At the intersection of Cancer and Orthopedics

“I was diagnosed with breast cancer and my doctor said the cancer has spread to my thighbone.  He wants me to see an orthopedic surgeon about surgery to prevent this bone from breaking.  Why?”

What comes to mind when you think about cancer?  Go ahead. Take a minute to think about it.

I’m guessing orthopedic surgery did not come to mind, but in reality, orthopedic surgery can have a role in cancer treatment.

That role usually comes into play when cancer spreads to bones of the body, known as metastatic bone disease.

Multiple bones of the body can be affected, such as the skull, ribs, spine, pelvis and long bones.

So how does breast cancer affect the bones?  Cancer can spread to the bone and grow bigger in size such that it replaces part of the bone.  Bone is hard and strong but the cancer that spreads and replaces the bone is very soft and weak.

It’s as if you drilled a hole in a piece of wood and replaced it with Jell-O.  As the cancer grows, the hole becomes bigger and bigger and the bone weaker and weaker.

As a result of this growth, a trivial injury or stress can cause the bone to break, which in turn adds to the suffering and hardship a person is already experiencing.

An orthopedic surgeon can frequently use a rod or pin to stabilize your thighbone before it actually breaks.

Of course, surgeons do not want to perform surgery unnecessarily, so we use a scoring system to try to predict an impending fracture, taking into consideration the bone that is affected, the size of the lesion, the appearance of the lesion, and the amount of pain the patient has.

The most common symptom of metastatic bone disease is pain. It is usually described as a deep, aching sensation.  It tends to be worse at night and can be decreased by activity.  Symptoms often increase as the lesion gets larger.

Not all metastatic tumors require surgery.  Chemotherapy and hormonal therapies are the mainstays of treatment.  Radiation therapy is commonly used for painful lesions.  Braces are sometimes used to prevent bone fractures.

I cannot stress the importance of breast cancer screening.  Early detection of cancer will decrease complications such as metastatic bone disease.