Logan Steele
Bone cancer includes several types of rare, malignant tumors that start in your bones. The symptoms of bone cancer vary from person to person, but the first sign is often pain. This pain is usually worse at night and may feel like a throbbing, aching, or stabbing sensation. The location of the tumor can also cause muscle pain and weakness. For example, if the tumor is near a joint, it may cause difficulty in moving the joint and walking. This is because bone and muscle physiology are closely interrelated, and cancer can disrupt the normal functioning of both.
| Characteristics | Values |
|---|---|
| Cancer-induced bone pain | Caused by cancerous cells weakening the bone |
| Cancer-induced muscle wasting | Caused by cancerous cells weakening the muscle |
| Cancer-associated muscle weakness | Caused by reduced muscle mass or reduced muscle function |
| Cancer cachexia | A common paraneoplastic syndrome that causes severe wasting due to loss of skeletal muscle mass |
| Cancer-induced bone pain treatment | Resiniferitoxin, selective androgen receptor modulators |
| Bone cancer symptoms | Pain, painless lump, swelling, difficulty moving around, weight loss |
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What You'll Learn
Cancer-induced muscle wasting (CIMW)
The prevalence of muscle loss in cancer patients ranges from 16% in early-stage breast cancer to 40.3% in hepatocellular carcinoma patients. Muscle wasting is more common in advanced cancer patients and is dependent on tumour type, stage, and assessment tools. Chemotherapy can also induce fatigue and a severe decrease in muscle strength.
There are several pharmacologic therapies currently in pre-clinical and clinical testing that appear promising as adjuncts to current CIMW therapies. These include resiniferitoxin, a targeted inhibitor of nociceptive nerve fibres, and selective androgen receptor modulators, which show potential in increasing lean mass. Other medications such as mirtazapine and olanzapine can help control nausea, increase appetite, and improve quality of life. Exercise has also been proposed as a crucial component of the multimodal approach to CIMW, as it can modulate inflammation and skeletal muscle metabolism.
While palliative care is the primary approach to managing CIMW, targeted therapies are expected to revolutionize the treatment of this condition. Early recognition and treatment of nutritional and metabolic alterations during cancer are essential to prevent and delay the progression of CIMW.
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Cancer-induced bone pain (CIBP)
CIBP has distinctive and complex mechanisms that are not yet fully understood. Current evidence suggests that neuropathic mechanisms are involved, including cancer-induced damage to sensory fibers, pathological remodeling of the peripheral nervous system, and the consequences of cancer treatments such as chemotherapy, radiotherapy, or surgery. Central and peripheral sensitization caused by afferent pain impulses can result in hyperexcitability of the dorsal horn neurons in the spinal cord. Additionally, factors such as central sensitization, neuroinflammation, glial cell activation, and an acidic environment are believed to contribute to neuropathic pain in CIBP.
The treatment of CIBP has proven challenging and often relies on opioids, which have negative side effects. This has prompted the search for alternative therapeutic agents, such as the cysteine/glutamate antiporter system, cannabinoids, kappa opioids, and a ceramide axis. These novel targets have shown potential in pre-clinical and clinical testing without the adverse effects associated with opioids. Combination therapy, for instance, has shown additional benefits by lowering tumor burden and the number of osteoclasts.
The interdependent relationship between bone and muscle physiology is altered in cancer patients. Bone releases multiple growth factors during physiological remodeling, impacting muscle function. Tumor metastasis to the bone disrupts the interaction between osteoclasts and osteoblasts, along with various signaling pathways. This alteration in the microenvironment accelerates myofibrillar degradation and apoptosis, leading to muscle weakness, fatigue, and cachexia in skeletal muscle, accompanied by bone pain, fractures, and neuropathy. The diagnosis of CIBP is primarily clinical, with imaging and biochemical studies aiding in more challenging cases.
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Muscle weakness and fatigue
This clinical manifestation can range from muscle weakness and fatigue to cachexia in skeletal muscle, accompanied by bone pain, fractures, and neuropathy. Cachexia is a common paraneoplastic syndrome characterised by severe wasting due to loss of skeletal muscle mass (with or without loss of fat mass) due to a negative protein balance caused by abnormal metabolism. It is estimated that cachexia occurs in around 80% of patients with advanced malignancy and leads to significant function deficits, contributing to about 20% of cancer-related deaths.
Bone cancer can also cause problems with movement, especially if the cancer is close to a joint, making it difficult to walk or move the joint. This can result in a limp or other changes in mobility.
There are currently no treatments specifically for cancer-associated muscle weakness. However, several pharmacological therapies are in pre-clinical and clinical testing as adjuncts to current cancer-induced bone pain (CIBP) and cancer-induced muscle wasting (CIMW) therapies. These include resiniferitoxin, a targeted inhibitor of nociceptive nerve fibres, and selective androgen receptor modulators, which show promise in increasing lean mass.
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Cancer cachexia
Cachexia can make individuals feel tired and unable to perform their daily activities. It can also cause alarming changes in appearance. It is thought to directly cause up to 30% of cancer deaths, often due to heart or respiratory failure related to muscle loss. Cachexia is most common in people with advanced pancreatic and lung cancer but also frequently occurs in people with other cancer types, including head and neck, colorectal, ovarian, and liver cancers. It is believed that inflammation is the main cause of cachexia, and increased metabolism, insulin resistance, and hormone changes may also play a role.
Currently, there are no effective treatments for cachexia. Adequate nutritional support is the main method of cachexia treatment, but it cannot completely reverse the condition. However, researchers have launched clinical trials to test exercise and nutrition-based treatments for cancer cachexia. At least one drug has been shown in large studies to help people with cancer cachexia maintain lean muscle mass, which is critical for daily functioning and the ability to tolerate cancer treatments.
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Treatment and recovery
Treatment for bone cancer depends on the type, stage, and location of the cancer, as well as the patient's individual needs and preferences. Surgery is the most common treatment for bone cancer, but other treatments may include chemotherapy, radiation therapy, proton therapy, and targeted therapy.
In the case of osteosarcoma, chemotherapy is often given before surgery to shrink the tumor and make it easier to remove, and after surgery to destroy any remaining cancer cells. Chemotherapy is also used for bone cancer that has spread to other organs, such as the lungs. For chordoma, surgery is usually the first treatment recommended, and it may involve a complex and lengthy procedure performed by a team of specialists.
Radiation therapy is not commonly used as bone cancer is not highly sensitive to radiation. However, it may be considered if the tumor cannot be operated on or if cancer cells remain after surgery. Radiation can also help relieve symptoms if the bone cancer returns. New radiation therapy techniques allow doctors to target tumors more precisely, minimizing damage to healthy cells. Proton therapy is a type of radiation therapy that delivers high doses of radiation directly into the tumor while sparing nearby healthy tissue and vital organs.
Targeted medicines aim to stop the cancer from growing and may be used alone or in combination with other treatments such as chemotherapy. While bone cancer can be cured in some cases, advanced bone cancer can be challenging to treat and may require palliative care to manage symptoms and improve the patient's comfort.
The recovery process for bone cancer patients can vary. Rehabilitation and physical therapy may be necessary, especially after surgery, to help patients adjust to any physical changes and regain their strength. This process can take several months or even up to a year for more complex cases. Overall, many people with bone cancer make a full recovery, and the survival rate is estimated at 68.2% for five years after diagnosis. Lower-stage bone cancers have a better chance of a full recovery, while higher-stage cancers have an increased risk of recurrence.
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Frequently asked questions
Bone cancer includes several types of rare, malignant tumors that start in your bones.
The symptoms of bone cancer vary from person to person. The first sign is usually pain, but other symptoms include lumps, swelling, and weight loss.
Yes, bone cancer can cause muscle pain and weakness. This is due to the interdependent relationship between bone and muscle physiology, which is altered in cancer patients.
Treatment for bone cancer often involves surgery, radiation therapy, and chemotherapy. Rehabilitation and physical therapy may also be necessary during recovery.
If you are experiencing unusual changes in your bones, such as increasing bone pain, a lump, or swelling, you should see a healthcare provider. They will be able to diagnose your symptoms and determine the appropriate course of action.
