Metastatic Disease of the Musculoskeletal System, Causes and Symptoms

Metastatic disease of the musculoskeletal system is the result of spread of cancer cells from another organ to the bone.  While it may be occur in any type of carcinoma, bone is among the most common sites for metastasis from carcinoma of the breast, prostate, lung, thyroid, and kidney.  When the cells spread, they create tumors on the bones. These cells can be asymptomatic in the body until they spread to the bones, which can make them difficult to detect. In some of carcinomas, up to 35% to 73% will metastatic diseases of the musculoskeletal system.

Metastases are thought to primarily spread through the blood, though certain characteristics of the tumor cells make skeletal lesions more or less likely.  Tumors in the bone may cause significant pain and can increase the risk of fracture, either of which may require treatment.  Significant advances in surgical techniques and medical management have greatly improved the quality of life related to metastatic bone disease.
Anatomy of the Musculoskeletal System
The musculoskeletal system is an important part of keeping the shape and strength of the human body. It consists of the following:

  • Bones (the skeleton)
  • Muscles
  • Cartilage
  • Tendons
  • Ligaments
  • Joints

The skeletal system is complex, and each bone serves as a depository for many cells, nutrients, and minerals.  A rich blood supply and a supportive environment for cells from many different tumors favors the development of metastatic disease of the musculoskeletal system in several carcinoma types.

Types of Metastatic Diseases of the Musculoskeletal System
Metastatic diseases of the musculoskeletal system can attack any bone. However, studies have shown that there are several bones that are at significantly more risk:

  • Breast cancer – One of the most common types of cancer in women is breast cancer. In up to 73% of patients with metastatic breast carcinoma, a bone lesion will be identified.  While medications may decrease the risk of skeletal complications, breast carcinoma lesions may weaken the bone to the point of fracture.
  • Prostate cancer  – If a patient with prostate carcinoma develops metastatic disease of musculoskeletal system, the bone lesion may become dense and hard.  Though this has some protective effect relative to most metastatic lesions, the bone may become brittle and still at risk for pain or fracture. 
  • Lung Cancer – While often presenting late in the disease course, lung carcinoma may develop extensive disease within the skeleton.
  • Kidney Cancer – Renal cell carcinoma has a tendency towards large and destructive bone tumors.  Coordinated care between specialists can improve the quality of care and the timing of medical and surgical treatment, in order to maximize the patient’s health and comfort.     

Causes of Metastatic Disease of the Musculoskeletal System
The primary cause of metastatic disease of the musculoskeletal system is to have cancer in another form. However, the manner in which it spreads can be caused in two different ways:

  • Hospitable environment – According to Stephen Paget, metastasis of carcinoma cells is akin to a fertile seed landing upon hospitable soil.  The bone environment provides a favorable bed for certain types of tumor cells.   
  • Rich blood supply – According to another expert, James Ewing, cancerous cells are spread more frequently via the bloodstream. Because bones consist of a well-vascularized region with factors promoting growth and development of various cell types, it supports growth of some metastatic tumor cells as well.     

Symptoms of Metastatic Disease of the Musculoskeletal System
Depending on the form of cancer cells and how affected the organs where they are traveling from are, symptoms of metastatic disease of the musculoskeletal system can vary. 

The following are some of the most common symptoms:

  • Broken bones caused by weakening from the tumors
  • Nerve damage from compression, which can lead to paralysis
  • Severe pain in the area of the major bones, such as spine, long bones, hips and pelvis
  • Anemia
  • Unexplained fatigue

Fortunately, the symptoms of metastatic disease of the musculoskeletal system often appear very early on, which makes it easier to catch before it’s too late. If you may be at risk, it is important to contact your doctor in case any of these symptoms appear or continue.

The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute's musculoskeletal oncology services in New York treats metastatic disease of the musculoskeletal system as well as a broad range of conditions that affect the bones within the body.

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