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News Archive - Progress Newsletter Spring 2000 Online

Innovative New Clinic Helps Patients with Metastatic Bone Cancer

"With contemporary cancer treatments patients can be alive with metastasis for years or even decades."
--Dr. J. Sybil Biermann

Facing cancer is hard enough. But facing the fact that part of your cancer has broken loose and invaded your bones -- once seen as a guarantee of an imminent and painful death -- is even harder.

Now, patients at the Cancer Center have a new team of allies when confronting cancer that has spread, or metastasized, from their original tumors to their bones. A group of physicians from many specialties has banded together to start an innovative Bone Metastasis Clinic, allowing them to choose the best treatment for each individual from a range of new pain-alleviating and even life-saving options.

"The cooperative approach -- unique in the nation -- gives patients a much better chance of surviving or living comfortably with their secondary cancer," says clinic head and Director of Orthopaedic Oncology J. Sybil Biermann, M.D. "Bone cancer no longer automatically carries the weight of a death sentence.

"There used to be a very limited number of treatments available for bone metastases -- patients could either have surgery or they could have radiation, and there wasn't really much else," Dr. Biermann explains. "In the last few years, a number of medications and other therapies have been developed that can be used very effectively for bone metastasis. In fact, this has presented a fairly confusing array of alternatives for both patients and the physicians who manage their care."

So, Dr. Biermann and her colleagues decided to help metastatic bone cancer patients sort through the confusion by reviewing each case together and recommending which treatments to pursue, from surgery and chemotherapy to radiation and radioactive drugs. Patients can even elect to try brand-new treatments by participating in clinical trials offered at the clinic -- including tests of treatments being developed at the U-M.

With an estimated 500,000 Americans living with bone metastasis, and 190,000 more being diagnosed each year, the clinic's concept may become a model for hospitals nationwide.

Bone cancer arises when cancerous cells from the main tumor break off and travel through the bloodstream or lymphatic system. When they lodge in the bone, the cells can take root in the welcoming environment and begin to multiply. As the new tumor, or lesion, grows, it can press on nearby nerves, causing pain and swelling. It also can weaken the bone, increasing the risk of fractures, and cause too much calcium to enter the bloodstream, a condition called hypercalcemia.

The American Cancer Society estimates that half of all cancer patients, except those with skin cancer, will develop metastatic bone cancer. Most common are metastases that spread to the bone from breast, prostate, lung and kidney cancers -- with the spine, pelvis, hip and upper leg bones being the most likely sites.

"As cancer treatments become in general more effective, patients are living longer and longer with cancer," Dr. Biermann comments. "It also means that a substantial part of the population actually has metastasis of the bone, and those patients are needing treatment as well."

The U-M clinic gives such patients easy access to a diverse range of specialists, all in one visit. For those who must rely on others to transport them to medical appointments, the "one-stop shopping" approach makes a world of difference. Dr. Biermann also hopes the clinic will help clear up some of the popular ideas about metastatic bone cancer that have become untrue in recent years as medicine has advanced.

"A common misconception is that patients with bone metastasis are in the very terminal phases of their disease. While it's always a more serious situation when a cancer has spread from one place to another, with contemporary cancer treatments patients can be alive with metastasis for years or even decades," Dr. Biermann explains.

As for the idea that bone cancer means excruciating pain, crippling bone weakness or constant sedation, she adds, "With new treatments we can stabilize the bones, we can strengthen the bones, and we can allow patients to get out and do the things that they want to do with less pain and more mobility."


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