Hi! My name is 
I am studying to become a doctor of chiropractic. As I go through my course work; I have decided to put some educational material out into the blockchain. I will write a brief summary of the material I am learning about and a little blurb at the end about how this all applies to my profession.
I do not believe people realize the extent of the education a chiropractor receives in the United States. Some deem us "quacks" without much contemplation.
I am NOT here to give advice about carcinoma or bone cancer. I am NOT here to diagnose. I am NOT here to do anything other than provide reading material for those who deem it interesting.
There are primary and secondary bone cancers. A primary bone cancer arises as a malignant tumor of the skeleton first. Whereas a metastatic tumor arises secondarily from some other tumor in another location in the body.
Metastatic simply means secondary bone tumor.
Of the total cumulative types of bone cancers diagnosed -- seventy-percent of them are metastatic, while only thirty are primary. This means that the majority of bone cancers that are diagnosed stem from another tumor in a different location in the body.
Of the seventy-percent of secondary bone cancers diagnosed each year -- eighty-percent of those come from the following six regions of the body: breast, lung, thyroid, prostate, bladder, and bowel.
The majority of these secondary bone cancers will come from various types of breast cancers in females and prostate cancer in males. On X-Ray, they show up as either osteolytic or osteoblastic in nature.
This simply is referring to their appearances on the radio-graphic image. Blastic tumors are radiopaque, while lytic lesions are translucent in nature.
Breast cancer tends to be osteolytic in nature whereas prostate metastatic projections tend to show up in the lumbar spine as a blastic lesions. Usually, blastic tumors will increase levels of alkaline phosphatase. If this shows up in males, a prostate-specific antigen test (PSA test) would be used to determine if the Blastic-Mets arose from the prostate. This is due to the fact that if the prostatic capsule has been broken there will be an increase in acid phosphatase.
There are some key clinical features of symptomatology that a patient will face when confronted with the potentiality of either primary or secondary bone tumors. Usually, the individual will be older than forty and they may have noticed extreme weight loss. If the person in question has had primary cancer approximately ten or fifteen years prior -- it is not unusual to detect a secondary osteolytic or osteoblastic lesion during a routine x-ray at a chiropractic office.
This is why chiropractors are trained to recognize bone cancers -- not to diagnose or treat. Simply to identify and refer out. If a carcinoma is detected they will not be fit for a manual adjustment at that time.
How does a primary tumor spread to become a secondary osteometastasis? This can happen simply if a soft tissue tumor is lying adjacent to a bone. An example would be a uterian tumor pressing against the iliac bone of the pelvis. It could result in secondary tumor arising. This method is called a direct extension.
Hematogenous spread is the most common way that cancer cells are distributed; specifically veinous channels. The larger walls of the arteries limit the ways in which tumor cells can transfer to various other types of tissue in the body. The veins, on the other hand, are more likely to allow penetration. Specifically the Batson's Venous plexus as it provides passageway for cancer cells to invade bone quite easily.
[source: https://www.slideshare.net/ThomasMcCombsDO/anatomy-of-alchemy]
Although the lymphatic channel is large component of soft tissue cancer dissemination; it is not relevant in the spread to bone due to the lack of lymph in hard tissues.
There are two general ways bone cancer presents itself. It is called osteolytic and osteoblasic. Basically, osteolytic has to do with the breakdown of a bone cell. This is why we find increased levels of calcium in the serum of the blood when these types of carcinomas are present. Whereas, osteoblastic tumors increases alkaline phosphatase in order to correct for the damages the tumor is causing in the matrix.
In order for a lytic lesion to show up on an X-Ray 50-70% of bone density must be destroyed in order to produce visible effects. It will cause a lucency or transparency on the X-Ray film.
This is an example of a translucent lesion on the radial bone. It is similar to what lysis looks like on radio-graphic film.
The lesion is not caused due to osteoclastic activity (or innate osteocyte cell breakdown); rather, pressure erosion from a tumor inside the medullary cavity.
Osteoblastic-mets (short for osteoblastic metastasis) has an increase density due to osteoblastic activity. The body is laying down new material, or attempting to repair the damage that the tumor has created inside the osteoid tissue. It is futile attempt to repair the damage that is being created by the growth of the tumor cell. The medullary cavity is unaffected thus why there is an increased density when looking at films of osteoblastic metastasis. Whereas in osteolytic metatasis the medullary cavity is expanding creating a translucent effect.
The X-Ray shown above is a classic example of an ivory vertebra. This is simply an example of a radiopaque lesion similar to those seen in osteoblastic metastatic carcinomas. It can also been seen in paget's disease with an increased size of vertebra and Hodgkins Lymphoma (which would also have anterior scalloping of vertebral body). Anterior scalloping of a vertebral body is where the endosteal resorped the inner layer of the cortex due to slow-growing medullary lesions.
Osteoblastic metastatic carcinomas also rarely have perosteal responses. Most periosteal responses are seen in primary bone carcinomas; whereas osteoblastic metastatic carcinomas are a secondary response usually to a soft tissue tumor. Secondary responses such as osteolytic or osteoblastic will have multiple lesions. Primary lesions are solitary.
[source: https://learningradiology.com/archives05/COW%20142-Osteoblastic%20mets/blasticmetscorrect.htm]
Bone scans can be done by nuclear imaging or conventional radiography. The benefit to a nuclear imagine is that it can detect alteration in bone metabolism. So low in fact that changes can range from only three to five percent.
Very rarely does a bone tumor go past the distal extremities of the upper or lower portion of the body. Eighty percent of all hard tissue metastasis are located in the pelvis or spine.
There are some fundamental signs of alterations to bone density and architecture. This is called fundamental roentgen signs. This term means that there is noticeable change in the size of an organ or structure on an imaging system.
As stated earlier, we know that seventy percent of bone cancers are metastatic in origin. Of that percentage -- seventy-five percent of that is osteolytic, while fifteen percent are osteoblastic in nature. The rest (ten-percent) is mixed.
Osteolytic structures are known for their "moth-eatten" or permeative appearance.
The fifteen percent of osteoblastic lesions show amorphic (having no defined shape) radiopaque lesions. These are commonly known as "cotton ball lesions" or "snowball patterns".
Mixed lesions are bubbly, highly expansible and associated with renal or thyroid malignancies.
Benign tumors differ from malignancies as they do have well-defined margins and have a short zone of transition. Whereas malignant tumors are irregular, ragged and ill-defined margins. They also have long zones of transitions.
Osteoblastic Metastatic Carcinoma is also known as diffuse sclerotic metastatic disease. It is predominately seen in 40+ year old men (as prostate cancer is most likely to spread as blastic mets to the lumbar spine). There will be both persistent nocturnal pain and weight loss. There will be an increase in bone density (radioopacity).
The practitioner will take a good look at the bodies of the vertebras and pedicles (increased density in pedicles is called a "pedicle sign" which is an increased density) as this is a common site that blastic lesions appear.
Also, ivory vertebra is a common occurrence. In the lab, higher levels of acid phosphate could be present for prostate cancer. And/or a possible increase in alkaline phosphate.
Osteoblastic lesions account for fifteen percent of all metastatic carcinomas.
Osteolytic Metatstatic Carcinoma is typically seen in females over the age of forty. They also have pain that increases at night with extreme weight loss. The features include: motheaten pattern with a long zone of transition. Vertebral bodies and pedicles are commonly affected (one-eyed pedicle or winking owl sign or a bilateral lysis of pedicles known as blind vertebra). In the lab there could be a possible increase in serum calcium levels due to the breakdown of bone matrix.
Osteolytic lesions account for seventy-five percent of all metastatic carcinoma.
Taking a strong case history because secondary bone cancer usually occurs ten to fifteen years after treatment/surgery of primary neoplasm (a new and abnormal growth of tissue in some part of the body).
Why are chiropractors required to take these courses? We use X-Ray analysis to determine if it is safe to care for a patient. Some chiropractors use linear analysis by using radio-graphic material as a tool to visually see and treat vertebral subluxations.
With the amount of xray analysis that we are expected to do on the general public; we may come across carcinomas. We are expected to simply identify a troubled area (NOT diagnose) and refer the patient onward to a oncologist.
[source: https://prohealthsys.com/students/professional-comparison/]
Chiropractors take similar boards to medical doctors for their general sciences. There are many differences between M.D.'s and D.C.'s. Both are highly educated medical professionals.
I hope you enjoy this series as I continue posting more about carcinomas and much, much more over the coming months and years.
This is simply suppose to be a resource for those who are interested in the subject.
