DOCSLIB.ORG

Managing Bone Metastasis in the Patient with Advanced Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Managing Bone Metastasis in the Patient with Advanced Cancer 2.0 ANCC Contact Hours Managing Bone Metastasis in the Patient With Advanced Cancer Lisa Monczewski Bone is the third most common site of cancer metastasis internal fi xation with a plate to her right humerus (see resulting in pain and other serious morbidities that can Figures 1 and 2 ). Mrs. A’s medical history includes a di- affect one’s quality of life. The orthopaedic patient with agnosis of Stage IIIA invasive ductal carcinoma of the bone metastasis faces many challenges and has complex right breast in 2006, at which time she underwent a nursing care needs. Managing care involves astute right mastectomy with lymph node dissection (with assessment skills, knowledge of treatments including four positive lymph nodes) and completed eight cycles of chemotherapy. Mrs. A also had radiation therapy to medication, surgery, and radiation therapy, and recognition the breast and axillary area following chemotherapy of serious complications such as fracture, spinal cord and she was started on hormone therapy to further compression, and hypercalcemia. Nurses play a vital role in decrease the risk of cancer recurrence. the patient treatment plan by implementing interventions For the next 5 years, Mrs. A did well as she continued that promote positive outcomes and prevent injuries. on hormone therapy and with routine follow-up visits and scans. However, in 2011, Mrs. A was diagnosed with bone metastasis to the right pelvis following a bone ore than 1.6 million people in the United scan. She began treatment with intravenous bisphos- States are expected to be diagnosed with phonate therapy every 4 weeks and another course of cancer this year (American Cancer Society, chemotherapy. Bisphosphonate therapy continued for 2012a). The leading cause of death among the next several months. Mpatients with cancer is metastatic disease. The bone is A few weeks ago, during one of Mrs. A’s follow-up the third most common site for cancer to spread to after visits, she reported new-onset sharp pain to her right the liver and lungs (Narazaki, Alverga Neto, Baptista, upper arm. She rated it as a 5/10 and noted that it in- Caiero, & DeCamargo, 2006). Breast, prostate, lung, creased in intensity with mobility. The medical oncolo- thyroid, and kidney cancers are the types of solid tumor gist ordered radiographs, which confi rmed the presence cancers that are most likely to spread to the bone of metastatic bone lesions and a fracture to the right (Narazaki et al., 2006 ). Multiple myeloma, which is a humerus. At that time she was referred to an orthopae- cancer of the plasma cells in the bone marrow, can dic surgeon for evaluation and surgery followed. invade the skeleton and form bone lesions. The spine, pelvis, femur, humerus, ribs, and skull are the most common sites of bone metastasis, although it can occur Pathophysiology anywhere in the skeleton (American Cancer Society, Bone remodeling is a physiologic process by which the 2012b). existing bone is resorbed and replaced with a new bone. This article examines the nursing management of a This process occurs when bone is exposed to stimuli patient with bone metastasis, including pain assessment, such as mechanical stress, hormones, drugs, or vita- recognition of serious complications, and treatment in- mins that activate bone cell apoptosis (Crowther- terventions. Insight into these areas will facilitate a better Radulewicz, 2010 ). In the normal remodeling cycle, a understanding of how bone metastasis can be managed structured balance exists between osteoclast cells to improve patient outcomes and increase quality of life. degrading and resorbing bone and osteoblasts building The case study described later illustrates how a patient new bone. Growth factors and hormones released dur- with cancer may present on an orthopaedic unit after ing bone remodeling play a role in regulating osteoclast being diagnosed with bone metastasis. and osteoblast activity (Reich, 2003 ). Case Study Lisa Monczewski, MSN, RN, OCN, Senior Clinical Nurse, University Mrs. A is a 60-year-old woman who has suffered a path- Hospitals Case Medical Center, Seidman Cancer Center, Cleveland, OH. ologic fracture of her right humerus as a result of breast The author has disclosed that she has no fi nancial interests to any cancer that has metastasized to her bone. She is recov- commercial company related to this educational activity. ering postoperatively following an open reduction and DOI: 10.1097/NOR.0b013e31829a4da3 © 2013 by National Association of Orthopaedic Nurses Orthopaedic Nursing • July/August 2013 • Volume 32 • Number 4 209 Copyright © 2013 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. NNOR200401.inddOR200401.indd 220909 004/07/134/07/13 55:21:21 PPMM F IGURE 1 . Permeative lytic lesion within the mid humeral diaphysis with a demonstrated transverse pathologic fracture. A disruption in the normal bone remodeling cycle The nurse should begin the review of systems with a occurs when cancer cells invade the bone matrix. focus on the patient’s pain. When caring for a patient Tumor cells reach the bone by detaching from the site with a known history of cancer, any report of new onset of the primary tumor, entering the vasculature, and ad- bone pain must be evaluated. The National hering to the capillaries of the bone (Albert, 2007 ). This Comprehensive Cancer Network (NCCN) guidelines for migration of cells into the bone further stimulates bone adult cancer pain include several components (NCCN, disintegration and the release of more growth factors 2012a). A quantifi ed pain intensity score should be ob- near the cancer cells (Fitch et al., 2009 ). Tumor cells tained using numerical rating scale when possible. The release their own growth factors in the bone and more nurse should perform a formal comprehensive pain as- bone degradation takes place (Albert, 2007 ). A vicious sessment asking the patient specifi c questions including cycle begins as more growth factor stimulates local location, duration, intensity, and the character of the tumor cell growth and more bone destruction. pain. The use of body sketch diagrams as part of the Metastatic lesions can be characterized as osteolytic, pain assessment documentation is helpful if pain occurs osteoblastic, or mixed (see Table 1 ). in more than one location. The nurse should ask the patient to describe what aggravates the pain and what relieves it, including an analgesic history. Often, pain Assessment related to bone metastasis is described as constant and Pain is the hallmark symptom of bone metastasis and usu- dull and is greater in intensity at night and with weight ally develops gradually (Albert, 2007 ). This type of pain is bearing (Reich, 2003 ). The physical examination should thought to result from tumor growing into the bone and include noting areas of edema, tenderness, decreased stimulating nerve endings in and around the bone. The range of motion, or abnormal positioning. pain may also be caused by the tumor stretching the peri- If bone metastasis is suspected, the nurse should no- osteum of the affected bone (Johnson & Knobf, 2008). tify the patient’s oncology physician or practitioner and F IGURE 2 . Placement of a lateral plate and screws at the pathologic fracture site of the mid humeral diaphysis. 210 Orthopaedic Nursing • July/August 2013 • Volume 32 • Number 4 © 2013 by National Association of Orthopaedic Nurses Copyright © 2013 by National Association of Orthopaedic Nurses. Unauthorized reproduction of this article is prohibited. NNOR200401.inddOR200401.indd 221010 004/07/134/07/13 55:21:21 PPMM although any tumor can cause SCC (Lewis, Hendrickson, TABLE 1. FEATURES OF METASTATIC BONE LESIONS & Moynihan, 2011). Spinal cord compression is an Type of oncologic emergency with early recognition and inter- Metastatic Associated vention crucial to patient outcomes. About 75%–100% Bone Lesions Characteristics Cancers of patients who are able to ambulate prior to SCC will Osteolytic • Increased bone breakdown • Lung remain ambulatory after treatment (Colen, 2008 ). causing bone erosion • Multiple However, of the patients who are experiencing partial or • Appear as punched out myeloma full paralysis prior to therapy, only 15%–30% will regain areas on x-ray • Kidney • More likely than • Breast function (Colen, 2008 ). Early signs of SCC include back osteoblastic lesions to • Thyroid pain, constipation, urinary retention, and incontinence. cause pathologic fracture Later signs are weakness, sensory impairment, and Osteoblastic • Increased sclerotic bone • Prostate sensory loss. Intravenous corticosteroids administered formations • Breast immediately are needed to decrease swelling, halt progression of neurologic symptoms, and reduce pain. Mixed • Include features of both • Breast Treatment may include surgery, external beam radia- osteolytic and osteoblastic tion therapy, or both, depending on degree of compres- Note : Based on the information from “Evaluating Bone sion, spinal column stability, and radiosensitivity of the Metastases,” by K. Albert, 2007, Clinical Journal of Oncology Nursing , 11 (2), pp. 193–197; and “Advances in the Treatment tumor (Lewis et al., 2011 ). of Bone Metastases,” by J. Reich, 2003, Clinical Journal of Oncology Nursing , 7 (6), pp. 641–646. HYPERCALCEMIA Approximately one-third of patients with cancer will ex- perience hypercalcemia at some point in the course of prepare the patient for diagnostic testing. This may their disease (Lewis et al., 2011 ). Eighty percent of ma- include
Load more

Recommended publications
  • When Cancer Spreads to the Bone
    When Cancer Spreads to the Bone John U. (pictured) was diagnosed with kidney cancer which metastasized to the bone over 10 years ago. Since then, he has had over a dozen procedures to stabilize his bones. Cancer occurs when cells in your body their cancer has spread to their bones. start growing and dividing faster than is booklet explains: normal. At rst, these cells may form into • Why bone metastases occur small clumps or tumors. But they can • How they are treated also spread to other parts of the body. When cancer spreads, it is said to have • What patients with bone metastases can “metastasized.” do to prevent broken bones and fractures It is possible for many types of cancer to spread to the bones. People with cancer can live for years after they have been told What is Bone? BONE ANATOMY Many people don’t spend much time thinking about their bones. But there’s a lot going on Trabecular Bone inside them. Bone is living, growing tissue, Blood vessels in bone marrow made up of proteins and minerals. Your bones have two layers. The outer layer— called cortical bone— is very thick. The inner layer—the trabecular (truh-BEH-kyoo-ler) bone—is very spongy. Inside the spongy bone is your bone marrow. It contains stem cells that can develop into white blood cells, red blood cells, and platelets. Cortical Bone The cells that make up the bones are always changing. There are three types of cells that are found only in bone: Osteoclasts (OS-tee-oh-klast), which break down the bone LLC, US Govt.
    [Show full text]
  • Atacicept (TACI-Ig) Inhibits Growth of TACI High Primary Myeloma Cells in SCID-Hu Mice and in Coculture with Osteoclasts
    Leukemia (2008) 22, 406–413 & 2008 Nature Publishing Group All rights reserved 0887-6924/08 $30.00 www.nature.com/leu ORIGINAL ARTICLE Atacicept (TACI-Ig) inhibits growth of TACIhigh primary myeloma cells in SCID-hu mice and in coculture with osteoclasts S Yaccoby1, A Pennisi1,XLi1, SR Dillon2, F Zhan1, B Barlogie1 and JD Shaughnessy Jr1 1Myeloma Institute for Research and Therapy, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA and 2ZymoGenetics Inc., Seattle, WA, USA APRIL (a proliferation-inducing Ligand) and BLyS/BAFF activity in patients with myeloma results in partial or no (B-lymphocyte stimulator/B-cell-activating factor of the TNF response,9,10 suggesting that additional growth factors and/or (tumor necrosis factor) family have been shown to be the cell-to-cell interactions may be involved in the growth and survival factors for certain myeloma cells in vitro. BAFF binds to the TNF-related receptors such as B-cell maturation antigen survival of myeloma cells within the BM. (BCMA), transmembrane activator and CAML interactor (TACI) Two TNF (tumor necrosis factor) family members known to and BAFFR, whereas APRIL binds to TACI and BCMA and to play key roles in normal B-cell biology, BLyS/BAFF (B- heparan sulfate proteoglycans (HSPG) such as syndecan-1. lymphocyte stimulator/B cell activating factor of the TNF family) TACI gene expression in myeloma reportedly can distinguish and APRIL (A PRoliferation-Inducing Ligand), also promote tumors with a signature of microenvironment dependence high low the survival of various malignant B-cell types, including (TACI ) versus a plasmablastic signature (TACI ).
    [Show full text]
  • ASTRO Bone Metastases Guideline-Full Version
    1 Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline Stephen T. Lutz, M.D.,* Lawrence B. Berk, M.D., Ph.D.,† Eric L. Chang, M.D.,‡ Edward Chow, M.B.B.S.,§ Carol A. Hahn, M.D.,║ Peter J. Hoskin, M.D.,¶ David D. Howell, M.D.,# Andre A. Konski, M.D.,** Lisa A. Kachnic, M.D.,†† Simon S. Lo, M.B. ChB,§§ Arjun Sahgal, M.D.,║║ Larry N. Silverman, M.D.,¶¶ Charles von Gunten, M.D., Ph.D., FACP,## Ehud Mendel, M.D., FACS,*** Andrew D. Vassil, M.D.,††† Deborah Watkins Bruner, R.N., Ph.D.,‡‡‡ and William F. Hartsell, M.D.§§§ * Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, Ohio; † Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida; ‡ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; § Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada; ║ Department of Radiation Oncology, Duke University, Durham, North Carolina; ¶ Mount Vernon Centre for Cancer Treatment, Middlesex, UK; # Department of Radiation Oncology, University of Michigan, Mt. Pleasant, Michigan; ** Department of Radiation Oncology, Wayne State University, Detroit, Michigan; †† Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts; §§ Department of Radiation Oncology, Ohio State University, Columbus, Ohio; ║║ Department of Radiation Oncology, Sunnybrook Odette Cancer Center and the Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; ¶¶ 21st Century Oncology, Sarasota, Florida; ## The Institute for Palliative Medicine, San Diego Hospice, San Diego, California; *** Neurological Surgery, Ohio State University, Columbus, Ohio; ††† Department of Radiation Oncology, The Cleveland Clinic 2 Foundation, Cleveland, Ohio; ‡‡‡ School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; §§§ Department of Radiation Oncology, Good Samaritan Cancer Center, Downers Grove, Illinois Reprint requests to: Stephen Lutz, M.D., 15990 Medical Drive South, Findlay, OH 45840.
    [Show full text]
  • Prostate Cancer: Role of SPECT and PET in Imaging Bone Metastases Mohsen Beheshti, MD, FEBNM, FASNC,* Werner Langsteger, MD, FACE,* and Ignac Fogelman, Bsc, MD, FRCP†
    Prostate Cancer: Role of SPECT and PET in Imaging Bone Metastases Mohsen Beheshti, MD, FEBNM, FASNC,* Werner Langsteger, MD, FACE,* and Ignac Fogelman, BSc, MD, FRCP† In prostate cancer, bone is the second most common site of metastatic disease after lymph nodes. This is related to a poor prognosis and is one of the major causes of morbidity and mortality in such patients. Early detection of metastatic bone disease and the definition of its extent, pattern, and aggressiveness are crucial for proper staging and restaging; it is particularly important in high-risk primary disease before initiating radical prostatectomy or radiation therapy. Different patterns of bone metastases, such as early marrow-based involvement, osteoblastic, osteolytic, and mixed changes can be seen. These types of metastases differ in their effect on bone, and consequently, the choice of imaging modal- ities that best depict the lesions may vary. During the last decades, bone scintigraphy has been used routinely in the evaluation of prostate cancer patients. However, it shows limited sensitivity and specificity. Single-photon emission computed tomography increases the sensitivity and specificity of planar bone scanning, especially for the evaluation of the spine. Positron emission tomography is increasing in popularity for staging newly diag- nosed prostate cancer and for assessing response to therapy. Many positron emission tomography tracers have been tested for use in the evaluation of prostate cancer patients based on increased glycolysis (18F-FDG), cell membrane proliferation by radiolabeled phospholipids (11C and 18F choline), fatty acid synthesis (11C acetate), amino acid transport and protein synthesis (11C methionine), androgen receptor expression (18F-FDHT), and osteoblastic activity (18F-fluoride).
    [Show full text]
  • Analgesic Activity of High-Dose Intravenous Calcitonin in Cancer Patients with Bone Metastases
    871-875 11/9/06 13:40 Page 871 ONCOLOGY REPORTS 16: 871-875, 2006 871 Analgesic activity of high-dose intravenous calcitonin in cancer patients with bone metastases NICOLAS TSAVARIS1, PETROS KOPTERIDES1, CHRISTOS KOSMAS2, MARIA VADIAKA1, ANTONIOS DIMITRAKOPOULOS1, HELIAS SCOPELITIS1, ROXANNI TENTA1, GEORGE VAIOPOULOS1 and CHRISTOS KOUFOS1 1Department of Pathophysiology, Oncology Unit, ‘Laiko’ General Hospital, University of Athens School of Medicine, Athens; 22nd Department of Oncology, ‘Metaxa’ Hospital, Piraeus, Greece Received January 24, 2006; Accepted April 17, 2006 Abstract. We undertook a prospective, nonrandomized study progression of the underlying disease (1). Primary malignant with the objective to evaluate the efficacy of salmon calcitonin bone tumors are relatively uncommon but approximately (sCT) in controlling pain secondary to bone metastases. Our 80% of patients with breast, lung and prostate cancer develop study population consisted of 45 cancer patients with bone bone metastases (2). More than half of these patients suffer metastases (26 men) with a mean age of 64 years (range, 48- from pain and functional disability and approximately 20% 70) who had completed chemotherapy, hormonal therapy and experience a bone fracture and/or hypercalcemia (3). The fact radiation therapy at least 30 days prior to enrollment in the that approximately 1 in 3 individuals in the developed world study, and had intractable pain despite the use of common develops cancer and almost half of them die of progressive analgesics (acetaminophen, nonsteroidal anti-inflammatory disease highlights the magnitude of the problem of metastatic agents, opioids) and bisphosphonates. The study medication bone disease (4). was a 300-IU dose of sCT administered intravenously daily Multiple modalities are used nowadays to manage meta- for 5 consecutive days and repeated every two weeks until no static bone pain.
    [Show full text]
  • Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians
    cancers Review Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians Fabio Marazzi 1, Armando Orlandi 2, Stefania Manfrida 1 , Valeria Masiello 1,* , Alba Di Leone 3, Mariangela Massaccesi 1, Francesca Moschella 3, Gianluca Franceschini 3,4 , Emilio Bria 2,4, Maria Antonietta Gambacorta 1,4, Riccardo Masetti 3,4, Giampaolo Tortora 2,4 and Vincenzo Valentini 1,4 1 “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario, 00168 Roma, Italy; [email protected] (F.M.); [email protected] (S.M.); [email protected] (M.M.); [email protected] (M.A.G.); [email protected] (V.V.) 2 “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario, 00168 Roma, Italy; [email protected] (A.O.); [email protected] (E.B.); [email protected] (G.T.) 3 “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario, 00168 Roma, Italy; [email protected] (A.D.L.); [email protected] (F.M.); [email protected] (G.F.); [email protected] (R.M.) 4 Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Roma, Italy * Correspondence: [email protected] Received: 1 May 2020; Accepted: 20 August 2020; Published: 24 August 2020 Abstract: The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms.
    [Show full text]
  • When Cancer Spreads to the Bone
    When Cancer Spreads to the Bone What is bone metastasis? As a cancerous tumor grows, cancer cells may break away and be carried to other parts of the body by the blood or lymphatic system. This is called metastasis. It is called metastases when there are multiple areas in the bone with cancer. One of the most common places cancer spreads to is the bones, especially cancers of the breast, prostate, kidney, thyroid, and lung. When a new tumor develops in the bones as a result of metastasis, it is not called bone cancer. Instead, it is named after the area in the body where the cancer started. For example, lung cancer that spreads to the bones is called metastatic lung cancer. What are the symptoms of bone metastasis? When cancer spreads to the bones, the bones can become weak or fragile. Bones most commonly affected include the upper leg bones, the upper arm bones, the spine, the ribs, the pelvis, and the skull. Bone pain is the most common symptom. Bone breaks, called fractures, may also occur. Bones damaged by cancer may ONCOLOGY. CLINICAL SOCIETY AMERICAN OF 2004 © LLC. EXPLANATIONS, MORREALE/VISUAL ROBERT BY ILLUSTRATION also release high levels of calcium into the blood, called hypercalcemia, which may be detected in your blood work. If the cancer is advanced, this can cause nausea, fatigue, thirst, frequent urination, and confusion. If a tumor presses on the spinal cord, a person may feel weakness or numbness in the legs, arms, or abdomen, or develop constipation or the inability to control urination.
    [Show full text]
  • Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them
    Journal of Clinical Medicine Review Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them Angelica Petrillo 1,2,* , Emilio Francesco Giunta 1,2 , Annalisa Pappalardo 1,2, Davide Bosso 1, Laura Attademo 1, Cinzia Cardalesi 1, Anna Diana 1,2 , Antonietta Fabbrocini 1, Teresa Fabozzi 1, Pasqualina Giordano 1, Margaret Ottaviano 1,3,4 , Mario Rosanova 1, Antonia Silvestri 1, Piera Federico 1 and Bruno Daniele 1 1 Medical Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; [email protected] (E.F.G.); [email protected] (A.P.); [email protected] (D.B.); [email protected] (L.A.); [email protected] (C.C.); [email protected] (A.D.); [email protected] (A.F.); [email protected] (T.F.); [email protected] (P.G.); [email protected] (M.O.); [email protected] (M.R.); [email protected] (A.S.); [email protected] (P.F.); [email protected] (B.D.) 2 Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Naples, Italy 3 Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy 4 CRCTR Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy * Correspondence: [email protected] Abstract: Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported Citation: Petrillo, A.; Giunta, E.F.; in the literature.
    [Show full text]
  • Back Pain in a Cancer Patient: a Case Study Lucinda Morris Peter Gorayski Sandra Turner
    CLINICAL Back pain in a cancer patient: a case study Lucinda Morris Peter Gorayski Sandra Turner Answer 1 Keywords therapy, palliative; neoplasm metastasis; radiotherapy General inspection for cachexia, anaemia and gait assessment should be performed, as well as neurological examination of the upper and lower Case limbs. Examine the lower back for bony tenderness. A man aged 78 years presented to his general practitioner with new-onset low back Answer 2 pain. The patient had metastatic prostate The differential diagnoses include: cancer, which was diagnosed 2 years ago, • osteoarthritis and a solitary asymptomatic bone metastasis • musculoskeletal strain in the right pubic bone. To date, he had • osteoporotic crush fracture. been managed with androgen deprivation Given the history, a new bone metastasis should be therapy (goserelin) alone. His performance considered. status was good and his prostate-specific antigen (PSA) level stable. His past medical Answer 3 history included hyperlipidaemia and atrial fibrillation. He was on atorvastatin and Malignant spinal cord compression (MSCC) and cauda warfarin. He had no known allergies, was a equina syndrome should be excluded. Symptoms non-smoker and did not drink alcohol. may include worsening back pain, weakness in the He reported a 6-week history of constant, lower limbs, altered sensation and bladder or bowel burning pain in the lower lumbar region, incontinence. MSCC is an emergency and warrants which was worse at night and was 7/10 in urgent referral to a radiation oncologist within severity on the Numeric Pain Rating Scale. 12–24 hours to prevent irreversible progression to He had no relief with regular paracetamol paraplegia.1 Referral can be made directly to the or ibuprofen.
    [Show full text]
  • Download This Topic [PDF]
    cancer.org | 1.800.227.2345 Advanced and Metastatic Cancer Advanced cancers are not usually curable, but can be treatable. Symptom management is also an important part of treatment for advanced cancer. ● Understanding Advanced and Metastatic Cancer ● Managing Advanced Cancer ● Bone Metastases ● Brain Metastases ● Liver Metastases ● Lung Metastases ● Coping with Advanced and Metastatic Cancer Understanding Advanced and Metastatic Cancer If you or a loved one is told that you have advanced cancer, it’s very important to find out exactly what the doctor means. Some may use the term to describe metastatic cancer, while others might use it in other situations. Be sure you understand what the doctor is talking about and what it means for you. What is advanced cancer? Advanced cancer is most often used to describe cancers that cannot be cured. This 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 means cancers that won’t totally go away and stay away completely with treatment. However, some types of advanced cancer can be controlled over a long period of time and are thought of as an ongoing (or chronic) illness. Even if advanced cancer can’t be cured, treatment can sometimes: ● Shrink the cancer ● Slow its growth ● Help relieve symptoms ● Help you live longer For some people, the cancer may already be advanced when they first learn they have the disease. For others, the cancer may not become advanced until years after it was first diagnosed. Advanced cancers can be locally advanced or metastatic. Locally advanced means that cancer has grown outside the body part it started in but has not yet spread to other parts of the body.
    [Show full text]
  • Neurologic Complications of Prostate Cancer RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California
    Neurologic Complications of Prostate Cancer RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California Neurologic complications continue to pose problems in patients with metastatic prostate can- cer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson’s plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 per- cent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neu- rologic complications of metastatic prostate cancer require prompt treatment, early recogni- tion is important. Physicians should consider metastasis in the differential diagnosis of new- onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment. (Am Fam Physician 2002;65:1834-40. Copyright© 2002 American Academy of Family Physicians.) This article rostate cancer is second only to time, and 2.9 percent will succumb to this exemplifies the AAFP lung cancer as the leading cause malignancy.2,3 2002 Annual Clinical of cancer-related deaths in men.1 Although most men with prostate cancer Focus on cancer: Histologic evidence of prostate have asymptomatic, indolent disease, central prevention, detection, adenocarcinoma is present in nervous system (CNS) complications often management, support, 4,5 and survival.
    [Show full text]
  • Myeloma Bone Disease: Pathogenesis and Treatment
    Myeloma Bone Disease: Pathogenesis and Treatment Elizabeth K. O’Donnell, MD, and Noopur S. Raje, MD Dr O’Donnell is an instructor and Dr Abstract: Bone involvement manifesting as osteolytic bone disease Raje is an associate professor at Harvard (OBD) or osteopenia is one of the defining features of multiple Medical School in Boston, Massachusetts. myeloma (MM). Osteolytic lesions develop in nearly 90% of patients with MM, and these are frequently complicated by skeleton-related Corresponding author: events (SREs) such as severe bone pain, pathologic fractures, verte- Elizabeth K. O’Donnell, MD bral collapse, hypercalcemia, and spinal cord compression. SREs Massachusetts General Hospital have a negative effect on patients’ quality of life and affect their 55 Fruit Street long-term outcomes, including survival. In MM, the delicate balance Boston, MA 02114 between bone formation and bone destruction is perturbed. OBD is Tel: (617) 724-4000 a consequence of increased osteoclast activation along with osteo- E-mail: [email protected] blast inhibition, which alter bone remodeling. Although MM remains incurable, tremendous progress has been made in the treatment of the disease. As such, there is a need to address the symptoms of the disease that affect quality of life and, ultimately, overall survival. Novel agents targeting OBD are promising therapeutic strategies not only for the treatment of MM OBD but also for the treatment of MM itself. In addition to bisphosphonates, several novel agents are currently under investigation for their positive effect on bone remodeling via osteoclast inhibition or osteoblast stimulation. Future studies will look to combine or sequence all of these agents to improve quality of life, decrease the symptoms of MM OBD, and enhance antitumor activity.
    [Show full text]