From the Guidelines
Hepatocellular carcinoma (HCC) does metastasize to the bone, with common sites including the vertebrae, pelvis, ribs, and long bones, causing significant pain, pathological fractures, and reduced quality of life. According to the most recent and highest quality study, bone metastasis occurs in HCC patients, with the lung, adrenal glands, peritoneum, and bone being common sites of metastasis 1. The mechanism involves cancer cells from the primary liver tumor entering the bloodstream and traveling to bone tissue, where they establish new tumor growth.
Management of Bone Metastases
Management of bone metastases in HCC patients typically involves a multidisciplinary approach, including:
- Pain control with analgesics
- Radiation therapy to control pain and reduce skeletal-related events
- Bisphosphonates or denosumab to reduce skeletal-related events
- Surgical intervention for stabilization of pathological fractures or spinal cord decompression
As noted in the guidelines, external beam radiotherapy can be used to control pain in patients with bone metastases 1. Additionally, palliative radiotherapy can be beneficial for bone metastases causing pain or at significant risk of spontaneous secondary fracture 1.
Quality of Life Considerations
It is essential to prioritize the quality of life for patients with HCC and bone metastases, as the prognosis is often poor. Psycho-oncological support and adequate nutrition are recommended according to the patient's condition 1. Symptomatic treatment, including management of pain and nutrition, is advocated for patients with end-stage disease and heavily impaired liver function or poor performance status 1.
From the Research
Hepatocellular Carcinoma and Bone Metastasis
- Hepatocellular carcinoma (HCC) can metastasize to the bone, although it is a rare occurrence 2, 3, 4, 5, 6.
- The incidence of bone metastases in HCC patients is increasing due to advances in diagnosis and treatment 4.
- Bone metastases from HCC are often associated with a poor prognosis and reduced life quality 2, 3, 4, 5.
Clinical Characteristics of HCC with Bone Metastasis
- The most common sites of bone metastasis from HCC are the spine, rib, and pelvis 3, 6.
- Pain is a common symptom of bone metastasis from HCC, occurring in up to 88% of patients 3.
- The median survival time for patients with HCC and bone metastasis is generally poor, ranging from 5-6 months 3, 5.
Treatment and Management of HCC with Bone Metastasis
- Radiation therapy is often used to palliate pain and improve quality of life in patients with bone metastases from HCC 3, 6.
- Systemic chemotherapy and sorafenib may also be used to treat HCC with bone metastasis, although their effectiveness is limited 2, 5.
- Surgery may be necessary to prevent and treat complications such as nerve compression and pathologic fracture 6.