Treatment (tumours, metastases, bone instability, vertebrae)
The pain is caused by tumour cells growing into the nerve fibres, nerve structures being displaced by tumour growth, or instability of the bone or spine. Tumours and metastases make bones unstable by breaking down bone substance, thus weakening the bones or vertebrae so that they can no longer withstand the forces exerted on them. It is therefore particularly important that the various options available for treating patients with these diseases – chemotherapy, radiotherapy or surgery – are discussed in an interdisciplinary setting.
These treatments are often combined, in which case we at Zurich University Hospital coordinate the sequence in which they are best administered. Nowadays, pain caused by infiltration of the nerve fibres often responds very positively to specialised radiotherapy, while pain caused by significant instability or so-called pathological breaks must be stabilised surgically. We in Zurich University Hospital’s Department of Traumatology regularly use special carbon implants for this purpose; these are not only exceptionally stable but also permit x-rays to pass through them, thus enabling us to optimise our radiotherapy planning and use more focused, precise techniques in addition to minimising disturbance during check-ups. This is a significant advantage for our patients when they are undergoing follow-up treatment.
Depending on how far the disease has progressed, we also use other – if possible, minimally invasive – procedures to treat the pain, always with an eye to the patient’s best interest. These procedures may include inserting implants into the bone or spine through small incisions (minimally invasive surgery), or cauterising the tumour or metastatic tissue using probes inserted through small incisions then filling the bone with bone cement during the same procedure in order to stabilise it.