14 March 2022, Monday

What is Stage 4 Bone Cancer?

stage-4-bone-cancer

Overview:

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, including lymph nodes and lungs. It can also lead to liver or brain involvement or both. This means that cancer that has started in one bone has now spread to other area/areas of the body.

The most common area of spread for primary bone cancer (called sarcomas) is the lung. In almost 90% of patients with metastatic bone cancer, the spread of disease is found in the lungs. The next most likely area of spread is other bones. Spread of primary bone cancer to other organs and tissues is quite rare, but not unknown.

It is important to understand that besides the possibility of being diagnosed with stage 4 disease at the time of cancer diagnosis, the spread of cancer to other organs or systems is possible long after successfully completing treatment for a localized disease with no detectable spread of disease at the time of diagnosis and treatment.

Hence, all cancer patients are advised to regularly follow-up with their doctors for several years after completing their treatment and undergo periodic investigations to screen their entire body for any possible signs of disease spread/relapse.

Symptoms of Stage 4 Bone Cancer:

The primary site of bone cancer (where the cancer has started) will cause local symptoms which are mostly pain and/or swelling. Besides this, depending on the location, size and extent of the disease, it will cause some disability with the use or function of that particular limb or joint. Rarely, in some cases it can cause a pathological fracture.

In stage 4 bone cancer, the patient may have additional symptoms besides the local symptoms mentioned in the above paragraph. At this point it is very important to know that in the beginning, a patient with stage 4 bone cancer may not display any additional symptoms and will be completely unaware of the spread of the disease.

Only when the metastatic disease in the lungs grows to a significant size and number, patients may display respiratory symptoms like breathlessness, unexplained coughing, etc. When the metastatic disease affects other bones, patients may complain of pain and/or swelling in that region.

Stage 4 bone cancer is usually diagnosed when cancer has spread to the bone. Many symptoms can help people identify if they have developed stage 4 bone cancer. Besides this, when the disease continues to grow, patients may develop loss of appetite, lose weight, become weak, etc.

Is Stage 4 bone cancer curable:

In general, diagnosis of stage 4 cancer indicates a much poorer prognosis for cure and survival in most cancers, and the same is true for primary bone cancer. Although stage 4 bone cancer generally indicates a poor prognosis for survival, it does not mean that cure is not possible.

When stage 4 bone cancer is detected early and treated properly, cure may still be possible in approx.15 to 25 % of these patients. This is especially true in those patients who did not have any symptoms of stage 4 disease and who were identified as stage 4 on routine staging investigations like CT scan of chest or PET-CT scan and in whom the spread of disease is small and limited.

So, at the time of diagnosis, all cancer patients undergo staging investigations to detect any early spread of the disease which may not be causing any symptoms at that time. Aggressive treatment may lead to cure in a small but significant number of such patients. In those where cure may not be achieved, such treatment may still improve survival.

Stage 4 bone marrow cancer life expectancy can be increased by following a healthy lifestyle, eating healthily, exercising often, and having a strong immune system. It will help keep the disease from spreading into other parts of your body, soothe your immune system, fight against any germs that may cause this type of cancer, etc.

Treatment of Stage 4 Bone Cancer:

Treatment of stage 4 bone cancer depends on the nature of the primary bone cancer. The three most common primary bone cancers are Osteosarcoma, Ewing’s Sarcoma and conventional Chondrosarcoma. In Osteosarcoma patients, the treatment is with chemotherapy and surgery. In conventional Chondrosarcoma, treatment is only with surgery and in Ewing’s Sarcoma, the treatment is with chemotherapy + surgery and/or radiotherapy.

Depending on the extent of spread of the primary disease in the lungs (and rarely in other bones), a decision is taken at the beginning of treatment as to whether to proceed with an intention to cure the patient or with an intention to provide palliative care. (A lot of other factors are also taken into consideration when making this decision.)

Often, this decision may be taken after assessing the response to the initial few cycles of chemotherapy with help of a fresh MRI, X-ray and/or PET-CT scan. When the findings are favourable, one may pursue a curative line of management with an intention to eradicate all identifiable focus of disease in the body – with appropriate surgical procedures and sometimes, in selected cases of Ewing’s sarcoma, with radiotherapy.

When the goal of treatment is to provide palliation (in cases where cure is not possible), the treatment is less aggressive and is focused on treating the patient’s symptoms rather than on eradicating the disease.

The chemotherapy dose and cycles may be adjusted to control the disease without risking major chemotherapy related issues to the patient. Role of surgery and radiotherapy again will be limited to restoring the quality of life of the patient. The whole focus is on managing pain, discomfort and disability. The idea is to make the limited life of the patient as pleasant and comfortable as possible for as long as possible with as little intervention as possible.

Conclusion:

Primary bone cancer is a serious condition with many implications. Systemic staging is an important part of the work-up of any cancer patient. Bone scan, CT scan of chest and PET-CT scan are important staging investigations in the work-up of any patient with primary bone cancer. Depending on the diagnosis, the doctor may advise one or more of these investigations for staging the disease.

Stage 4 cancer means the cancer has spread to another region/s or organ/s of the body. In general, stage 4 cancer indicates a poor prognosis for cure and survival. However, when the spread of disease is small and limited, with aggressive treatment cures may be possible in a small but significant number of stage 4 bone cancer patients. In those where cure is unlikely, treatment is directed at providing the best possible palliation which focuses on improving the quality of life of the patient to make the remaining life pain free and comfortable.

It is very important to know that spread of disease is possible even after successful completion of treatment in patients who at the time of their diagnosis and treatment did not have any detectable spread of disease. Hence a regular follow-up and periodic whole-body screening is a must for all cancer patients for a few years after completion of their cancer treatment.

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    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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