An Overview of Bone Metastases

Bone metastases are common in people who've had cancer, especially that of the breast, lung, or prostate. They occur when cells from the original tumor break off and take up residence in the bone. Metastases are very painful and are different from tumors that originate in the bone. For example, breast cancer that moves to the bones is not bone cancer, but rather breast cancer metastatic to bone.

Common Sites

Each type of cancer has a tendency to spread to certain bones in the body more often than others, but this can vary. Metastases have occurred to nearly every bone in the body.

	Breast Cancer	Prostate Cancer	Lung Cancer
Spine	✓	✓	✓
Ribs	✓	✓
Pelvis	✓		✓
Long bones of arms, legs	✓		✓
Hips		✓

It's not uncommon for bone metastases to occur in a few different bones at the same time, such as the spine and the pelvis. Metastases may also occur in other regions of the body (such as the liver, lungs, or brain) at the same time as the bones.

Symptoms and Complications

Bone metastases can lead to many different symptoms and complications, some of which may lead to the discovery that cancer has recurred. Many of them may require treatment above and beyond what's needed to battle the tumor(s).

• Difficult-to-manage pain
• Fractures and fracture risk
• Spinal cord compression
• Loss of mobility
• Hypercalcemia

All of these concerns can significantly reduce your quality of life. Reporting new symptoms to your doctor and getting prompt diagnosis and treatment can help you get ahead of their progression and preserve your quality of life.

Hypercalcemia

In hypercalcemia, bones release calcium into the blood as they're broken down by cancer. While calcium is something your body needs, having too much leads to several problems. Symptoms include:

• Constipation
• Fatigue
• Extreme thirst
• Muscle weakness

In severe cases, untreated hypercalcemia can lead to:

• Kidney failure
• Coma
• Death

Get treatment right away if you have symptoms that suggest hypercalcemia.

Causes

Experts don't yet understand why cancer spreads to bones. The bones are rich with blood vessels, but so are the liver and lungs—areas to which cancer spreads less frequently than bone. Metastases are the cause of death in 90 percent of fatal breast cancer cases, so this area is being actively investigated.

One theory is that cancer may lie dormant in bone marrow since the bones that cancer most commonly spreads to are those that are rich in bone marrow. This may explain why cancer can hide in the body for years, or even decades, and then recur.

Diagnosis

Bone metastases from breast cancer may be diagnosed in a number of different ways. Sometimes metastases are seen when an X-ray is done for a fracture that occurred with minimal trauma due to the weakening of a bone (what's known as a pathological fracture).

Other times, they're diagnosed incidentally when a test such as a positron emission tomography (PET) scan is done for another reason.

Tests done specifically to look for bone metastases include:

• Bone scans
• PET scans
• Computed tomography (CT) scans
• Single-photon emission computerized tomography (SPECT) scans
• Whole-body magnetic resonance imgaing.

The types of scans your doctor orders will depend on a variety of factors, and some scans may be done in combination to reach a diagnosis. There's no consensus that one test or combination of tests is best in all cases.

Treatment

Addressing bone issues and bone metastases are important no matter what stage of cancer a person has. Cancer treatments such as hormonal therapies can lead to bone loss. In fact, medications used for bone metastases  (bisphosphonates) are now being considered even for those with early-stage breast cancer as a way to strengthen bones and possibly prevent bone metastases from occurring in the first place.

A number of different treatments are available for bone metastases. The option that is best for you depends on a number of factors, such as the number and location of bones affected, the presence of other metastases, and your general health.

General cancer treatments such as chemotherapy, hormonal therapies, and targeted medications are often used, as are treatments designed specifically to slow the spread of cancer to bones. They frequently result in the successful management of cancer for quite some time.

Radiation Therapy

Radiation therapy is a common choice. It can help both to decrease pain and reduce the risk of fractures, often being the most effective treatment for alleviating pain. Radiation is a "local treatment," which means that it works better for isolated areas of metastases than those that are widespread. Even so, when combined with immunotherapy drugs, some people experience what's referred to as the abscopal effect, in which radiation appears to prime the immune system. This results in a decrease in the tumor at sites distant from where the radiation was given.

In the past, radiation was often given over several sessions, but a 2019 study suggests that a single dose is not only easier from a quality-of-life standpoint (fewer visits), but may more effectively reduce pain and reduce the risk of cancer recurring at the site—and with no greater side effects. In this approach, a single dose (either 12 Gy or 16 Gy, depending on the size of the metastasis) given by a specialized type of radiation called sterotactic body radiotherapy (SBRT)  was even more effective than 10 sessions delivering a total of 30 Gy of radiation.

Radiopharmaceuticals

Radiopharmaceuticals are medications that include a particle of radiation attached to another chemical, which is injected into the bloodstream. The radiation is thus delivered directly to the bone metastases. Examples of these drugs include Strontium-89 and Radium-223.

Radiopharmaceuticals may be particularly helpful for those who have multiple or extensive bone metastases that would be difficult to treat with local therapies such as radiation therapy. These medications have relatively few side effects and can be very effective in controlling bone pain.

Bone-Modifying Agents

Bone-modifying agents are drugs that can be used orally or by injection to reduce bone metastases. These include:

• Bisphosphonates: First approved for osteoporosis, these drugs were later then found to be effective in treating and preventing bone metastases. They also appear to have strong anti-tumor effects and help prevent bone loss due to hormonal therapies (such as aromatase inhibitors). An example is Zometa (zoledronic acid). These medications are being considered for treating early-stage breast cancer in women on ovarian suppression therapy. Bisphosphonates do carry a rare side effect of osteonecrosis of the jaw.
• Xgeva (denosumab): Denosumab is an antibody that has been found to be effective in reducing complications such as fractures for people with bone metastases. It also appears to have anti-cancer properties. It is given as a subcuticular injection once every four weeks.

Treatment for Complications

While the following will not address the metastasized cancer itself, they can help patients with issues that stem from such disease.

• Pain control: Metastases to bones can be very painful, but you have a lot of options for pain relief. Finding the right medications and balancing the side effects with effectiveness can be challenging. If you're struggling to find that balance, you may want to work with a palliative care physician or pain specialist. They use numerous therapies in addition to medications, including nerve blocks.
• Fractures and fracture risk: Surgery is used most often to stabilize fractures or areas of bone at risk for fractures. (It may also be done to remove tumors putting significant pressure on the spinal cord.) When fractures are in the long bones of the arms or legs, a rod is usually placed to provide support for a weakened bone. Vertebroplasty or "cement" may be used for spinal fractures or weakened areas where fractures are likely to occur.
• Hypercalcemia: First-line treatment includes IV rehydration and bisphosphonates. Sometimes other medications, such as calcitonin, gallium nitrate, or mithramycin may be used. If hypercalcemia is severe, dialysis is another option.

Prognosis

The prognosis for bone metastases depends on what type of cancer it is.

For example, the average overall survival for metastatic breast cancer with bone metastases is 18 to 24 months (and thought to be increasing), with around 20 percent of people surviving beyond five years. In bone metastases from lung cancer, the median survival time is just six months.

It's important to note that the prognosis is better for people with only bone metastases and, thanks to treatment, there are some long-term survivors.

A Word From Very well

While bone metastases confirm that your cancer has spread and can be painful, there are some excellent treatment options available, with more treatments currently being evaluated in clinical trials . After you have adjusted to this diagnosis, work with your healthcare team to find the best regimen to control your disease and ease symptoms. Take it one day at a time.

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Breast cancer drugs may put some cells into 'sleeper mode'

Breast cancer drugs may force some cancer cells into 'sleeper mode', allowing them to potentially come back to life years after initial treatment.

The research could open avenues for finding ways of keeping the cancer cells dormant for longer, or even potentially finding a way of awakening the cells so they can then be killed by the treatment.

The team studied human breast cancer cells in the laboratory and examined the effects of a group of breast cancer drugs called hormone treatments.

"For a long time scientists have debated whether hormone therapies - which are a very effective treatment and save millions of lives - work by killing breast cancer cells or whether the drugs flip them into a dormant 'sleeper' state," said the lead author of the study.

"This is an important question as hormone treatments are used on the majority of breast cancers. Our findings suggest the drugs may actually kill some cells and switch others into this sleeper state," she added.

"If we can unlock the secrets of these dormant cells, we may be able to find a way of preventing cancer coming back, either by holding the cells in permanent sleep mode, or be waking them up and killing them," she said.

In the study, the team studied around 50,000 human breast cancer single cells in the lab, and found that treating them with hormone treatment exposed a small proportion of them as being in a dormant state.


The 'sleeper cells' may also provide clues as to why some breast cancer cells become resistant to treatment, causing a patient's drugs to stop working, and their cancer to return, the researchers said.

Hormone therapies are used to treat a type of breast cancer called estrogen-receptor positive. These make up over 70 per cent of all breast cancers, and are fuelled by the hormone estrogen.

These cancers are usually treated with surgery to remove the tumour, followed by a course of targeted hormone therapy - usually either aromatase inhibitors or tamoxifen, which target estrogen receptors.

However, around 30 per cent of breast cancer patients taking hormone therapies see their cancer eventually return - sometimes as long as 20 years after treatment.

This returning cancer is usually metastatic, meaning it has spread around the body, and the tumours are often now resistant to medication.

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Indian scientists claim to have found 100% cure for tuberculosis

Infecting about nine million people worldwide every year, Tuberculosis is a deadly disease. Out of the nine million people infected from the disease, 32 per cent are from India. Many people don’t even realise that they have the infection as it remains dormant for years before becoming infectious.

What causes Tuberculosis?
The tuberculosis bacterium is hunted by the white blood cells called macrophages. A macrophage is an important part of our immune system. The term literally means big eaters. A macrophage is an amoeba-like organism and it’s work is to clean the body of microscopic invaders and debris. The macrophage has the innate ability to consume all the invaders including fungi, viruses, bacteria and parasites. But instead of killing the bacteria, it forms a sac-like body called granuloma around it, which keeps the bacteria dormant for as long as it’s present.

But this sac can get ruptured when your immunity is lowered due to weakness or any other illness like HIV. TB is a leading killer among people who are infected with HIV.

The new cure for tuberculosis
A team of scientists found how tuberculosis is released from the sacs granuloma formed by the macrophages around them. The granuloma keeps the TB bacteria under control. The topic has been researched and studied for years with no positive result.

ResultsScientists found that these TB bacteria secrete a protein called MPT63, which might be the reason behind the sac break. When there is acidity, these protein structures change their formation and suddenly become toxic to the host cells (macrophages). This ends up killing the cell and releasing the bacteria.

The Head of Structural Biology and Bioinformatics Division said, “Our team would now try to validate these findings in field strains of TB bacillus and see whether they can be used to develop new therapeutic interventions”.

Now with this discovery, scientists will begin looking for methods to negate the effect of the MPT63 protein. Keeping the TB locked-in permanently and saving millions of patients every year.

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Ancient herbal Chinese medicine can help fight TB

Researchers have found that centuries-old herbal medicine, discovered by Chinese scientists to treat malaria, can aid in tuberculosis (TB) treatment and even slow drug resistance.

One-third of the world's population is infected with TB, which killed 1.8 million people in 2015, according to the Centers for Disease Control and Prevention.

Mycobacterium tuberculosis (Mtb) -- the TB-causing bacteria -- needs oxygen to thrive in the body and the immune system starves this bacterium of oxygen to control the infection.

The study found that artemisinin -- the ancient remedy -- stopped the ability Mtb to become dormant -- a stage of the disease that often makes the use of antibiotics ineffective.

"When TB bacteria are dormant, they become highly tolerant to antibiotics. Blocking dormancy makes the TB bacteria more sensitive to these drugs and could shorten treatment times," said Robert Abramovitch, Assistant Professor at Michigan State University in the US.

Artemisinin attacks a molecule called heme, which is found in the Mtb oxygen sensor.

By disrupting this sensor and essentially turning it off, the medicine stopped the disease's ability to sense how much oxygen it was getting, the researchers said.

"When the Mtb is starved of oxygen, it goes into a dormant state, which protects it from the stress of low-oxygen environments. If Mtb can't sense low oxygen, then it can't become dormant and will die," Abramovitch said

TB takes up to six months to treat and is one of the main reasons the disease is so difficult to control, the researchers said.

They also said that the finding could be key to shortening the course of therapy because it can clear out the dormant, hard-to-kill bacteria.

The paper was published in the journal Nature Chemical Biology.

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.

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Researchers have found that centuries-old herbal medicine, discovered by Chinese scientists to treat malaria, can aid in tuberculosis (TB) treatment and even slow drug resistance.

One-third of the world's population is infected with TB, which killed 1.8 million people in 2015, according to the Centers for Disease Control and Prevention.

Mycobacterium tuberculosis (Mtb) -- the TB-causing bacteria -- needs oxygen to thrive in the body and the immune system starves this ba ..

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Shingles, painful summer malady, rises with mercury

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A chickenpox bout does not in sure one against the contagion. The virus just stays dormant, waiting for the host to show signs of weakness to surface again in a different avatar this time as shingles.

With the peak of summer just two months away, city doctors are all set to see the routine summer-related ailments, including chickenpox. For the last few years, they have added a new malady to their list - herpes zoster, also known as shingles. Caused by the same virus that triggers chickenpox, varicella-zoster, shingles presents as a single stripe of blisters on either the left or the right side of the torso.

Doctors say the infection is often misdiagnosed as it first manifests as pain."The blister may develop three or four days later. In some cases, it may not appear at all. So, the symptoms are often mistaken for problems affecting the heart, lungs or kidneys," said K N Sarveswari, consultant dermatologist, Sundaram Medical Foundation.

 After a chickenpox bout, the virus lies dormant in the nerve tissues. Years later, it resurface when the immune system is weak. Doctors say stress, erratic sleeping patterns, malnutrition and trauma can also rouse the virus.

The elderly, most of who have already had chickenpox once, form the largest group of people who suffer from the infection. Shanthi Raju, assistant professor, geriatric medicine at Madras Medical College, said the department saw at least 10 cases of shingles in the past month. "The infection, like chicken pox, surfaces during summers and the blister stay on for a week. However, there are a lot of other differences - patients rarely present with fever, the blisters form only on one side of the body along the affected nerve and the pain may last even after the blisters are gone," said Dr Shanthi. Doctors observed that diabetes also precipitated the infection as it lowers immunity levels.

Most of the elderly say the pain which comes with the infection can be constant dull, and cause a burning sensation "Sometimes, the pain can be jabbing or just numbness," said Dr Shanthi.

While vaccine is available to prevent shingles, doctors say awareness is still low among the public as many believe they are immune to the virus after having contracted chickenpox once. "We treat patients who come to us with anti-viral and advise them bed rest," said infectious diseases specialist Dr V Ramasubramanian, adding he also advised the patients to keep the blisters covered to prevent the infection from spreading.

Director of Public Health K Kulandaisamy said officials have been alerted to monitor areas that register unusually high number of cases of chickenpox and shingles. Public health specialists say cases of shingles have seen a rise over the past few years. "The incidence of herpes zoster is still relatively low, but we have included the virus too under our surveillance," he said.