Tumours (Cancer) and Specific Back Pain
Tumours affecting bone can be either Primary, arising from the bone itself, or secondary satellite deposits called Metastases arising from a distant non-bony tumour. The following tumours commonly metastasise to bone:
- bronchus
- thyroid
- breast
- kidney
- malignant melanoma
- multiple myeloma
Primary bone tumours are far less common than metastases, and present with local pain and swelling. Treatment will depend upon the type of tumour, but usually involves surgery followed by radiotherapy and chemotherapy.
The majority of spinal pain arising from tumours is due to metastases. These satellite deposits invade the bone (and other tissues) and alter the function of that tissue or put pressure on surrounding tissues and structures. This may result in a variety of symptoms. Back pain from metastases can result from the cancer growing inside non-expandable bone, or from pressure on nerves and/or other surrounding structures.
Metastatic bone disease typically presents with bony pain, pathological fractures or spinal cord compression syndrome. Most tumours weaken bone by producing substances, which encourage bone re-sorption. The weakened bone is thus more likely to fracture than normal bone, (a pathological fracture), and due to the presence of the cancer is less likely to heal.
Disabling effects
Spinal cord compression syndrome occurs when the tumour compresses the spinal cord or the nerve roots in the spinal canal. This causes pain and loss of function of the nerves (neurological deficit). Such a person may develop severe mobility restrictions and may have difficulty getting into and out of bed and the bath, rising from a chair, dressing and undressing, preparing a main meal and attending to toilet needs. Under these circumstances there may be care needs both day and night.
The longer a person has a neurological deficit, the less likely normal nerve function will return. Urgent surgical decompression of the spinal canal may be indicated, along with other treatments to inhibit the cancer, and control pain. If performed promptly, this may restore much functional ability and decrease care and mobility needs.
Management of metastatic bone disease
The most effective way to treat metastases is with anti-tumour therapy, e.g. radio or chemotherapy. Where this is ineffective, efforts should be concentrated on the following:
Control of pain:
- Pain relief medication.
- Non Steroidal Anti Inflammatory Drugs (NSAIDs).
- Nerve blocks.
Treatment of local lesions:
- Surgical fixation of fractures, if possible.
- Spinal cord decompression.
Drugs to inhibit bone re-sorption:
A cure may not normally be possible with advanced metastatic bone disease, and the above measures may be palliative in their intent (i.e. designed to relieve symptoms rather than cure the disease). Palliative therapy can often improve quality and length of life, but with this level of disease a claim under the Special Rules would not be unreasonable.
