Bone metastasis of lung adenocarcinoma received targeted therapy. CT showed that the primary lesion was stable, but my legs hurt when I walked recently. What should I do next? Some netizens asked a question on the platform: lung adenocarcinoma bone metastasis received targeted therapy, CT showed that the primary lesion was stable, but the leg hurts recently when I walked, how should I treat it next? Lung cancer is prone to bone metastasis, and 30-40% of lung cancer patients will eventually have bone metastasis, especially lung adenocarcinoma, which is easily metastasized to the bone tissue of the body through the blood. The more common bone metastases include ribs, thoracic vertebrae, lumbar vertebrae, ilium, femur, humerus, etc. in turn. Once bone metastasis occurs, it means that lung cancer is at an advanced stage, and the chance of cure is minimal. Bone metastasis of lung adenocarcinoma belongs to the advanced stage of lung cancer. Although the chance of radical cure has been lost, fortunately there are targeted drugs available. The patient’s lung CT primary tumor was stable, but his legs hurt as soon as he walked. This requires further examination and comprehensive evaluation. 1. If there is no bone metastasis in the leg in the past, but the bone metastasis of the leg pain has been detected by CT or MRI recently, consider local progress. Local progress can continue to use the original targeted drugs, and local radiotherapy for bone transfer to relieve pain. If the femur and other key parts have severe osteolytic damage, there is a greater probability of pathological fractures, which will affect the later walking. At this time, radiotherapy alone is not enough. According to the patient’s wishes, orthopedic surgery may be performed. 2. CT of the patient’s lungs indicated that the primary tumor was stable, but were other locations assessed? Lung adenocarcinoma is easy to metastasize to various organs of the body, such as liver, adrenal gland, brain, etc. Therefore, a comprehensive examination and evaluation of head MR, abdominal enhanced CT or PET-CT is required. If there is a metastasis or an increase in the number of lesions in organs other than the lungs, it means the disease is progressing. At this time, considering the resistance of the original targeted drug, it is necessary to re-test the gene, change other targeted drugs or use intravenous chemotherapy combined with bevacizumab. Multiple bone metastases throughout the body can be irradiated with radioisotopes to relieve pain and kill cancer cells to a certain extent. Local pain is very obvious after lung cancer bone metastasis, and strong opioid anesthetics such as morphine, fentanyl patch, and oxycodone are needed to improve the symptoms of pain. Bisphosphonates play a role in patients with bone metastases. Bisphosphonates can inhibit the activity of osteoclasts, induce osteoclast apoptosis, and can also block the absorption of mineralized bone and cartilage by osteoclasts by binding to bone. Therefore, patients with bone metastases from lung cancer can infuse bisphosphonates (zoledronic acid, ibandronic acid) on a monthly basis to inhibit bone destruction and relieve bone pain. In short, the symptom of leg pain after walking needs to be clear whether it is caused by bone metastasis. If it is not caused by bone metastasis but other diseases, then continue the original targeted therapy. If it is a new bone metastasis, it is necessary to determine the probability of pathological fractures. If pathological fractures are more likely to occur, in addition to systemic treatments such as replacement of targeted drugs or chemotherapy, local surgical fixation and radiotherapy are required to prevent fractures. The quality of life has dropped significantly.
Many patients with lumbar intervertebral disc herniation have this experience: when they have back pain, it is considered to be lumbar intervertebral disc herniation. It will be treated as a cure after a while, and the leg will start to hurt again after a while. After a period of treatment, there was no effect. Go to the hospital for examination, and the result was diagnosed as lumbar disc herniation. “The waist doesn’t hurt anymore. Isn’t the lumbar disc herniation cured? Besides, how can the lumbar disc herniation cause leg pain?” Frequently asked by a friend of the patient while seeing a doctor. Click to add a picture description (up to 60 words) to edit the lumbar disc herniation, why does the leg hurt? This starts with the structure of the lumbar spine. In the human body, there are a total of 5 lumbar vertebrae, with lumbar intervertebral disc connection between each segment, similar to bamboo. Unlike bamboo, the lumbar intervertebral disc has a certain elasticity, which makes the lumbar spine have good mobility (such as bending) and can also cushion the lumbar vertebrae! Click to add a picture description (maximum 60 words). The lumbar disc is composed of the nucleus pulposus, the annulus fibrosus, and the cartilage plate. The nucleus pulposus is located in the center and is surrounded by the fibrous ring. The protrusion of the lumbar intervertebral disc is actually the compression of the nucleus pulposus that plays a weight-bearing role. Gradually invade outward, and even break through the fiber ring. When the nucleus pulposus protrudes outward, it will affect the surrounding tissues. The most common is the nerve around the protruding part, and may even directly compress the nerve, causing the patient to show the corresponding symptoms. Click to add a picture description (maximum 60 words) to edit lumbar disc herniation causes the human body to show certain symptoms, which is clinically called lumbar disc herniation. So, why the main symptom of patients with lumbar disc herniation is not back pain but leg pain? it’s actually really easy! Because the innervation of the waist is not the waist, but the lower limbs, that is, the legs. Click to add a picture description (up to 60 words) to edit the lumbar nerve in the lumbar vertebral canal, just like a rubber tube with water flowing. The lumbar disc herniation and compression of the lumbar nerve can also be imagined as a stone pressed against a certain position of the rubber tube. The rubber tube is pressed by the stone, and the water flow decreases after the stone; after the lumbar nerve is compressed by the protruding intervertebral disc, the compression position is affected later. Therefore, patients with lumbar disc herniation will not experience discomfort in the waist, but symptoms in the legs below the waist. Conversely, when symptoms such as leg numbness and pain appear, it is one-sidedly considered that “leg pain” is undesirable. It is more important to fully understand the causes of leg pain and determine whether it is caused by lumbar disc herniation or other diseases, and Relative treatment is performed accordingly. Otherwise, even if the symptoms can be relieved for a short period of time, there is no cure for the cause, but it is just “a cure for the symptoms”.