Therapeutic oncosurgical spectrum

General informations to bone metastasis

Metastatic lesions within the bone are lesions of the skeleton that result from the spread of cancer from another organ such as the lung, breast, prostate or kidney. Most frequently the spinal column is involved, followed by the ribs, the extremities and pelvis. Most common malignant types of tumor that tend to spread into the skeleton are breast cancer, lung cancer, prostate cancer, kidney cancer and colorectal cancer.

Once bone metastasis is diagnosed a dissemination of tumor cells by blood or lymph flow can be assumed, indicating that more metastatic lesions even at remote regions may arise.

If a metastatic lesion is developing several symptoms including pain, loss of function during weight bearing or walking may become apparent. The progressive bone destruction is caused by local host cells (osteoclasts) which are activated by the tumor cells. This local bone destruction may progress and reach a certain threshold beyond which the bone is not able to withstand the local forces, loading and stress conditions and subsequently undergoes a so-called pathological fracture. In many patients this often painful event represents the first symptom or sign of the underlying tumor disease. Despite intensive diagnostic measures the primary tumor origin from which the cancer spreads to the bone can sometimes not be identified.

The primary goal of the surgical treatment of bone metastasis is the palliative resection with reconstruction and stabilization of the resulting defect. Thereby the local stability, function and overall mobility of the patient is restored and the associated pain is reduced.

In case of solitary (single) bone metastasis following a radically treated primary cancer and a long time period between primary tumor therapy and appearance of metastatic lesions the surgical management of such lesions should be to be performed in a curative approach similar to primary bone cancer.

The local radiotherapy and systemic hormonal or chemotherapy is closely related to the local surgical management of metastatic lesions. Additionally, the pharmacological treatment using a so called "inhibitors of osteoclasts"-medication can be performed.