Secondary tumor formations that spread the primary malignant tumor to other organs and tissues are called metastases. On a share of all bone malignant neoplasms about 90% have a metastatic character, that is, they are secondary. The peculiarity of bone metastasis is its multiple nature.
Causes of
Usually vertebral metastasis is observed with such types of cancer as:
- Pulmonary;
- Prostatic;
- Kidney;
- Milky fat;
- Thyroid cancer;
- Malignant lesions of the digestive system;
- Myeloma and sarcoma;
- Lymphomas.
With kidney cancer
Usually, vertebral metastasis in renal cancer spreads through the bloodstream. Usually, the lesion of the osseous system begins with the venous epidural plexus - it is in this zone that the atypical malignant cells enter the bone structures.
If the metastases in the kidney cancer penetrated the vertebral tissues, then this indicates that the oncology process reached stage III-IV.
The main sign of vertebrate metastasis in malignant kidney damage is an intense pain syndrome, and from radicular soreness it is characterized by strength and stability.
With advanced stages of renal cancer with a similar metastasis, about 5% of cancer patients suffer from vertebral compression with pelvic disorders with paralysis of the legs and hands. Most often, with cancer of the kidney is affected by metastases, the cranial-lumbar zone, less often - thoracic.
Video about the surgical treatment of metastases of kidney cancer in the spine:
Classification of
Bone metastases are divided into:
- Osteoblastic - which is characterized by uncontrolled enlargement and proliferation of bone tissue. On X-ray images, these metastases look like a speckled spot, they increase the affected bone and change its shape.
- Osteolytic - for them a typical dissolution of bone tissue, which is associated with abnormal activity of osteoclasts. On the X-ray, this metastasis is manifested by a decrease in the height of the vertebral parts.
There are many variants of vertebral metastasis in terms of morphological characteristics. According to histological data, they are divided into squamous cell carcinoma, anaplastic carcinomatous formations, low-, medium- and highly differentiated cancers, as well as other types of formations.
Symptoms of metastases in the spine
For any metastasis formation, the presence of tenderness is typical, which is mainly local, aching and obtuse, rarely spreading beyond the boundaries of the affected department.
With the development of the oncological pathology, pain symptoms become permanent, it can persist even in a calm state. Particularly concerned about pain at night, and when driving they resemble an electric shock.
The characteristic sign of metastasis in the vertebrae is paresthesia and hyperhidrosis, reduced sensitivity of the feet and palms.
Often disturbed by motor disorders, coupled with disorders of the pelvic region.
In the cervical department of
If metastasis is localized in the cervical vertebrae, the pain syndrome appears immediately, and the metastatic formation rapidly develops and grows.
The clinical picture as a whole comes down to the severe pain that occurs when trying to tilt or turn the head. In connection with the compression of the arteries of the spine, cancer patients begin to worry about frequent dizziness and headaches.
In the thoracic department of
With this localization of vertebral metastasis, cancer patients begin to be disturbed by discomfort-painful sensations in the interblade zone.
Similar metastases usually manifest later lumbar and cervical, which is due to the peculiarities of the anatomy of the thoracic vertebral department.
Lumbar
The clinical picture of lumbar metastasis is somewhat different from the rest of the localizations of secondary cancers. It is characterized by signs of various kinds of kidney pathologies.
Similar metastases can cause a strong static stress, which is fraught with compression vertebral fractures that distort the posture. Such injuries often lead to spinal injuries, causing paralysis of the legs of a full or partial nature.
Diagnostics of
The primary task in detecting vertebral metastasis is to identify a primary cancerous focus. There are such procedures as magnetic resonance imaging or CT, X-ray examination of the affected area.
Also shown carrying out:
- Ultrasonic inorganic diagnostics;
- Detection of oncomarkers in the blood;
- Scintigraphic study;
- Osteodensitometry, etc.
Photo of MRI and PET diagnostic of metastases in the spine of
Biopsy is often the final stage of diagnosis, but with vertebral localization of the tumor process or its location in the cerebrospinal fluid, biopsy is not always possible.
Treatment
As always, the approach to treatment is determined by the prevalence and type of the primary oncochamber, the extent of metastasis and the volume of the secondary tumor process.
The main goal is to get rid of the pain syndrome, prevent or eliminate spinal compression, increase life expectancy and improve the life of the oncology patient. For this, the following methods are used:
- Chemotherapy;
- Surgical interventions;
- Hormonal treatment;
- Radiation therapy;
- Therapy with bisphosphonates, etc.
Usually, surgical manipulations are used in cases when the formed tumor poses a mortal danger for the oncological. But, for example, with metastasis in the cervical spine, such a method is not suitable, because such a localization is very difficult.
Pain relief is important:
- For the anesthesia in the early stages, preparations like Ibuprofen and Ketoprofen, Nimesulide and others are used;
- Medium intensity pains already require the use of opioid pain relievers like Promedol, Prosidol or Tramadol;
- In the 3-4 stages of the tumor process, pain relief is indicated with such drugs as Buprenorphine, Fentanyl, or a variety of morphine forms.
Surgical intervention is performed endoscopically, if the metastases are large, then removal through the opening of the tissues is indicated. In this case, the neurosurgeon removes all tissues that have been metastasized.
Sometimes there are situations where secondary tumors grow to too large a size, then any interference can threaten the life of the cancer patient, so such metastases do not touch. If oncomprocess has reached the terminal stage, then palliative therapy is applied, designed to eliminate intolerable soreness.
Chemotherapeutic treatment is used as part of primary oncocholastic therapy, taking into account metastasis to other organs. Usually the chemotherapy complex includes about 7-12 sessions, conducted daily.
Given the inaccessibility of bone metastases, radiosurgery is often the most effective method of their treatment, especially with the use of a cyber knife. If the formation is less than 20 mm and is located in the access zone of gamma rays, then radiation therapy is performed.
How long does it take to live with metastases in the spine?
Most often, vertebral metastasis occurs already at the final stages of the primary oncoprocess, which in themselves are prognostically unfavorable.
With small tumors in the spine and slow development of the main oncochamber, survival forecasts are more favorable.
Unfortunately, on average, metastasis to the spine is characterized by low survival rates, in more than 90% of cases, patients do not survive 2 years.