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How long does cancer live when spreads to bones?

Most patients with metastatic bone disease survive for 6-48 months. In general, patients with breast and prostate carcinoma live longer than those with lung carcinoma. Patients with renal cell or thyroid carcinoma have a variable life expectancy.

emedicine.medscape.com - Metastatic Bone Disease - Medscape Reference

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Metastatic bone disease occurs when cancer spreads from a primary organ site to bone. The spine is the most common location of metastatic disease. See the image below. Lateral radiograph shows sclerotic metastasis of the L2 vertebra in a 54-year-old man with prostatic carcinoma. View Media Gallery

Diagnosis

Pain is an important symptom of musculoskeletal metastases, but it is nonspecific. The pain pattern can be helpful if, in addition to being activity related, it is present at rest and at night, especially in patients older than 50 years. However, this pain pattern can be present in patients with osteomyelitis and Paget disease, and in these instances, it is also nonspecific.

Testing

Laboratory tests that can be used to aid in the diagnosis of metastatic bone disease include the following:

Serum alkaline phosphatase: Indirect reflection of bone destruction

Serum protein electrophoresis

Urinalysis, urine protein electrophoresis

N-telopeptide of type II collagen: Marker of bone resorption but not widely used

Imaging studies

The following radiologic studies may be used to evaluate metastatic bone disease:

Radiography: For the basic assessment of the extent of a tumor and the degree of cortical erosion; can also be used for skeletal survey in patients with multiple myeloma Computed tomography: Most sensitive imaging modality to detect bone destruction, providing the best assessment of the extent of cortical destruction Magnetic resonance imaging: Most sensitive study for the assessment of the anatomic (intramedullary and extraosseous) extent of a lesion Bone scanning: Very sensitive study for the detection of occult lesions and the assessment of the biologic activity of lesions Angiography: Depicts devascularization of vascular metastases; may also be used to assess pain palliation in patients with nonresectable metastases

Procedures

Biopsies should be obtained from any soft-tissue mass or, if no soft-tissue mass is present, from the most accessible bone in a mechanically safe area (eg, metaphysis vs diaphysis, acetabulum vs subtrochanteric femur). In selected patients with metastatic disease of the spine, the following diagnostic procedures may be performed:

Percutaneous core needle biopsy

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Open biopsy

See Workup for more detail.

Management

The life span of patients with metastatic bone disease is limited; thus, the goal of management needs to be centered on returning as much function as possible as rapidly as possible. Patients with metastatic bone disease are generally treated with surgery or radiation therapy.

Radiation therapy

Radiation therapy remains a primary therapeutic modality for the treatment of spinal metastasis, because nearly 95% of patients who are ambulatory at the start of radiation therapy remain so. Consequently, the possibility of regaining cord function once it is lost as a result of spinal metastasis is dismal. Therefore, such loss needs to be avoided by early diagnosis, treatment, and, if indicated, surgical intervention.

Surgery

The goals of surgical intervention for spinal surgery in patients with metastatic bone disease includes decreasing or eliminating pain, decompressing neural elements to protect cord function, and mechanically stabilizing the spine. [1, 2] Anterior or posterolateral decompression, combined with anteroposterior reconstruction, may be used in the following:

Diagnostic spinal surgery

Cervical spinal surgery

Thoracic and lumbar spinal surgery

Vertebroplasty, in which polymethylmethacrylate is percutaneously introduced, may be a minimally invasive treatment alternative for patients with one- or two-level vertebral body compression fractures. [3] For the management of long-bone metastatic disease accompanied by an impending or completed fracture, open internal fixation is usually the preferred method of treatment. Stabilization with a locked intramedullary device followed by radiation therapy to the entire bone as soon as the surgical wounds have healed is preferred. [4] Devices and/or procedures used in the surgical fixation of long bones include the following:

Standard or cemented stems

Dynamic hip screws or plates

Intramedullary fixation devices

Total hip arthroplasty

Pharmacotherapy

Medications used in the treatment of metastatic bone disease include the following:

Monoclonal antibody antineoplastic agents (eg, denosumab)

Calcium metabolism modifiers/bisphosphonates (eg, pamidronate, zoledronate, and ibandronate)

See Treatment and Medication for more detail.

emedicine.medscape.com - Metastatic Bone Disease - Medscape Reference

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