Bone Metastases Treatment

Effective treatment of bone metastases is performed at the Oncology Department of Israel’s leading private hospital Herzliya Medical Center. Metastatic bone disease treatment at Herzliya Medical Center (HMC) is directed through the leadership of Professor Jacob Bickels, who performs unique organ surgery for metastases in the bones by preventing severe functional impairment and the development of disability, he guides a highly professional team. Coordination of the orthopedic and oncology clinic at HMC helps achieve the best results in the treatment of progressive forms of cancer with bone metastases.

What Is Metastatic Bone Disease?

Metastasis or metastatic disease is spread of cancer from its site of origin tumor (the primary tumor) to other parts of the body (secondary tumors), this pathological process occurs via blood vessels (hematogenous spread), lymphatics (lymphomatous spread) or through both routes, as well as a local invasion to adjacent tissue. Common sites of bone metastases include the spine, ribs, skull, pelvis, upper legs and arms – areas of dense bone marrow and large quantities of red blood cells are produced making these areas more susceptible to secondary tumors. Bone metastases (metastatic bone disease) mainly originate from metastasis of the breast, prostate, thyroid or kidney, to name a few. In addition, the secondary tumor may be observed in skeletal lung cancer and neoplasia of the gastrointestinal tract. Cancer that has spread to other areas is named from the site of the primary tumor and not the secondary tumor; for example, breast cancer that spreads to the lungs is called metastatic breast cancer and not lung cancer. Metastatic bone disease (bone metastases) differs from bone cancer – bone cancer, which is relatively rare and originates within the bones (the primary tumor).

Bone Metastases Symptoms

The symptoms of bone metastases varies according to the degree of cancer spread, and the bones affected. Bone metastases ultimately causes bone destruction, secondary clinical signs and symptoms can include:

• Bone pain – Most bone and joints metastases lead to pain in the bones. The pain is usually the result of periosteum involvement (due to its saturation in nerve endings) or appears when the metastases are close to nerves (i.e. the spinal cord)
• Pathological fractures at the site of the tumor and caused by the tumor itself, weakening the bone resulting in increased bone fragility (hip fractures, for example, are due to metastases in the bones of the pelvis). Pathologic fractures can occur without the event of a trauma
• Anemia – reduced the production of red blood cells due to tumor growth
• Abnormal biochemical composition of the blood, caused by the release of large amounts of calcium from bone destruction. Increased levels of calcium (hypercalcemia) can cause severe metabolic disorders, which often pose a threat to the life of the patient and requires immediate intensive care
• Urinary or bowel incontinence
• Weakened arms and/ or legs – metastatic cancer of the spinal bones

Bone Metastases Diagnosis at HMC

Herzliya Medical Center utilizes modern methods of diagnosis, allowing accurately determining the presence of secondary bone tumor foci and their nature. Among the main diagnostic methods, it is important to note:

• Laboratory diagnosis of bone metastases. The Oncology Clinic at HMC widely uses methods for studying levels of tumor markers (PSA, CA 15-3), as well as biochemical assays, which determine the decay products of bone (calcium, alkaline phosphatase)
• Radiological research methods for determining the presence of a tumor and the degree of bone involvement in the pathological process. The clinic also utilizes the high-precision method of computed tomography (CT) to detect bone destruction
• Diagnosis of metabolic activity in the bone tissue. Increased metabolic activity characteristic of the malignant process and can be diagnosed by isotope bone scan (scintigraphy) and positron emission tomography (PET-CT)
• Magnetic resonance imaging (MRI) is used in the diagnosis of malignant lesions, performed by specialists and clinics in the presence of appropriate indications
• Bone biopsy – the final diagnosis of bone metastases is used to determine the exact nature of the tumor and its sensitivity to anticancer therapy

Treatment of Bone Metastases

Methods of treating bone metastases depend on the type of primary tumor and severity (extent of tumor spread). The main objective of the Orthopedic Oncology Department at Herzliya Medical Center is to preserve the skeleton support function by utilizing innovative surgical methods, such as implants and grafts; performing amputation only in extreme cases. Effective preoperative therapy includes radiation and modern medication drugs which can reduce the size of tumors and (in most cases) organ surgery. Comprehensive treatment of bone metastases comes amid detoxification therapy, which lowers the level of calcium and prevents the development of metabolic complications. Pain therapy with the use of safe and highly effective drugs for long-term action is an important aspect in the treatment of progressive forms of cancer at HMC. Treatment of bone metastases of the spine, pelvis and other regions described below in more detail:

Treatment of metastases in the spine

Surgical treatment of metastases in the spine may be associated with a number of difficulties due to the anatomical proximity of the spinal cord. Modern methods of drug treatment can prevent the need for surgery. Removal of metastases in the spine is indicated in the case of instability caused by a pathological fracture of the vertebral body and the pressure on the spinal cord and/ or the spinal nerve roots. Surgery might include removal of metastases, depressurizing of the dura mater and of the spinal cord nerve endings. Timely diagnosis and treatment of metastases in the spine can prevent severe neurological complications.

Treatment of metastases in the pelvis

The pelvis is the supporting structure of the skeleton and is subject to significant loads. Where conservative treatment is unsuccessful, surgery may be required, which is often associated with reconstructive and/ or prosthetic hip joint surgery. Pre-treatment of metastases in the bones of the pelvis can significantly reduce the need for any surgical procedure and maintains the stability of the pelvis, guaranteeing the preservation of motor function.

Treatment of metastases in the area of ​​large joints

Metastases in the hip, knee or shoulder joints often entail the necessity of surgical removal followed by prosthetics. Surgery of metastases of the joints forms part of an integrated treatment plan, aimed at preventing the spread of the tumor and achieving stable remission. In addition, surgery as a palliative treatment, preventing the development of intra-articular pain and pathological fractures.

Treatment of metastases in upper and lower extremities

Treatment of metastases in the long bones requires a complex of rehabilitation measures aimed at the preservation of limb function. The primary task of doctors is to prevent pathological fractures that occur under the influence of strong muscle contractions. In cases of inoperable metastases in the bones of the limbs, modern methods of external fixation are widely used, allowing patients to maintain long-term physical activity without the risk of possible complications.

The benefits of treatment of metastatic tumors at HMC

Effective treatment of metastatic and recurrent forms of cancer requires a high level of professional and technological capabilities to accurately identify the histological type and sensitivity of tumors, and thus determine optimum methods of complex therapy. In addition, the treatment of orthopedic oncology involves a number of rehabilitation activities. Herzliya Medical Center is a leading private hospital in Israel, combining a high professional level of specialists in various fields, an unprecedented quality of care, as well as utilization of high precision medical technologies that can successfully manage medical problems of any complexity.