A number of benign and malignant systemic diseases can originate in the bone or – more commonly – migrate there and form metastases. Malignant tumours of the lung, breast, prostate, kidney and thyroid are mostly likely to metastasise in the bone, which means that such developments must be monitored closely. Other diseases such as lymphoma can also migrate to the bone, and the tumours that develop there can make the bone unstable. This often causes pain in the affected part of the axial skeleton or spine.
The pain is caused by tumour cells growing into the nerve fibres, nerve structures being displaced by tumour growth, or instability of the bone or spine. Tumours and metastases make bones unstable by breaking down bone substance, thus weakening the bones or vertebrae so that they can no longer withstand the forces exerted on them. It is therefore particularly important that the various options available for treating patients with these diseases – chemotherapy, radiotherapy or surgery – are discussed in an interdisciplinary setting.
These treatments are often combined, in which case we at Zurich University Hospital coordinate the sequence in which they are best administered. Nowadays, pain caused by infiltration of the nerve fibres often responds very positively to specialised radiotherapy, while pain caused by significant instability or so-called pathological breaks must be stabilised surgically. We in Zurich University Hospital’s Department of Traumatology regularly use special carbon implants for this purpose; these are not only exceptionally stable but also permit x-rays to pass through them, thus enabling us to optimise our radiotherapy planning and use more focused, precise techniques in addition to minimising disturbance during check-ups. This is a significant advantage for our patients when they are undergoing follow-up treatment.
Depending on how far the disease has progressed, we also use other – if possible, minimally invasive – procedures to treat the pain, always with an eye to the patient’s best interest. These procedures may include inserting implants into the bone or spine through small incisions (minimally invasive surgery), or cauterising the tumour or metastatic tissue using probes inserted through small incisions then filling the bone with bone cement during the same procedure in order to stabilise it.
Interdisciplinary treatment planning involves precisely tailoring the treatment concept to the patient’s condition in close discussion with the patient and their relatives.
The surgical treatment of significant bone instability caused by tumours and metastases may also be indicated if the patient does not respond to conservative treatment (radiotherapy, chemotherapy) or if new neural deficits occur; these may take the form of paralysis or impaired sensory perception. Surgery may at times also be necessary if the tumours/metastases continue to grow despite conservative treatment. At Zurich University Hospital, a special treatment and reaction plan has been developed by the Departments of Oncology, Neurosurgery, Radiation Oncology, Neurology and Traumatology for the most urgent cases in which a metastasis or tumour is pressing directly on the spinal cord and causing paraplegia. This ensures that internal and external contacts and the necessary emergency diagnostic procedures are available 24/7 so that these oncological emergencies are treated as quickly as possible. In up to 20% of cases, the appearance of metastases in the spine is the first sign of malignancy. Major studies have shown that fast action can in fact completely reverse this paralysis.
The paramount goal of all treatment methods is to maintain the best possible quality of life for as long as possible so that cancer patients keep their independence and can stay at home with their families.
As a patient, you cannot register for a consultation directly. Please ask your family doctor, your specialist to refer you. Please use our contact form if you have any questions.
University Hospital Zurich
Department of Traumatology