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Bone metastases

In about every second cancer patient, bone metastases occur during the course of the disease. The Medical Center - University of Freiburg was one of the first hospitals in Germany to establish a special tumor board for bone metastases.

Once a week, orthopedists and trauma surgeons, oncologists, thoracic and plastic surgeons, radiation therapists, radiologists and pathologists meet to discuss individual patients. Established colleagues may also participate in the board. The aim is to develop an individual treatment recommendation appropriate to the disease stage and including the patient's wishes. In his interview, the senior physician in the Department of Orthopedics and Trauma Surgery at the Medical Center - University of Freiburg and the supervisor of the tumor board for bone metastases, PD Dr. Georg Herget, explains what the disease means to patients.

What are bone metastases?

Bone metastases propagate from tumors such as those of the breast, prostate, or lungs. In principle, almost all tumors can form bone metastases.

How are bone metastases detected?

Patients who receive a tumor diagnosis are routinely tested for metastases. In people who have been diagnosed with cancer in the past, bone pain is a possible indication of a metastasis; in many cases, discomfort is reported in the hip or spine. Unlike the common degenerative skeletal diseases such as osteoporosis, complaints often first occur when at rest and then later under stress as well. When should the cause of such pain be ascertained?

If a tumor is present, an examination should be carried out after two to three weeks of ongoing complaints. In our special clinic we see such cases every day and thus have a great deal of experience in diagnosis and therapy.

Can bone fractures be an indication?

Yes, especially fractures that have arisen with no or only slight cause, for example because the person has stumbled. One speaks then of so-called pathological fractures. Metastases lead to instability through bone resorption and alteration, which can ultimately lead to a fracture. How are bone metastases diagnosed?

Local pains will usually be X-rayed or computed tomography will be performed. In skeletal scintigraphy a substance accumulates in the area of the metastatically affected bone; on a whole body image, possible metastases can then be identified. Other methods are magnetic resonance tomography and removal of tissue samples. Further methods are employed individually.

Is there any hope of healing?

In contrast to about 15 years ago, a tumor-free state can be achieved through the surgical removal of metastases. For this we work in close cooperation with other experts at the Medical Center and also with established colleagues.

What can you do if a cure is no longer possible?

A lot. For example a preventive operation can forestall a bone fracture or, along with medicinal therapy, a metastasis can be controlled locally by irradiation. The aim is to maintain or improve quality of life - and this means, above all, maintaining mobility.

How do you do that?

Aside from surgery, also via conservative procedures such as corsets that support and protect the brittle bones. Patients are thus less afraid of physical activity. We can also encourage those affected. Because in our outpatient clinic, besides serious cases, we see findings that have no direct consequences on lifestyle. Following some clarification, activities such as cycling and hiking can often be undertaken without fear.