Bone Cancer Pain, Mechanism and Treatment

Abstract

The world health organization (WHO) has predicted a global amount of 19 million cancer cases by 2025. Breast, prostate and lung cancer are common cancer types and show metastasis in 60 to 84% of the cases, with 75 to 90% experiencing life-altering cancer-induced bone pain (CIBP), characterized by continuous, dull progressive pain with movement-induced incident peaks and random breakthrough spikes. Therefore, it is the most difficult pain condition to treat. CIBP is a unique type of pain with neuropathic and nociceptive components. Briefly, an invading tumor cell disturbs the healthy balance of the bone resulting in an acidic microenvironment, activating sensory fibers in the bone. The invaded tumor cell and adjacent stromal cells secrete mediators initiating an immune response with transcriptional signaling, resulting in increased cytokines and growth factors. Sensory nerve fibers are damaged and start to sprout, causing ectopic firing, and as tumors grow in size they activate mechanoreceptors. Aside from bisphosphonates and antibody therapy, CIBP is treated by a range of NSAIDs to strong opioids, but remains undertreated in one-third of cases. This chapter discusses the accompanying CIBP of bone tumors, the mechanism of action and current treatments.

Early Imaging to Detect Bone Metastatic Disease of a 54-Year-Old Woman with History of Breast Cancer: A Case Report

“…Bone is the most common site for breast cancer metastases, and 70% of patients with advanced breast cancer suffer from osteolytic bone metastases [6,7]. Bones are classified by their shapes, those are flat, short, long and irregular bones [1]. The outer part is covered with a fibrous layer and an inner osteogenic layer, the periosteum, and cambium layer which contains progenitor cells for the bone building cells, osteoblasts [1].…”

“…Bones are classified by their shapes, those are flat, short, long and irregular bones [1]. The outer part is covered with a fibrous layer and an inner osteogenic layer, the periosteum, and cambium layer which contains progenitor cells for the bone building cells, osteoblasts [1]. Behind the periosteum are densely packed tube-like structures called osteons (Haversian system) which consists of several layers (lamella) with small gaps (lacunae) in between, containing nutrient transportation cells, osteocytes, constituting 90 to 95% of the bone cells present in the mature human skeleton [1].…”

“…The World Health Organization (WHO) has predicted a global amount of 19 million cancer case in 2025 [1]. After the lungs and liver, bone is the third most common site of tumour spread [2].…”

“…The bone is a dynamic tissue that plays a critical role not only in structural support and movement, a reservoir for minerals and energy, but also houses of the bone marrow, which is the main site of postnatal hematopoiesis [3]. The incidence of ability to interfere by secretion of Osteoprotegerin (OPG) [1]. The degradation of bone is initiated after maturation of osteoclasts and their allocation to the site-of-destruction, where they form a closed space, the resorption lacuna [1].…”

“…The incidence of ability to interfere by secretion of Osteoprotegerin (OPG) [1]. The degradation of bone is initiated after maturation of osteoclasts and their allocation to the site-of-destruction, where they form a closed space, the resorption lacuna [1].…”