Bony Metastasis In the Spine, Treatment Options

In this video, Dr. David A. Margileth discusses the causes and treatment options for cancer recurring along the spinal bone.




David A. Margileth, MD: I have recently received a question about what is the best way to treat breast cancer that has spread to the spine.  Now we have other videos at Breast Cancer Answers about stage IV disease, so that breast cancer that has spread to the spine is in fact stage IV disease, but there are some special things about that location of metastasis that I am particularly concerned about.

Remember that the spinal column is a bony column.  The cancer can spread into those building blocks of bone, the vertebral bodies or some of the other parts around the spinal column and remember inside this is bony column, with a rough over it if you will, goes the spinal cord itself.  So this is a particularly vulnerable place that could lead to some really serious consequences with spread of breast cancer to the spine.

Now just like everything else we talked about with breast cancer, the extent of the spread to the spine can be one isolated area or multiple areas along the bony spinal column.  What we are particularly concerned about is if there is a collapse of those vertebral bodies or the bony structure surrounding the spinal cord to the point that it pinches or impinges on the spinal cord itself.  If that were the set of circumstances we are talking about urgent to emergent decompressive surgery to unrough the spinal cord and to free it up from that kind of compression before paralysis or other serious injuries sets in.

So it takes a team to deal with that extent of spread and so I cannot generalize about what is the best way to treat metastasis to the bone without knowing a lot more about the individual cancer.  As an example, is the cancer estrogen receptor positive, yes or no; as an example, is just one vertebral body involved and it is stable and I have seen plenty of stable disease to the bone throughout my career and I will have others here on our breast cancer experts’ team comment about some of the medical treatment if you will.

In a addition, there are times when radiation therapy is needed to help treat the metastasis along the vertebral bodies to help relieve pain, stabilize the disease, etc., so just like everything else this is potentially a galaxy of problem that occur when you are in that set of circumstances, you clearly need to be in the hands of a multidisciplinary team that can give various aspects of treatment, do not give up, get into the hands of a multidisciplinary team and we will also be sharing more about this treatment here at Breast Cancer Answers.

Dr. David A. Margileth practices medical oncology at St. Joesph Hospital in Orange, CA specializing in oncology, hematology, and internal medicine (board certified). His selected area of interest is breast cancer. Dr. Margileth graduated from Baylor College of Medicine in 1971 and has since spent time treating patients at the National Cancer Institute and Methodist Hospital in Houston, TX.
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