Most patients, whom doctors have diagnosed with stage cancer and metastases, ask mainly about what are the chances of getting rid of the problem. It is the stages of cancer and metastases that determine life expectancy. For example, in stage 4 cancer, when metastases are widespread and considered incurable, patients tend to prepare only for the worst. In fact, the answer to the question is far from clear; the stage of cancer and metastases of the disease may not always mean death.
In some cases, primary formation can become a significant problem, in which it is difficult to predict a favorable prognosis. Conversely, cancer stage and metastases can be significantly mitigated by many factors, because There are many nuances that affect the prognosis of tumor spread:
- Ki67 index, - cell differentiation, - mutations, - tumor localization in the body, - features of detected metastases and other points.
Metastatic cancer - what is it?
Almost any late-stage cancer is called metastatic. From Greek metastasis means – meta stateo – “I stand at a distance.” In this case, damage to organs somewhat distant from the main tumor is observed; this is due to the spread of malignant cells from the tumor through the lymphatic or blood vessels.
This can be illustrated with the following example. The woman was diagnosed with breast cancer; she has a tumor in her right gland. After some time, repeated examination shows that secondary formations have appeared in the liver. It is incorrect to consider this the appearance of cancer in the liver - in this case, the progression of breast cancer is observed. After such a phenomenon is detected, the diagnosis of “breast cancer” is changed to “metastatic breast cancer.”
Management of patients with bone metastases and pain syndrome
When cancer cells metastasize, they can spread both locally and to other organs. It is not possible to predict exactly how cancer cells metastasize, but over the years, researchers have begun to note that certain types of tumors metastasize in a specific pattern, and their metastases are more often found only in certain areas. For unknown reasons, prostate cancer often affects bone tissue after spreading beyond the pelvis. Unlike bone cancer, which originates from bone tissue initially, bone metastases of prostate cancer are clusters of prostate cancer cells. Therefore, the same treatment that is used to treat prostate cancer (hormonal and chemotherapy) is also suitable for the treatment of bone metastases of prostate cancer.
But cancer cells in bones don't just sit there, they interact with bone tissue, often disrupting the normal growth and structure of the bone, making it more fragile. So, in addition to traditional methods of treating prostate cancer, a lot of attention should be paid to maintaining good bone health.
In general, treatment of patients with bone metastases has three main goals: directly combating cancer cells, combating possible complications caused by increased bone fragility, and, very importantly, relieving pain. Many men with bone metastases from prostate cancer experience pain. And if the pain is not stopped, it will take a lot of strength. The strength needed to fight the disease. This section provides an overview of the problems caused by bone metastases, methods of treating them and improving the quality of life of such patients.
Detection of bone metastases.
Since the prostate is located in the pelvic cavity, the pelvic bones and adjacent bones are the first to be affected by metastases. These include the pelvic bones, vertebrae, sacrum bones, and the upper parts of the femurs. In most cases, the appearance of pain in this area is the first sign of metastasis. Some patients experience constant pain in a specific location, while others experience pain of varying intensity in different areas. If the doctor suspects that the pain is a sign of the presence of metastases or believes that the risk of developing them is very high, then he may prescribe additional testing for you. The gold standard for diagnosing bone metastases is bone scintigraphy. In this test, a radioactive substance is injected into the body and deposited in the bones. As a result of the interaction of cancer cells and bone tissue, the processes of cell reproduction and death intensify in the latter, and the radioactive substance accumulates to a greater extent in such tissues, that is, around bone metastases.
Bone scintigraphy is a very sensitive method, which means it detects minute changes in the bones. But it is not very specific, which means that the method detects changes not only caused by bone metastases, but, for example, the consequences of past fractures, infections, arthritis, even hormonal therapy.
This is another reason why your doctor should be thoroughly familiar with your medical history. Such information will allow the doctor to reliably evaluate the results of scintigraphy, which will help determine the appropriateness of treatment. Even if the treatment is effective, it should be remembered that scintigraphy does not always reveal changes in the bones after treatment. Therefore, you can resort to other diagnostic methods, such as radiography, CT, MRI, to determine the effectiveness of treatment or to determine the appearance of new metastases.
Treatment of bone metastases.
There are several treatments for prostate cancer metastases to bone. Since the nature of their action is different, the attending physician may resort to several of them. Thus, the doctor tries to achieve the maximum effect of treatment. Before starting treatment for bone metastases, it is necessary to introduce some adjustments to your diet and lifestyle, which must first be discussed with your doctor. First of all, you need to take enough calcium and vitamin D, as well as exercise regularly. Even if the treatment is not entirely successful, such measures will help minimize the manifestations of osteoporosis and keep the bones themselves strong.
Patients experiencing bone pain are often treated with targeted doses of radiation aimed directly at the area where the metastasis is located. This will kill cancer cells and relieve pain. But the goals of such therapy are fundamentally different from those of primary treatment. And bone radiation for pain relief can be used regardless of what treatment the patient has already received for prostate cancer.
External beam radiation therapy uses X-rays to kill cancer cells in the bones. This treatment is sometimes called targeted irradiation; the procedure is planned in detail by a specialist so as not to damage surrounding tissues and organs. Also, sometimes the lower half of the body is irradiated, covering large areas.
Some other techniques use radiopharmaceuticals to combat metastases. These radioactive drugs, containing samarium (Quadramet) or strontium (Metastron), are injected intravenously and lodged in metastases, where their radioactivity kills cancer cells. Researchers have shown that the drug strontium is very effective in relieving pain when used immediately after a course of chemotherapy with doxorubicin (Adriamycin), which can be done by the attending physician. External beam radiation therapy and radiopharmaceutical therapy are called targeted treatments, which means that their effects are highly localized. There is also a group of drugs called bisphosphonates, which are used in systemic therapy to relieve pain and reduce the risk of complications caused by cancer metastases.
Under normal conditions, bone cells break down and divide in a constant proportion. Increased activity of osteoblasts, cells responsible for the formation of new bone cells, leads to bone growth; An increase in the activity of osteoclasts, which destroy bone cells, leads to increased porosity and fragility of the bone. Increased porosity and fragility of bones leads to an increased risk of fractures. Bisphosphonates are drugs designed to restore the balance between bone growth and destruction. Zoledronic acid (Zometa), a drug given intravenously, relieves pain and reduces the risk of bone complications. Another intravenous bisphosphonate, pamidronate (Aredia), is used less frequently because it is less effective. Most men experience flu-like symptoms after the first injections of zoledronic acid, such as weakness, nausea, vomiting, and pain, which subside after a few days. The drug may also cause some kidney problems. Therefore, before starting treatment, the necessary studies are carried out to determine the condition of the kidneys.
Also, if you are taking zoledronic acid, you should tell your dentist about this. Since taking the drug may cause some difficulties during dental procedures. Always remember that any doctor you contact must be informed about all your diseases and medications you are taking. There are also tablet forms of bisphosphonates. These include alendronate (Fosamax) and risedronate (Actonel), although they are mainly used in postmenopausal women or on hormone therapy to prevent osteoporosis.
Waiting for complications of bone metastases
Combating complications of metastases is one of the main goals of the treatment undertaken. Pathological fractures are bone fractures that are primarily the result of a disease. This happens, as already mentioned, due to the fact that metastases lead to increased bone fragility. Due to the characteristic location of prostate cancer metastases, the sacrum, pelvic bones, and femur are most often susceptible to pathological fractures. So, if you have had courses of hormonal therapy or any other reasons that previously weakened bone tissue, try to inform your doctor about them. You should also notify the doctor about all significant falls and bruises, which is also important. Surgery to stabilize the bones to reduce the risk of fractures is also likely.
In the long-term period, the most important complication of bone metastases is compression of the spinal cord. The spinal cord, starting at the base of the brain, runs within the vertebrae that make up the spine. The spinal cord is where most of the nerves that control movement and activity in the body originate. Therefore, damage to the spinal cord can lead to disability.
The vertebrae are located one on top of the other. Vertebrae weakened by metastases can flatten and shift, putting pressure on the spinal cord. Spinal cord compression that is not corrected can lead to serious consequences, possibly even paralysis. Therefore, if the possibility of compression is suspected, additional studies are carried out, for example, MRI, and a number of additional medications are prescribed.
Remember that the symptoms of spinal cord compression may not be pronounced and may be similar to other pathological conditions. This may be pain in the lumbar region, pain in the legs or weakness, problems with urination and defecation.
Since only the patient knows his body best, any discomfort or discomfort that arises should not be interpreted by him only as another side effect of the treatment. Any changes should be reported to your doctor.
Pain relief
Although pain often goes away with successful treatment of metastases using the above methods, sometimes patients need additional painkillers.
There are 3 basic rules that you should always remember: 1) Don't try to be a hero. Cancer pain can be quite significant. And there is no point in experiencing it stoically. Pain can take away valuable strength that you may need to fight the disease. And pain can be dealt with very effectively with the help of medications. 2) Pain relief can be achieved using quite simple methods. You should not expect that relief will come only when you are completely “pumped up” on drugs. The main goal of pain relief is to support the body. Sometimes oral medications are enough to make the pain go away. 3) Do not be afraid of becoming psychologically dependent on painkillers. The main reason why doctors try not to prescribe, and why patients do not take painkillers, is psychological dependence. But you need to understand the difference between addiction, physical dependence and stability.
Addiction is a psychological syndrome in which prolonged or increasing use of medications occurs regardless of negative psychological, physical or social consequences. In the case of cancer, taking medications is aimed at healing, a positive outcome.
With physical dependence, the body is not able to quickly cope with an abrupt cessation of taking the drug, and patients experience the so-called withdrawal syndrome. Therefore, withdrawal of any drug most often occurs with a gradual reduction in doses.
If you take the drug long enough, resistance may occur, in which the drug no longer has an effect. Gradually increasing the dose of medication may have a temporary effect, but most likely you will have to change the drug. Always keep your doctor informed about what pain medications you have already taken and what their effect was. If your doctor does not yet consider the need to take painkillers, consult with pain specialists. If the drugs do not work, even some minor surgical interventions are possible to eliminate the pain.
Remember that like any other medicine, painkillers have side effects. The most common of these is constipation. Constipation occurs so often that sometimes the question arises not if, but when it will appear. When taking painkillers, even in minute doses, it is necessary to reconsider your diet or even start taking laxatives.
Other side effects include nausea, vomiting, drowsiness, and confusion. Over time they may go away. The goal of pain relief is to preserve your strength to fight the disease. If something remains unclear, try to talk about it with your doctor.
Using materials from the site www.cancer-prostate.ru
First stage of pathology
The first stage of cancer development is the presence of a tumor node. At the same time, the lymph nodes are not yet affected and there are no metastases in the body. Recently, the number of detected and treated tumors has increased significantly. This indicates an increase in people's awareness of this issue and their ability to take care of their health. Competent treatment helps in most cases.
Treatment
What to do in case of metastases in the brain is decided by a council of doctors based on the diagnosis and medical history of the patient. Treatment of metastases in the head is very difficult, which is due to the inaccessibility of the location of secondary lesions in the brain, the presence of multiple tumors in other organs, the patient’s condition in the later stages, age and a number of other factors. Today, in the presence of secondary tumors in the head, stereotactic radiosurgical techniques are used, which stop or slow down the growth of pathological tissue. The best result is achieved when tumors are removed surgically, but at these stages treatment is always difficult. The method of treatment will depend on the location of the tumor, the intensity of damage to other organs and the general condition of the patient.
Main types of treatment
- Surgical treatment is possible only in cases where there is access to tumors in the brain. As a rule, in the terminal stages many other organs are already affected, so surgical treatment is carried out mainly for palliative purposes, to eliminate negative signs and alleviate the patient’s condition. In some cases, it is possible to remove a few tumors or metastases are removed en bloc (when they are located nearby). If there are many lesions in the brain, then surgical treatment is not advisable.
- Treatment with radiotherapy is more preferable in this case. For deep, hard-to-reach locations of secondary tumors in the brain, this type of treatment is the main one. For a few tumors, stereotactic proton therapy (irradiation of an organ from several sides) will be an effective method.
- Chemotherapy and drug treatment for brain metastases are not effective. Drugs are prescribed to relieve negative symptoms and reduce side effects. Thus, drug therapy is palliative.
Development of metastases
When the problem develops to the level of stage 3 cancer with metastases, the tumor becomes very active, quickly increases in size, growing into nearby tissues. In most cases, screenings are observed in distant lymph nodes. The prognosis takes into account factors such as the degree of differentiation and location of the tumor, and the general condition of the patient. These moments can both aggravate and reassure the patient’s situation. Successful treatment here is still quite possible.
Diagnostics
Since the formation of secondary tumors in the brain causes the death of the patient, it is important to identify the presence of a pathological formation as early as possible. If cancer is present, the patient must be diagnosed continuously to monitor the situation and timely identify secondary tumors in the brain. If the tumor in the head is small, it usually already has a pronounced clinical picture, however, it can be diagnosed at the earliest stages using computed tomography (CT) or magnetic resonance imaging (MRI). A biopsy is important to establish the metastatic process and clarify all the nuances of pathogenesis. The presence of metastases can be suspected even with a biochemical blood test.
