Orthopedics and traumatology Children's Orthopedic Institute G.I. Turner Osteosynthesis by academician G.A. Ilizarov

What cancers develop?

The leader among all malignant processes occurring with metastatic lesions of the skeleton is myeloma - bone destruction begins at the very beginning of the disease and in 100% of clinical cases multiple destruction of bone tissue is noted.

In case of breast and prostate cancer, skeletal metastases are diagnosed in two thirds of patients, and pathological observations reveal the involvement of bones in the malignant process in almost 90% of patients. In breast cancer (BC), mixed and osteolytic variants predominate; in prostate cancer, osteoblastic variants predominate.

A high frequency of bone metastases is observed in lung cancer, but in the small cell variant there are twice as many bone defects, while in the non-small cell variant it occurs in 40% of patients with a tendency towards single or solitary lesions, that is, a single one.

Every fourth person suffering from kidney cancer has skeletal metastases; in bladder carcinoma, bone tumors are much less common.

In case of colon cancer, bone metastasis is detected in every eighth patient, in case of stomach cancer - not often, since the cancer affects the liver and abdominal cavity earlier and more abundantly. Colon cancer tends to be small-focal and multiple secondary formations.

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Rehabilitation period

The rate of bone tissue fusion is influenced by several factors:

• Age of the victim;
• The presence of harmful addictions - smoking and alcohol abuse;
• Nature of injury;
• The presence of pathologies in a chronic form.

Activities prescribed by the doctor during the rehabilitation period:

1. Taking medications that accelerate bone healing;
2. Massotherapy;
3. exercise therapy;
4. Physiotherapy and others.

Bone tissue fusion occurs within a month to a month and a half.

It takes 6 months or more to fully restore motor function.

Which parts of the skeleton are most often affected?

The localization of bone metastases is determined not by the nosological affiliation of the primary malignant tumor, but by the functional load and the associated development of the blood supply. Multiple foci in the skeleton are more typical for highly aggressive cancer, single and especially one metastasis indicates a favorable prognosis of the disease.

• Most often, secondary cancer screenings occur in the spongy bones, the vertebrae, which are abundantly fed with blood, and mainly in the lumbar and thoracic spine, which are under high load.
• Next in frequency are metastases in the pelvic bones - almost half of all cases, typical locations are the ilium and pubic bones.
• Metastasis is half as common in the bones of the skull and lower extremity, where damage to the femur predominates.
• The chest, mainly the ribs and sternum, are involved in the malignant process in almost 30% of cases.

Why does pain occur?

Pain is caused by three reasons:

1. destruction of the richly innervated periosteum by a cancerous conglomerate;
2. irritation of pain receptors in the periosteum by biologically active waste products of cancer cells;
3. involvement of muscle nerve endings in the metastatic node.

Unbearable pain is not always associated with skeletal metastasis; as a rule, this is a consequence of the high aggressiveness of tumor cells in the terminal stage of the process, when the concentration of biologically active substances in the blood is enormous - cytokines, which literally “burn” the nerve endings of even tissues not affected by the tumor. With a high degree of malignancy of the primary tumor, pain is observed more often and more intensely. The most obvious example is widespread and persistent pain in completely intact bones due to lung adenocarcinoma; surgery to remove the affected lung completely cures the pain.

When do skeletal metastases appear?

In malignant processes, the time of appearance of bone metastases varies, while the rate of growth of the lesion depends solely on the individual biological characteristics of the tumor tissue, which change under the influence of treatment and as cancer disseminates.

At the initial treatment, bone lesions in the absence of other manifestations of the cancer process are present in hardly 20% of patients; in the vast majority of cases, tumor lesions of the bones are a sign of cancer dissemination—spread across systems or generalization. This is exactly what happens with breast cancer, non-small cell lung carcinoma and colon cancer.

In prostate cancer, skeletal pathology is often detected simultaneously with a prostate tumor or shortly after the diagnosis of problems in the gonad.

In kidney carcinoma, metastases are often first found in the bones and lung tissue, and then the primary tumor is discovered.

Rupture of the urethra

Rupture of the urethra occurs more often and occurs in its fixed membranous part. There are complete and incomplete ruptures of the urethral canal.

Symptoms of rupture:

1) a drop of blood in the external opening of the urethra; 2) urinary retention; 3) urge to urinate; 4) the bladder is enlarged in volume; 5) difficulty or impossibility of catheterization.

If necessary, the diagnosis can be clarified by radiopaque urethrography.

Bladder rupture ranks second in frequency. In case of injury, as a rule, the overfilled bladder ruptures. There are intraperitoneal and extraperitoneal bladder ruptures.

Signs of a ruptured bladder:

• a small amount of urine mixed with blood is released during catheterization;
• retention of a certain amount of furatsilin solution (1: 5000) after its introduction into the bladder through a catheter;
• absence of bubble contours during percussion and palpation examination;
• the absence of clear contours of the bladder wall on a contrast radiograph and the spread of the contrast agent beyond the boundaries of the bladder;
• irritation of the peritoneum, exudate in the lateral canals of the abdominal cavity, which is manifested by percussion, positive Blumberg's sign with intraperitoneal ruptures of the bladder, when peritonitis has already begun.

Why are bisphosphonates needed?

The use of bisphosphonates for skeletal metastases has become the standard of adequate therapy.

Human bones are constantly renewed: osteoclasts destroy, and osteoblasts build up tissue; normally, the processes are balanced; in the presence of a malignant tumor, osteoclasts become overactive. Bisphosphonates are similar in structure to the bone matrix, therefore, after introduction into the body, they are sent to the bones, where they have a detrimental effect on osteoclasts activated by cancer products, while simultaneously relieving pain and protecting against fractures.

Bisphosphonates can be treated for about two years; if sensitivity to them is lost, the monoclonal body denosumab plays a similar role. Demosumab and bisphosphonates are classified as osteomodifying agents (OMAs).

To prescribe OMA, it is not enough to identify “hot” lesions during osteoscintigraphy; they are used in cases of tumor lesions proven by radiological methods.

Chemotherapy and OMA are the main treatments for skeletal lesions, but they are not the only ones. Treatment of bone metastases should be comprehensive; only a combination of radiation and drugs, with the correction of metabolism and the addition of palliative surgery, can relieve pain and return the patient to an active life.

When and what is needed and possible in each specific clinical case of cancer, the specialists of our clinic know. Find out more, call:

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Bibliography:

1. Aliev M.D., Teplyakov V.V., Kallistov V.E., Valiev A.K., Trapeznikov N.N. / Modern approaches to surgical treatment of metastases of malignant tumors in the bones // Practical Oncology, No. 1(5) (March), 2001
2. Belozerova M. S., Kochetova T. Yu., Krylov V. V. Practical recommendations for radionuclide therapy for bone metastases // Malignant tumors, No. 4, 2021, Special Issue 2.
3. Kondratyev V.B., Martynyuk V.V., Lee L.A. / Bone metastases: complicated forms, hypercalcemia, spinal cord compression syndrome, drug treatment // Practical Oncology, No. 2 (June), 2000
4. Manzyuk L.V., Bagrova S.G., Kopp M.V., Kutukova S.I., Semiglazova T.Yu./ The use of osteomodifying agents for the prevention and treatment of bone tissue pathology in malignant neoplasms // Malignant tumors: Practical recommendations RUSSCO #3s2, 2021 (vol. 7)
5. Snegova A. V., Bagrova S. G., Bolotina L. V., Vladimirova L. Yu., Gorbunova V. A., Kogonia L. M./ Prevention and treatment of bone tissue pathology with osteomodifying agents (OMA) in malignant neoplasms // Malignant tumors, No. 4, 2016, Special issue 2.

First aid

If there is a suspicion of an iliac fracture, the patient is given first aid. The absence of one can cost a person his life. The victim is placed on his back. The legs are slightly bent at the knees and a cushion made from any available items is placed under them - a jacket, sweater, blanket and others. The patient is then hospitalized.

The victim is taken to a medical facility by an ambulance team. If the injury occurs in places remote from populated areas, the patient is taken to the hospital on their own. The main thing is not to change your body position. You cannot apply a splint to the damaged area yourself. This will lead to displacement of the bone and more dire consequences.