Bone marrow carcinomatosis refers to a rare diffuse metastasis of a cancerous tumor within the bone marrow. It is a complication of bone metastases.
What is bone marrow carcinosis?
Bone marrow carcinomatosis, also called bone marrow carcinosis, is the sequelae of a bone metastasis. In this case, the bone marrow is infiltrated by the small-bore metastases (daughter tumors) of a carcinoma. Bone marrow carcinoses are considered a complication of bone metastases. They occur in approximately eight to ten percent of all patients suffering from bone metastases. The development of bone metastases occurs primarily during the progression of cancers such as prostate cancer and breast cancer. Metastases to the human skeleton can also form as part of thyroid cancer, lung cancer and renal cell carcinoma. In prostate cancer and breast cancer, an average of seven out of ten patients suffer from a daughter tumor. Less commonly, bone metastases are possible in pancreatic cancer, stomach cancer, liver cancer, black skin cancer, bladder cancer, uterine cancer, ovarian cancer, and gallbladder cancer.
Causes
Bone marrow carcinomatosis is caused by malignant cancer tumors. Cancer cells are deposited by both the tumors and their daughter tumors, which are able to penetrate the substantia spongiosa (spongy bone, or ball bone) of the bone, allowing them to subsequently affect the bone marrow. In most cases, this occurs with a primary tumor such as breast carcinoma or bronchial carcinoma. The colonization is accompanied by diffuse infiltration of the hematopoietic (affecting hematopoiesis) system. The infiltration of cancer cells leads to a reduction in the number of hematopoietic cells or even to their not being produced at all. Doctors then speak of terminal myelosuppression. The build-up and breakdown of bone is already thrown out of balance by the bone metastases, but this does not happen immediately. The cancer cells can reach the bone marrow via the bloodstream, where they take root. From there, the growth of the daughter tumor subsequently begins. In this way, they emit signals that result in an interference with the functions of the osteoclastic and osteoblastic cells. This in turn leads to uncontrolled formation and degradation of bone tissue. The remodeling of the bone leads to a release of growth factors. These stimulate the metastases to continue growing. If anything, the cancer cells cause indirect damage to the bone.
Symptoms, complaints, and signs
Bone metastases or bone marrow carcinosis are mostly noticeable by pain in the back or limbs, but they cannot be clearly classified, as they may also have other causes. Characteristic symptoms of bone marrow carcinosis include anemia and decreased blood clotting due to thrombocytopenia (lack of platelets). Due to a deficiency of white blood cells (leukocytopenia), there are also disturbances of the immune system. As a result, affected individuals have an increased susceptibility to infections. Sometimes unexplained bone fractures also appear. If the bone metastases also exert pressure on nerves in the spinal cord, arm or leg, this leads to sensitivity disorders such as numbness and tingling. If the calcium level in the blood increases, this is considered an indication of remodeling processes within the bone. The increase in calcium levels often causes hypercalcemia, which in turn can cause dysfunctions in almost all organ systems. In severe cases, hypercalcemia can even reach life-threatening proportions. However, it occurs in only about 5 out of 100 patients. The anemia that occurs in bone marrow carcinosis often results in poor oxygen supply to the organism. This is usually noticeable by dizziness, breathing problems, and fatigue.
Diagnosis and course of the disease
If bone metastases or even bone marrow carcinosis are suspected, targeted examinations are used. The standard diagnostic procedure for bone metastases is scintigraphy, in which radioactive substances are injected into the patient’s bloodstream. The markers used resemble calcium and accumulate in bone regions where severe remodeling is taking place.However, there is a risk that a bone scintigram will be negative. For this reason, further examination methods are necessary. These include a bone marrow biopsy, in which a puncture is made on the breastbone or iliac crest using a hollow needle. The cancer cells can be identified in the bone marrow smear. In the peripheral blood, erythroblasts or immature granulocytes are occasionally found. Furthermore, there is often a slight increase in the number of reticulocytes, which also indicates bone marrow carcinosis. The course of bone marrow carcinosis is negative in most cases. Thus, a cure can usually no longer be achieved because the stage of the cancer has already progressed too far.
Complications
Bone marrow carcinosis causes cancer to develop in the bone marrow. This represents a very serious condition for the patient’s health. In most cases, patients suffer from severe back pain and also pain in the limbs during this process. If the pain also occurs at night, the patient may experience difficulty sleeping and general irritability. Sufferers continue to be susceptible to various infections and suffer increased bone fractures. Likewise, paralysis and disturbances in sensitivity develop throughout the body, significantly limiting the patient’s daily life. There may also be paralysis of the face, which usually makes it impossible for the affected person to take in food and liquids. Breathing difficulties also occur, which can lead to fatigue or dizziness. It is not uncommon for patients to lose consciousness. If treatment is successful, there is no reduction in life expectancy.
When should you see a doctor?
When increased susceptibility to infection, bone fractures, and other signs of serious illness are noticed, a visit to the doctor is always necessary. The affected person should quickly present to the family doctor or an internist and have the complaints clarified. This is especially true if other symptoms occur, for example a feeling of illness or numbness in the arms and legs. Bone marrow carcinosis can cause very different symptoms, which is why it is often only diagnosed by a specialist examination. This makes it all the more important to see a doctor early on if you have symptoms, who can make an initial diagnosis and refer the patient to a specialist if necessary. People who have already been diagnosed with cancer belong to the risk groups. They should definitely discuss the above-mentioned signs of the disease with the doctor in charge. If bone marrow carcinosis is indeed present, treatment must be initiated immediately. This is usually carried out by a specialist in internal medicine. In most cases, surgical intervention in the hospital is necessary.
Treatment and therapy
The appearance of bone metastases or bone marrow carcinosis is an indication that the cancer has already spread throughout the body. Therefore, in most patients, only palliative therapy remains an option. Treatment options include radiating the affected bone from the inside or outside. External radiation is referred to by physicians as percutaneous radiation therapy. In this case, high-energy rays from the outside pass through the skin and are intended to cause the tumor cells to die. Another treatment method is radionuclide therapy, in the course of which the patient is treated with weak radioactive substances. For this purpose he receives an injection. This procedure allows the radionuclides to be deposited directly in the bone and to affect the cancer cells, which in turn counteracts inflammation. The described procedures serve to alleviate pain. Furthermore, bone marrow carcinosis can be treated with chemotherapy.
Outlook and prognosis
The prognosis of bone marrow carcinosis is extremely unfavorable. Bone marrow disease is an indication that a cancer already present in the organism has already increased in extent and intensity. In common parlance, the cancer is said to have spread in this case. The therapy plan must be changed and adapted to the current findings. There are only a few therapeutic approaches that lead to an alleviation of the symptoms in the case of a slight affection of the bone marrow.If these are applied as quickly as possible and show a corresponding effect within a short time, there is a prospect of subsequent healing. The patient’s organism does not always respond as desired to the initiated therapies. A successful course of treatment lasts several years and is characterized by numerous side effects. The patient is threatened with further secondary diseases and is forced to adapt his entire lifestyle to the physical possibilities. Even during recovery, relapses can occur at any time in the further course or within a therapy that is taking place. The more severely the bone marrow is affected by cancer cells, the worse the prognosis. In some patients, the focus is on alleviating pain, which is no longer possible to cure. Premature death of the patient occurs within a few weeks, months, or years.
Prevention
Prevention measures against bone marrow carcinosis are not known. Thus, it is an advanced stage of cancer.
Follow-up care
Cancer is one of the diseases for which follow-up care is essential. Quarterly or biannually, the patient presents and participates in screening examinations. From the detection of a tumor in the early stages, doctors expect the greatest success in treatment. However, this type of follow-up is not possible in the case of diagnosed bone marrow carcinosis. The problem stems from the fact that a cure is virtually impossible. The disease is far advanced when it is diagnosed. Accordingly, recurrence cannot be prevented; the cancer is permanent. Therapy is aimed at eliminating complications and allowing the patient to live the rest of his or her life without pain. Strictly speaking, this part does not belong to follow-up, since treatment has not been previously completed or provisionally terminated. Diffuse metastases are treated by radiation and chemotherapy. A short-term freedom from symptoms is thereby realized. In rare cases, recovery actually occurs. But this is typically followed by a recurrence of cancer. A bone marrow biopsy promises clear results. Life expectancy is shortened again. Not infrequently, a bone marrow carcinosis brings with it inquiries about life and psychological problems. This can be addressed in the context of therapy.
This is what you can do yourself
Individuals who have been diagnosed with bone metastases can usually only receive palliative treatment. The most important self-help measure is to obtain information about bone marrow carcinosis and its progression. This often makes it easier for those affected to accept the disease. Attending a self-help group contributes to a more positive outlook, and patients often learn new strategies for dealing with their symptoms by talking to other sufferers. Accompanying medical treatment is always necessary. Since radiation therapy places a considerable strain on the body, sufferers need a lot of rest and recuperation. The doctor in charge will also recommend an individual diet to the patient. In cooperation with a physiotherapist, an exercise plan is worked out to ensure the functionality of the affected bones and, in the best case, to improve the patient’s well-being. The individual symptoms, such as pain or the typical feeling of illness, can also be alleviated by alternative remedies under certain circumstances. Which measures are useful here in detail is best answered by the responsible medical professional. Despite all these measures, bone marrow carcinosis often ends in the death of the patient. Support from friends and relatives is therefore all the more important.