Yeditepe University Hospitals Orthopedics and Traumatology Specialists answered the questions of how bone metastasis occurs, does bone metastasis give symptoms, does every cancer metastasize to the bone.  

What is Bone Metastasis?

Bone metastasis is when cancer that occurs in any organ in the body settles in the bone through various complex mechanisms and forms a cancerous mass.

Which Cancers Metastasize to Bone Most Frequently?

Every cancer has the potential to metastasize to the bone. However, breast and prostate cancers metastasize to the bone most frequently. Less frequently, lung cancer, thyroid cancer, bladder cancer, kidney cancer, and colorectal cancer are also among the cancers that can metastasize to bone.

Are Bone Metastases Common?

Bone metastasis is a very common problem. According to some studies, it is the most common site of metastasis, while according to some studies, it is the 3rd most common site of metastasis after lung and liver metastases. In autopsy studies, it was found that 70% of breast and prostate cancer patients and 35-42% of lung, thyroid, and kidney cancer patients had bone metastases. In addition, the incidence of bone metastases is increasing as a result of the increase in survival rates with new treatments.

Which Bones Most Often Get Bone Metastases? Is There a Reason for This?

Although bone metastases can be seen in any bone, they are most common in the spine, pelvis, and thigh bone close to the hip. The main reasons why bone metastases are more common in these areas are the more active bone marrow and the extensive venous network around the spine.

How Does Bone Metastasis Occur?

There are quite complex mechanisms in the formation of bone metastases. The main factor is the microenvironment of the tumor. Cancer cells separate from the main cancer as a result of various mechanisms and signals and come to the bone trying to adapt to this new microenvironment. Cancer cells that arrive in the bone sow the seeds of bone metastasis through a process called osteomimic, or premetastatic nich, in which they mimic bone cells. Interestingly, once in the bone, these cancer cells can remain in a low proliferation or dormant state until a signal arrives that triggers activation. When they start to proliferate, they first form undetectable micrometastases and then clinically detectable bone metastases.

What are the Symptoms of Bone Metastases?

In cases where there are no clinical symptoms or routine follow-up is not performed, they may not be recognized. It may present with pain, pathologic fracture, hypercalcemia, and spinal cord compression.

What to Do in the Treatment of a Patient with Bone Metastases?

The clinical condition of the patient, the number and location of metastases, and life expectancy are the factors considered for treatment. In the treatment of bone metastasis, surgery, radiotherapy, various drugs, thermal ablation, electrochemotherapy, MRI-guided high-intensity focused ultrasound can be used.