Metastases in the spine - what does that mean?

The diagnosis of cancer is always a shock to the patient, although modern medicine and researching science have created many possibilities which means that (some) cancers are curable and the diagnosis is no longer basically DEATH. This disease, anyway, is still a scourge of humanity. It changes people life, become an incision into everyday life and leads many affected people to think about their life expectancy.

Of course it becomes dramatic when the tumor is scattered. Cancer can not only spread to neighboring tissue, but cancer cells tend to spread through blood and lymph vessels in other organs and then create metastases. 

Metastases in the bone are a serious complication of cancer. For bone pain, it is therefore important to clarify the causes. The areas of the bones, where blood formation takes place, provide the tumor cells with favorable growth conditions.

The organs into which many types of cancer preferentially metastasize - after the liver and lungs – are the bones. The spine is the most common site of skeletal metastases (about two-thirds of all bone tumors). Mostly they are located in the thoracic spine and the lumbar spine.

Where bone metastases occur most often

Granted, it may take a bit of getting used to, but it's true: Metastases are being diagnosed more frequently on the basis of the improved prognosis for a malignant tumor. Ten percent of carcinoma patients have spinal metastases during their disease. Thus, the spread of cancer into the bone tissue is the commonest malignant disease of the bones. Most common are bone metastases in breast cancer, prostate cancer, lung cancer, thyroid cancer, malignant melanoma (black skin cancer), kidney cancer, and multiple myeloma.Thorough autopsy reveals bone metastases in 70 percent of patients who die from cancer. In the 210,000 cancer deaths per year in Germany, 150,000 of them are caused by bone metastases.

Metastases are cancerous cells on the move

The word metastasis comes from the Greek and means 'migration'. Metastases are thus cancerous cells that move within bodies.

The cancer cells that leave the tumor, that travel through the body in an uncontrolled manner and then settle in the bone, are literally destructive. They start a competition, a fight between bone-breaking and bone-building processes. Cancer cells produce cytokines and several growth factors. As a result, the Osteoclasts (bone cells) are strongly stimulated and at the same time, the balance between bone resorption and bone reconstruction is disturbed. The bitter winner is the metastases! And the tragic loser is the human being!

Metastases spread over two pathways throughout the body:

  • Through blood (the so-called hematogenous metastasis)
  • Through the lymphatics vessels (the so-called lymphogenic metastasis)

The areas of the bones, where blood formation takes place, provide tumor cells with favorable growth conditions.

Symptoms - pay special attention to spinal pain

The principal evil caused by the diseases that grow in our body is their silence. That's when we talk about a creeping process. Bone metastases do not have this property! They are loud! We can feel it and sometimes see it (often by a considerable weight loss).
 
In most cases, spinal pain is the first symptom of bone involvement. Many sufferers describe the pain, which does not improve even during periods of rest, as 'deep' and 'poorly locatable'. Responsible for this pain are nerve constrictions, reduced blood flow and the release of pro-inflammatory messengers. Motor and autonomic functional limitations are the second most common symptoms (85% of patients). Often these symptoms are accompanied by numbness in the extremities, gait disturbances (loss of power in the legs), loss of appetite, rapid fatigue. This often causes also bladder emptying disorders, increased urination, or inability to hold the urine, as well as fecal incontinence.

Important for the diagnosis: Tell the doctor where it hurts

The beginning of a revealing, accurate diagnosis is always the conversation between you and your doctor.

Through your very personal descriptions, your doctor can get a picture - but this picture is not enough for a final diagnosis. It's just that in addition to the detailed history and clinical examination, the imaging techniques have in fact a special meaning. They include the so-called skeletal scintigraphy (whole-body scintigraphy). If something is almost clearly noticeable in these images, further imaging procedures follow. X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) are possible. Computed tomography has a high priority with regard to the stability assessment of vertebral bodies. MRI is the favorite tool for assessing dilation in the spinal canal. In fact, the combination of several examination procedures is necessary for a perfect diagnosis. A biopsy (when doctors take a sample from the suspect area) of the bone usually occurs only when the original, primary tumor is unknown.

Positron emission tomography (PET) is a whole-body screening method for detecting metastases in patients with a known carcinoma. The PET has strengths, but also a few weaknesses, especially when it comes to making the surrounding tissue visible.

Sometimes a whole medical team is needed

Spinal metastases usually represent a complex situation in the context of a malignant systemic underlying disease. Therefore, a single doctor is not enough, a whole team will be necessary. These include specialists in radiation therapy (radio-oncologists), medical oncologists, pain therapists, and neurosurgeons! This team considers several aspects of therapies: clinical symptoms (pain/neurology), spine stability, the number of spinal metastases, the patient's mobility demands and the ways in which cancer can respond to radiation or chemotherapy.

Basically, therapy is about improving the quality of life by relieving or eliminating pain and maintaining bodily function. In therapy planning, the general condition of the patient plays an essential role! Not every patient has the strength to undergo extensive therapy (surgery, for example, to treat fractures) ... others are so strong that they attempt to the last. Most patients are aware that it is easier for physicians to beat a primary tumor than a whole army of malicious attackers attacking from different directions…!

However, there are a number of effective treatments for bone metastases. The most important and established treatments are radiation, hormone therapy, chemotherapy, bisphosphate therapy, antibody therapy, and surgical therapy. In case of microsurgery we remove the metastases and - if necessary - the affected segments are stabilized.

This is how you restore the quality of life and possibly extend it

Through neurosurgical interventions with decompression and eventual stabilizing measures - often accompanied by chemotherapy and/or radiotherapy - we improve the quality of life of the affected patients and relieve them from pain to let them be an active part of life - as long as possible.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.