage of bone cancer. It can also be called metastatic bone cancer. It starts to spread to other areas of the body…
When we say bone cancer, it refers to the first group of cancers mentioned above, called ‘primary bone cancer’. It belongs to a family of cancers called ‘Sarcoma’.
Dr. Chetan Anchan
MS - Orthopaedics, Diploma in Orthopaedics,
FCPS - Mid. & Gynae, MBBS
About Author - Dr. Chetan Anchan is an expert and well known orthopaedic surgeon and oncologist from Mumbai. He has a vast experience in treating all types of Malignant and Benign, Bone and Soft Tissue Tumors, and Skeletal Metastases.
To book an appointment, call: +91 – 93244 27302
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