By Jeyashree Sundaram (MBA)
While most patients have concerns about the prognosis when they develop secondary cancer, it depends on factors, such as the spread of the cancer to one or more parts in the body, spread rate and how the disease is responding to treatment. These are difficult to forecast and this indecision could be difficult to handle.
Patients may report symptoms of backache (which may worsen even after sufficient rest), gnawing pain (continuous pain), weaker bones, vomiting, dehydration, confusion, constipation, pain in the abdomen – all due to the increased levels of calcium. As bone marrow produces blood cells, due to cancer, blood cells can be lowered and the patient may be anaemic. The risk of infection, bruise and bleeding can increase; compression of spinal cord, such as weakness or numbness or pain in the legs, paralysis, incontinence and bladder control may also be lost. Though pains and aches may be common, if there is a new pain, it is better to discuss with a physician. Initial diagnosis and treatment will help to prevent additional problems such as severe pain or fractures of bone.
Patients with cancer in the bone marrow may feel very tired. Physicians suggest blood test for checking counts of blood cells. When red blood cells are reduced, then a blood transfusion is suggested.
When blood has more calcium, patients may tend to be weak, drowsy, confused and experience constipation. Medications such as bisphosphonates and fluids will be given to the patients so that the extra calcium is flushed out of the body. Bisphosphonates strengthen the bones and help in bone damage prevention. Patients consume them in the form of tablets or as drips; however, side effects such as stomach ache and constipation are possible with the use of bisphosphonates.
Diagnosis and Treatment
Tests such as X-rays, MRI scans, PET scans, bone scans and bone marrow tests are done for diagnosing bone cancer.
Calcium levels are checked using blood tests. Chest x-rays will determine whether the cancer has spread to the lungs. Changes to the bone and a possibility for a secondary bone cancer is diagnosed by bone x-rays. All the bones are viewed, and abnormal areas are clearly seen using bone scans. When the causative agent of the changes is unknown, then bone biopsy such as surgical biopsy or core needle biopsy is suggested where cell samples are taken from the affected bone. When secondary bone cancer is diagnosed before primary cancer, then further tests are carried out to detect the origin of primary cancer.
The treatments will shrink the size of the tumor and help in alleviating pain; when the tumor size is reduced, the pressure it exerts on the surrounding tissues or nerves is reduced.
In radiotherapy treatment, the waves focus on the cancer cells and destroy them, which decreases the pressure on the spinal cord. Thus, pain and few other symptoms can be reduced.
When cancer is found is the spine, rods are inserted for stabilizing and strengthening the spine. Painkillers and steroids are used for relieving pressure.
In cases where the spine bones have collapsed and painkillers are found to be ineffective, a special medical cement is injected to the spine by a method called kyphoplasty or vertebroplasty. During kyphoplasty, physicians use a balloon with the help of a needle and bring back the usual bone shape, whereas in vertebroplasty, medical cement is injected in the swelling area that actually presses the spinal cord.
Biological therapy such as use of denosumab (monoclonal antibody) helps in strengthening the bones and decreases the risk of bone breakages. Physicians often inject the medicine. Denosumab is approved by The National Institute of Health and Care Excellence (NICE) for treating breast cancer that has extended into the bones.
Though surgery is not a very commonly used treatment method, it is recommended when the bones are found to be weak. Specific surgeries such as hip joint surgery or surgery to place metal pins for fixing the fracture in weak bones generally help in strengthening the bones.
When patients have germ cell cancer, lymphoma or small cell lung cancer, chemotherapy treatment is provided for the compressed spinal cord.
When the spinal cord is subject to compression, the patient may not be able to move like a normal individual, which pose other health issues:
The risk of blood clots increases with increased lying time. To lower risk, elastic compression can be worn. Blood thinning medications (anticoagulants) can be taken in tablet form or as an injection. A higher lying time increases the risk of infection in the chest; practicing deep breathing exercises will reduce risk of this.
It is advised to change positions frequently to avoid pressure sores. Difficulty in controlling the bowel or bladder is possible due to the pressure exerted on the nerves. Medications can help in bowel functioning. A catheter – a small tube - is used to drain the bladder.