Yesterday, a patient with lung cancer two years after surgery came for a routine check-up. The bone scan showed that there were radioactive foci in the iliac bone, and metastasis was considered. The patient was surprised and said that I had a problem with my bones, why didn’t I feel anything. There are indeed some bone metastases. The degree of bone damage is not severe at the beginning. When the scope is small, there are no symptoms. It is not uncommon for people to find bone metastases in routine examinations. Since lung cancer is more prone to bone metastases than other malignant tumors, we recommend that patients have a bone scan every six months to one year during regular follow-up, especially for patients with advanced stages III and IV.
Bone metastases are classified into three types: osteolytic, osteogenic, and mixed. Generally speaking, the metastases of breast cancer and lung cancer are mainly osteolytic metastases, while prostate cancer is mainly osteogenic metastases. The symptoms of osteogenic metastases are relatively inconspicuous, while osteolytic metastases, as the name suggests, is that the bones are eroded by insects, and the bones are dissolved, which is low density on CT and low signal on MRI. The more severe the osteolytic destruction, the more pronounced the symptoms. When bone metastases develop to a certain extent, the following symptoms will appear.
1. Pain Pain occurs in 50% to 90% of patients with bone metastases from lung cancer, 50% of which are severe pain and 30% unbearable pain. Pain is the most common symptom of bone metastases from lung cancer. The pain is mild in the early stage and changes from intermittent to persistent. Spinal metastases may manifest as pain in the waist, chest and back, rib chest, and neck. Patients with thoracic metastases are often accompanied by unilateral or bilateral intercostal neuralgia. Some lumbar metastases can also show abdominal pain. The characteristics of pain often change, and immobilization is ineffective. The pain will get worse as the disease progresses. Those located in the pelvis are often accompanied by pain in the medial femoral joint of the hip joint, and those located at the upper end of the femur and the upper end of the humerus are often accompanied by joint dysfunction and cannot walk.
2. Pathological fractures
Pathological fractures are sometimes the first symptom in patients, and fractures occur without any cause or with only minor trauma. Pathological fractures have the highest occurrence rate in the lower extremities. Once pathological fractures occur, the pain increases and the swelling becomes obvious. People with pathological fractures of the spine quickly become paralyzed.
3. Compression symptoms of spinal metastasis and compression symptoms are more obvious, the tumor compresses the nerve root or spinal cord cauda equina, radicular neuralgia, hypoesthesia below the cross-section, or even paraplegia, and loss of lower limb sensory and motor functions , inability to pass urine or incontinence, abdominal distension.
4. Systemic symptoms Bone metastasis of lung cancer means that the tumor is advanced, and some systemic symptoms will appear, such as loss of appetite, fatigue, weight loss, and multiple bone metastases will affect bone marrow hematopoiesis and cause anemia. Cancer cells continuously destroy human bones, and a large amount of bone calcium enters the blood, which can easily lead to hypercalcemia. After being bedridden, it is easy to combine bedsores, lower extremity thrombosis, lung infection, and urinary tract infection.
After bone metastases from lung cancer, pain symptoms are the most common. Severe pain seriously affects the patient’s quality of life. Therefore, standardized pain relief is required. Don’t be afraid of addiction to anesthetics. For patients, painkillers are physical needs rather than psychological needs, so there is no problem of addiction. As long as standardized and reasonable pain relief is given, pain can be controlled within an acceptable range. Analgesics alone are not effective, but can also be combined with other modalities, such as local radiotherapy, systemic bisphosphonates, micro-analgesia pumps, or nerve damage in an analgesia department. For patients with spinal metastases at risk of paralysis, vertebroplasty and bone cement fixation can be performed early under intervention.