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Archive for the ‘Bone Scan’ Category

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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October is Breast Cancer Awareness Month. Although breast cancer is only one of many cancers, I am pleased of the exposure that the many “pink” ribbon brings. It gives me hope that other cancers can have a similar banner of awareness…in the near future. Despite our many progress and technological advances in medicine, cancer remains the second leading cause of death in the United States. For example, Breast Cancer has over 220,000 new diagnosis annually, and over 400,000 deaths each year. Many are surviving a longer time thank in the past.

  • Overall, cancer has taken on a more “chronic” long term debilitating effect, for those who survive initial treatment and are then diagnosed with recurrence/metastatic disease.
  • One the most feared symptom in this category of patients is pain. Overall, 50% to 70% of people with cancer experience some degree of pain, which usually intensifies as the disease progresses.
  • Less than 50% of these patients receive adequate relief of their pain, either because they are afraid to ask because they fear “addiction”, or physicians are unlikely to prescribe adequate medication to attain relief that will allow the patient continued good quality of life.
  • Suboptimal pain control can be debilitating and caregivers are often times unsure how to address this issue.

pm_general_cp_pain_approachThe World Health Organization program for cancer pain control recognizes that 1 in 5 patients with cancer has uncontrolled pain and has a ‘three-step ladder’ for the rational use of analgesics including morphine (recommended adaption to 4-step-ladder – see HERE).

Analgesic pain 4Morphine has long been the ‘gold standard’ for the treatment of severe cancer pain. However, its side-effects, particularly sedation/drowsiness, and cognitive impairment have led to ‘opioid rotation’ to alternatives such as methadone and hydromorphone. The one I like to use most in uncontrolled pain situation is the 72-h transdermal patch for Fentanyl, which offers advantages of reduced side-effects and increased convenience over oral morphine. Another novel pain medication is Intravenous (IV) strontium-89 and bisphosphonate therapy which are effective for both short- and long-term control of metastatic bone pain.

Pain Management Physician Review

Patient Discusses Pain

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

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From the Physician’s Desk … Weekly Blog!

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bonescanprepAs reviewed last week, a diagnosis of Cancer, may in some cases lead to Metastasis to different areas from origin, such as to the bone. Bone metastasis is a common cause of severe cancer pain that can be relieved 60-90% of the time with Radiation Therapy. Good pain control is important, as it also may lead to improved overall survival.

Primary cancers most likely to metastasize (spread) to bone are breast, prostate, thyroid, kidney and lung cancers. Most common sites of bone metastasis are to the spine (low back/lumbar region or mid/thoracic area), pelvis (hip bone), ribs, femur (long bone between the knee and the hip), and the skull.

In order to diagnose whether cancer has spread to the bone, the most common study is a Bone Scan (Not the same as a bone density/Dexa scan used in diagnosing Osteoporosis). A plain X-ray film may also be useful, as it is a good modality to look for fracture. MRI is the imaging of choice when evaluating if the bone is pressing on/collapsed on the spinal cord (spinal cord compression) – this is a very serious diagnosis which requires urgent care.

Treatment:

  1. If there is a pathological (Cancer causing) fracture, then surgery can be used. An Orthopedic Surgeon will stabilize the fracture with an expandable nail/pin (fixation/stabilization).
  2. bone stabilizationRadiation Therapy can be used for discrete painful lesion, and us usually given for 1, 5 or 10 separate, daily treatments. The single treatment (8Gy) is completed in one visit, but the choice of which treatment to use, usually depends on how ill the patient is, where the lesion is located, and discussions had with the Radiation Oncologist.
  3. Radio-pharmaceutical therapy is another option that is best for patients with multiple lesions, as identified on a Bone scan. This is an injectable radiation material/agent such as Strontium-89, Samarium-153.  Therefore, if there is a fracture, spinal cord compression, or a mass next to the bone lesion, then these injected radioactive agent would not be recommended. Additionally, labs must show that the patients blood counts are in an acceptable range. Response rate of 40-90%, pain relief at 2-3wks that last for up to 4mths, can make this treatment worthwhile for certain patients.
  4. A patient may also have options of treatment with Bisphosphonates (use to prevent bone loss and often used in treatment of osteoporosis) if there are multiple bone lesions (multiple metastasis). Hormone therapies are also very effective in breast and prostate cancer.
  5. Pain management is of the utmost importance, so the use of narcotics, steroids, nerve block, etc., should be used for maximal benefit to the patient. A personalized plan would be required. Additionally, precaution with braces, walkers and personal assistance, should be used generously to prevent an unwanted fall!

As noted above, the treatment options for bone metastasis can take many formats. Some may depend on type of original cancer (breast, lung, prostate, etc.,), location, may include hormone treatment, or radiation therapy or radiopharmaceutical. It is very important for patients to discuss with their oncologist (cancer doctors) which treatment is best suited for their particular presentation.

Great information below that put everything together! Breast Cancer mets..

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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