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Bone Pain from Cancer and percutaneous treatment methods

Bone Pain from Cancer and percutaneous treatment methods - What it is

​Spread of cancer to the bones, particularly the spine and pelvic bones. Pain may be caused by cancer weakening the bone or by invading the surrounding nerves. 

Bone Pain from Cancer and percutaneous treatment methods - Symptoms

​Usually begins as feeling of tenderness in the affected bone. This may progress to severe pain, which can be constant, or continues at night. Some patients can also get shooting pain down the leg on walking, also known as radicular pain, due to cancer invading the nerves exiting the spine.

Bone Pain from Cancer and percutaneous treatment methods - How to prevent?

Bone Pain from Cancer and percutaneous treatment methods - Causes and Risk Factors

​Spread of cancer cells to the bones. Some cancer spread more often to the bone than others, for example kidney and breast cancer.

Bone Pain from Cancer and percutaneous treatment methods - Diagnosis

​If you or your love ones with a background of cancer exhibit such symptoms, your doctor will ask for a CT scan or an MRI, which will diagnose the problem.  

Bone Pain from Cancer and percutaneous treatment methods - Treatments

There are many ways to treat bone pain due to cancer. Your doctor will likely prescribe you painkillers first. You may not need further treatment if you respond to them. 

However if the pain does not improve with medications then there may be a role in minimally invasive percutaneous treatment methods which are provided by our department, namely nerve blocks and/or ablations, cementoplasty (i.e. injection of bone cement), tumour ablation (using extreme heat or cold to kill the cancer cells). There are other methods of treatment bone pain from cancer, namely radiation and surgery. When you see the interventional radiologist, available options will be discussed and if needed consultations with other specialists will be carried out to find the best option for you. 

Nerve block and/or ablation

A nerve block can be performed by injecting medications directly to the nerves affected by the cancer. These can be performed as day procedures (can be discharged the same day). The nerves are located using a combination of X ray, CT or ultrasound guidance with a small needle. However the effects of the nerve blocks can be temporary. Some nerves can be ablated, that is to apply high or low temperature to either modulate or to destroy the nerve, using similar guidance but with more specialised needles.

Cementoplasty

If there is a fracture from tumour invading the spine or the pelvic bone, cement can be injected into these affected areas to lend strength to the bone and at the same time provide pain relieve. These are also performed with X ray or CT guidance but require larger size specialised needles. These procedures will generally require one or 2 nights’ stay in hospital and use of at least conscious sedation during the procedure. Other common terms vertebroplasty (cementoplasty specific to the spine) and kyphoplasty (vertebroplasty with inflation of balloon to try and restore lost bone height).

Tumour ablation

Sometimes if it needed to destroy the offending tumour cell directly with extreme heat or cold. The interventional radiologist will review your scans and discuss the best option for you. The ablations are also minimally invasively procedures and often these will be combined with cementoplasy. 
Bone Pain
Patient in his 60s who had kidney cancer spread to his lower spine causing pain.
A: pre-treatment CT scan showing a tumour invading the spine (*). 
B: CT scan taken during cryoablation, showing the extent of the ice ball which will destroy the tumour cell. 
C: post-treatment CT scan, showing the tumour being much smaller (#). Symptoms also improved. 

Bone Pain from Cancer and percutaneous treatment methods - Preparing for surgery

​Your doctor and the staff caring for you will instruction you as to when to fast the day before the procedure. If you are on any antiplatelet medications, e.g. aspirin or clopidogrel (Plavix), or blood thinning medications like warfarin or low molecular weight heparin (Claxane), you will be asked to stop these medications at the appropriate intervals before the procedure. 

Bone Pain from Cancer and percutaneous treatment methods - Post-surgery care

​Depending on the complexity of the procedure, these percutaneous procedures can be performed as day surgery cases or may require 1-2 nights hospitalisation. Some patients can resume normal activities / weightbearing as tolerated with a few days but more severe cases may need further assistance. 

Bone Pain from Cancer and percutaneous treatment methods - Other Information

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