Skeletal Metastases: What You Need to Know

Skeletal metastases are a type of cancer that affects the bones. They occur when cancer cells from another part of the body, such as the breast, prostate, lung, or kidney, travel through the bloodstream or lymphatic system and settle in the bone tissue. Skeletal metastases are also known as bone metastases or secondary bone cancer.

Skeletal metastases are a common complication of advanced cancer. They can affect any bone in the body, but they are more likely to occur in the spine, pelvis, ribs, skull, femur, and humerus. They can cause various symptoms and complications, such as:

• Bone pain, which may be worse at night or during activity

• Bone fractures, which may occur with minimal trauma or without any apparent cause

• Spinal cord compression, which may cause weakness, numbness, tingling, or paralysis of the arms or legs

• Hypercalcemia, which is a high level of calcium in the blood that can cause nausea, vomiting, constipation, confusion, or coma

• Bone marrow suppression, which can reduce the production of blood cells and increase the risk of infections, anemia, and bleeding

Skeletal metastases are usually diagnosed by imaging tests, such as X-rays, bone scans, CT scans, MRI scans, or PET scans. These tests can show the location and extent of the bone lesions and help to differentiate them from other conditions that can affect the bones. Sometimes, a bone biopsy may be needed to confirm the diagnosis and identify the type of cancer cells.

The treatment of skeletal metastases depends on several factors, such as the type and stage of the primary cancer, the number and location of the bone lesions, the symptoms and complications caused by them, and the overall health and preferences of the patient. The main goals of treatment are to relieve pain and other symptoms, prevent or treat complications, and improve quality of life.

The treatment options for skeletal metastases may include:

• Systemic therapy: This involves using drugs that circulate throughout the body and target cancer cells wherever they are. Systemic therapy may include chemotherapy (drugs that kill cancer cells), hormone therapy (drugs that block or reduce the effects of hormones that stimulate some cancers), immunotherapy (drugs that boost the immune system to fight cancer), or targeted therapy (drugs that interfere with specific molecules that help cancer cells grow and spread).

• Local therapy: This involves using treatments that directly affect the bone lesions. Local therapy may include surgery (removing part or all of the affected bone), radiation therapy (using high-energy rays to kill cancer cells), radiofrequency ablation (using heat to destroy cancer cells), cryoablation (using cold to destroy cancer cells), or cementoplasty (injecting cement into the bone to stabilize it and relieve pain).

• Supportive care: This involves using treatments that help to manage the symptoms and complications caused by skeletal metastases. Supportive care may include pain medication (drugs that reduce pain), bisphosphonates (drugs that prevent bone loss and lower calcium levels), denosumab (a drug that blocks a protein that stimulates bone resorption), corticosteroids (drugs that reduce inflammation and swelling), or blood transfusions (replacing lost blood cells).

Skeletal metastases are a serious condition that can affect many aspects of a person’s life. However, with proper diagnosis and treatment, many people with skeletal metastases can achieve pain relief and improved function. Moreover, with advances in research and technology, new and better treatments for skeletal metastases are being developed and tested.