Bone metastasis

Bone metastasis

Definition:
Bone metastasis occurs when cancer cells spread from their original site to a bone. Nearly all types of cancer can spread (metastasize) to the bones. But some types of cancer are particularly likely to spread to bone, including breast cancer and prostate cancer.

Bone metastasis can occur in any bone but more commonly occurs in the pelvis and spine. Bone metastasis may be the first sign that you have cancer, or bone metastasis may occur years after cancer treatment.

Bone metastasis can cause pain and broken bones. With rare exceptions, cancer that has spread to the bones can't be cured. Treatments can help reduce pain and other symptoms of bone metastases.


Symptoms:
Signs and symptoms of bone metastasis include:

• Bone pain
• Broken bones
• Urinary incontinence
• Bowel incontinence
• Weakness in the legs
• High levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting and confusion

When to see a doctor
If you experience persistent signs and symptoms that worry you, make an appointment with your doctor. If you've been treated for cancer in the past, tell your doctor about your medical history and that you're concerned about your signs and symptoms.


Causes:
Bone metastasis occurs when cancer cells break away from the original tumor and spread to the bones, where they begin to multiply. It's believed that cancer cells arrive in the bones by traveling through the blood vessels.

Doctors aren't sure what causes some cancers to spread. And it's not clear why some cancers travel to the bones rather than to other common sites for metastasis, such as the liver.

Treatments and drugs:

Treatments for bone metastasis include medications, radiation therapy and surgery. What treatments are best for you will depend on the specifics of your situation.
Medications
Medications used in people with bone metastasis include:

• Bone-building medications. Drugs commonly used to treat people with thinning bones (osteoporosis) may also help people with bone metastasis. These medications can strengthen bones and reduce the pain caused by bone metastasis, reducing the need for strong pain medications. Bone-building medications may also reduce your risk of developing new bone metastasis. These drugs can be administered every few weeks through a vein in your arm or through an injection. Bone-building medications can cause temporary bone pain and kidney problems. They increase your risk of a rare but serious deterioration of your jawbone (avascular osteonecrosis).
  
• Chemotherapy. If cancer has spread to multiple bones, your doctor may recommend chemotherapy. Chemotherapy travels throughout your body to fight cancer cells. Chemotherapy can be taken as a pill, administered through a vein or both. Side effects depend on the specific chemotherapy drugs you are given.
  
• Hormone therapy. For cancers that are sensitive to hormones in the body, treatment to suppress those hormones may be an option. Breast cancers and prostate cancers are often sensitive to hormone-blocking treatments. Hormone therapy can involve taking medications to lower natural hormone levels or medications that block the interaction between hormones and cancer cells. Another option is surgery to remove hormone-producing organs — in women, the ovaries, and in men, the testes.
  
• Pain medications. Pain medications may control the pain caused by bone metastasis. Pain medications may include over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others), or strong prescription pain relievers, such as morphine (Avinza, MS Contin, others). It may take time to determine what combination of pain medications works best for you. If you're taking medications but still experiencing pain, tell your doctor.

External radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be an option if your bone metastasis is causing pain that isn't controlled with pain medications. Depending on your situation, radiation to the bone can be administered in one large dose or several smaller doses over many days. Side effects of radiation depend on the site being treated. In general, radiation therapy causes skin redness and fatigue.
Surgery
Surgical procedures can help stabilize a bone that is at risk of breaking or repair a broken bone.

• Surgery to stabilize the bone. If the bone is in danger of breaking due to bone metastasis, surgeons can stabilize the bone using metal plates, screws and nails (orthopedic fixation). Orthopedic fixation can relieve pain and improve function. Often, radiation therapy is given after you have healed from surgery.
  
• Surgery to inject a bone with cement. Bones that can't be easily reinforced with metal plates or screws, such as pelvic bones and bones in the spine, may benefit from bone cement. Doctors inject bone cement into a bone that is broken or damaged by bone metastasis. This procedure can reduce pain.
  
• Surgery to repair a broken bone. If bone metastasis has caused a bone to break, surgeons may work to repair the bone. This involves using metal plates, screws and nails to stabilize the bone. Joint replacement, such as a hip replacement, may be another option. In general, broken bones caused by bone metastasis aren't helped by placing a cast on the broken bone.

Heating and freezing cancer cells
Procedures to damage cancer cells with heat or cold may help control pain. These procedures may be an option if you have one or two areas of bone metastasis and aren't helped by other treatments.
During a procedure called radiofrequency ablation, a needle containing an electric probe is inserted into the bone tumor. Electricity passes through the probe and heats the surrounding tissue. The tissue is allowed to cool down, and the process is repeated. A similar procedure called cryoablation freezes the tumor and then allows it to thaw. The process is repeated multiple times.
Side effects can include damage to nearby structures, such as nerves, and damage to bones that can increase the risk of a broken bone.

Intravenous radiation
For people with multiple bone metastases, a form of radiation called radiopharmaceuticals can be given through a vein. Radiopharmaceuticals use low levels of radioactive material that has a strong attraction to bones. Once in your body, the particles travel to the areas of bone metastasis and release their radiation.

Radiopharmaceuticals can help control pain caused by bone metastasis. This treatment doesn't require a hospital stay, and you won't be radioactive after treatment. Side effects can include damage to the bone marrow, which can lead to low blood cell counts.

Clinical trials
Clinical trials are studies of new treatments and new ways of using existing treatments. Enrolling in a clinical trial gives you the chance to try the latest treatments. But a cure isn't guaranteed, and the side effects of new treatments may not be known. Discuss the available clinical trials with your doctor.

Physical therapy
A physical therapist can work with you to devise a plan that will help you increase your strength and improve your mobility. A physical therapist may suggest assistive devices to help you cope. Examples might include crutches or a walker to take weight off an affected bone while walking, a cane to improve balance, or a brace to stabilize the spine. A physical therapist may also suggest specific exercises to help you keep your strength up and reduce your pain.

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Bone cancer

Bone cancer

Definition:
Bone cancer is an uncommon cancer that begins in a bone. Bone cancer can begin in any bone in the body, but it most commonly affects the long bones that make up the arms and legs.

Several types of bone cancer exist. Some types of bone cancer occur primarily in children, while others affect mostly adults.

The term "bone cancer" doesn't include cancers that begin elsewhere in the body and spread (metastasize) to the bone. Instead, those cancers are named for where they began, such as breast cancer that has metastasized to the bone. Bone cancer also doesn't include blood cell cancers, such as multiple myeloma and leukemia, that begin in the bone marrow — the jelly-like material inside the bone where blood cells are made.


Symptoms:

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Broken bone
• Fatigue
• Unintended weight loss

When to see a doctor
Make an appointment with your doctor if you or your child develops signs and symptoms that worry you.


Causes:
It's not clear what causes most bone cancers. Doctors know bone cancer begins as an error in a cell's DNA. The error tells the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Types of bone cancer
Bone cancers are broken down into separate types based on the type of cell where the cancer began. The most common types of bone cancer include:

• Osteosarcoma. Osteosarcoma begins in the bone cells. Osteosarcoma occurs most often in children and young adults.
• Chondrosarcoma. Chondrosarcoma begins in cartilage cells that are commonly found on the ends of bones. Chondrosarcoma most commonly affects older adults.
• Ewing's sarcoma. It's not clear where in bone Ewing's sarcoma begins. Scientists believe Ewing's sarcoma may begin in nerve tissue within the bone. Ewing's sarcoma occurs most often in children and young adults.

Treatments and drugs:
The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.

Surgery
The goal of surgery is to remove the entire bone cancer. To accomplish this, doctors remove the tumor and a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

• Surgery to remove a limb. Bone cancers that are large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. You'll likely be fitted with an artificial limb after surgery and will go through training to learn to do everyday tasks using your new limb.
• Surgery to remove the cancer, but spare the limb. If a bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another area of your body or with a special metal prosthesis.
• Surgery for cancer that doesn't affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body or with a special metal prosthesis.

Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body.
Radiation therapy may be used in people with bone cancer that can't be removed with surgery. Radiation therapy may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.
Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout your body.
Chemotherapy alone or combined with radiation therapy is often used before surgery to shrink a bone cancer to a more manageable size that allows the surgeon to perform a limb-sparing surgery. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.

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Boils and carbuncles

Boils and carbuncles.

Definition:
Boils and carbuncles are painful, pus-filled bumps that form under your skin when bacteria infect and inflame one or more of your hair follicles.

Boils (furuncles) usually start as red, tender lumps. The lumps quickly fill with pus, growing larger and more painful until they rupture and drain. A carbuncle is a cluster of boils that form a connected area of infection under the skin.

You can usually care for a single boil at home, but don't attempt to prick or squeeze it — that may spread the infection. Call your doctor if a boil or carbuncle is extremely painful, lasts longer than two weeks or occurs with a fever.

Symptoms:

Boils
Boils can occur anywhere on your skin, but appear mainly on your face, neck, armpits, buttocks or thighs — hair-bearing areas where you're most likely to sweat or experience friction. Signs and symptoms of a boil usually include:

• A painful, red bump that starts out about the size of a pea
• Red, swollen skin around the bump
• An increase in the size of the bump over a few days as it fills with pus (can sometimes reach the size of a golf ball)
• Development of a yellow-white tip that eventually ruptures and allows the pus to drain out.

Once the boil drains, the pain usually subsides. Small boils usually heal without scarring, but a large boil may leave a scar.

Carbuncles
A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs. Carbuncles:

• Cause a deeper and more severe infection than single boils do
• Develop and heal more slowly than single boils do
• Are likely to leave a scar

Signs and symptoms that may accompany carbuncles include:

• Feeling unwell in general
• Fever
• Chills

When to see a doctor
You usually can care for a single, small boil yourself. But see your doctor if you have:

• A boil on your face or spine
• A boil that worsens rapidly or is extremely painful
• Boils that are very large, haven't healed in two weeks or are accompanied by a fever
• Frequent boils
• A condition that suppresses your immune system, such as an organ transplant, corticosteroid use or an HIV infection
• Recently been hospitalized

Children and older adults who develop one or more boils also should receive medical care.

Causes:
Boils usually form when one or more hair follicles — the tube-shaped shafts from which hair grows — become infected with staph bacteria (Staphylococcus aureus). These bacteria, which normally inhabit your skin and sometimes your throat and nasal passages, are responsible for a number of serious diseases, including pneumonia and endocarditis — an infection of the lining of your heart. They're also a major cause of hospital-acquired infections.

Staph bacteria that cause boils generally enter through a cut, scratch or other break in your skin. As soon as this occurs, specialized white blood cells called neutrophils rush to the site to fight the infection. This leads to inflammation and eventually to the formation of pus — a mixture of old white blood cells, bacteria and dead skin cells.


Complications:
Complications of boils and carbuncles are generally few, but can be serious. They include:

• Blood poisoning. In some cases, bacteria from a boil or more commonly, a carbuncle, can enter your bloodstream and travel to other parts of your body. The spreading infection, commonly known as blood poisoning (sepsis), can lead to infections deep within your body, such as your heart (endocarditis) and bone (osteomyelitis). Blood poisoning itself — which is characterized by high fever, rapid breathing and elevated heart rate — can lead to septic shock, a life-threatening state of extremely low blood pressure.
• MRSA. Another potentially serious problem is the emergence of drug-resistant strains of Staphylococcus aureus. Up to half of the staph bacteria found in hospitals are resistant to many commonly used antibiotics, including methicillin. Methicillin-resistant staphylococcus aureus (MRSA) has led to the use of alternative antibiotics, such as vancomycin, but some strains of staph bacteria have become less susceptible to vancomycin, too. Although MRSA is often acquired in a hospital setting, it can be spread in the general community, as well.

Treatments and drugs:
You can generally treat small boils at home by applying warm compresses to relieve pain and promote natural drainage.
For larger boils and carbuncles, treatment usually includes draining the boil with an incision and sometimes taking antibiotics:

• Incision and drainage. Your doctor may drain a large boil or carbuncle by making a small incision in the tip. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely drained may be packed with sterile gauze so that pus can continue to drain.
• Antibiotics. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections, or infections that may be caused by MRSA.

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