Metastatic disease of the musculoskeletal system

Metastatic disease of the musculoskeletal system

Metastatic disease of the musculoskeletal system is the result of the spread of cancer cells from another organ to the bone. While metastatic disease may result from any type of carcinoma, bone is among the most common sites for metastasis from carcinoma of the breast, prostate, lung, thyroid and kidney. When the cells spread, they create tumors on the bones. These cells can be asymptomatic in the body until they spread to the bones, which can make them difficult to detect. In some carcinomas, up to 35 to 73 percent will become metastatic diseases of the musculoskeletal system.

Metastasized cells are thought to spread primarily through the blood, though the presence or absence of skeletal lesions is dependent on certain characteristics of the tumor cells. Tumors in the bone may cause significant pain and can increase the risk of fracture, either of which may require treatment. Significant advances in surgical techniques and medical management have greatly improved the quality of life of those with metastatic bone disease.

Anatomy of the musculoskeletal system

The musculoskeletal system maintains the shape and strength of the human body. It consists of the following:

  • Bones (the skeleton)
  • Muscles
  • Cartilage
  • Tendons
  • Ligaments
  • Joints

The skeletal system is complex, and each bone serves as a repository for many cells, nutrients and minerals. In several carcinoma types, a rich blood supply and a supportive environment for cells from many different tumors favor the development of metastatic disease of the musculoskeletal system.

Symptoms

Depending on the form of the cancer cells and how they affect the organs from which they are traveling, symptoms of metastatic disease of the musculoskeletal system can vary. The following are some of the most common symptoms:

  • Broken bones caused by weakening from the tumors
  • Nerve damage from compression, which can lead to paralysis
  • Severe pain in the area of the major bones, such as spine, long bones, hips and pelvis
  • Anemia
  • Unexplained fatigue

Fortunately, the symptoms of metastatic disease of the musculoskeletal system often appear very early, which makes it easier to catch. If you may be at risk, it is important to contact your doctor in case any of these symptoms appear or continue.

Causes

The primary cause of metastatic disease of the musculoskeletal system is cancer that is present in another area. It can be spread in two different ways:

  • Hospitable environment – According to disease expert Stephen Paget, metastasis of carcinoma cells is akin to a fertile seed landing upon hospitable soil. The bone environment provides a favorable bed for certain types of tumor cells.  
  • Rich blood supply – According to another expert, James Ewing, cancerous cells are spread more frequently via the bloodstream. Because bones consist of a well-vascularized region with factors promoting growth and development of various cell types, it supports growth of some metastatic tumor cells as well. 

Types

Metastatic diseases of the musculoskeletal system can attack any bone. However, studies have shown that there are several bones that are at significantly more risk from:

  • Breast cancer – One of the most common types of cancer in women is breast cancer. In up to 73 percent of patients with metastatic breast carcinoma, a bone lesion will be identified. While medications may decrease the risk of skeletal complications, lesions resulting from breast carcinoma may weaken the bone to the point of fracture.
  • Prostate cancer – If a patient with prostate carcinoma develops metastatic disease of the musculoskeletal system, the bone lesion may become dense and hard. Though this has some protective effect relative to most metastatic lesions, the bone may become brittle and still at risk for pain or fracture.
  • Lung cancer – While often presenting late in the disease course, lung carcinoma may develop extensive metastatic disease within the skeleton.
  • Kidney cancer – Renal cell carcinoma has a tendency towards creating large and destructive bone tumors. Coordinated care among specialists can improve the quality of care and the timing of medical and surgical treatment to maximize the patient’s health and comfort.     

The multidisciplinary team of musculoskeletal oncology experts at Northwell Health Orthopaedic Institute treats metastatic disease of the musculoskeletal system as well as a broad range of conditions that affect the bones.

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