A New Treatment for Painful Bone Mets from Pancreatic Cancer

“Silent killer”

Pancreatic cancer is often called a “silent killer” because it is one of the fastest spreading types of cancer. Most patients have no symptoms until the cancer has already begun spreading. Also, given the deep location in the body, discovering pancreatic cancer during a routine exam or imaging (incidental diagnosis) is rare. Roughly 40% of patients are diagnosed at a stage where the tumor is still confined to the prostate, but tumor cells have invaded arteries or veins leading to other organs. The majority of newly diagnosed patients (45-55%) already have pancreatic cancer that has metastasized (spread) to other organs and begun to form tumors there. Such tumors are called pancreatic cancer metastasis, or simply pancreatic cancer mets.

Pancreatic cancer mets in the bone

Since the pancreas is located in back of the abdomen (behind the stomach) it tends to spread first to nearby trunk and abdominal organs: lungs, liver, and the abdominal lining (peritoneum). It is also possible for pancreatic cancer to colonize parts of the skeleton. Since new chemotherapies and targeted therapies are extending life for patients, this increases the chances that breakaway tumor cells will establish pancreatic cancer mets in bone. According to Borad et al. (2009), “Skeletal metastases represent an underappreciated site of metastasis in patients with pancreatic cancer.¹”

Symptoms of pancreatic cancer bone mets

The true rate of pancreatic cancer bone mets is not known, though estimates range from 5-20% of cases.² When a patient is first diagnosed, imaging such as MRI, CT scans and PET/CT scans may be prescribed in order to detect bone mets. However, the first symptom of bone mets is often bone pain. Other symptoms include bone fractures, and elevated blood levels of calcium as the cancerous tumors in the bone break the bone down which releases calcium into the bloodstream.

MRgFUS for painful pancreatic cancer bone mets

Bone pain from metastatic pancreatic cancer can greatly diminish quality of life if it becomes excruciating. At some point, medication will not be enough to control the pain. The conventional standard of care for patients whose pain does not respond to drugs is surgery or radiation therapy. These are called palliative measures, because they relieve (palliate) the pain but are not curative of the disease. However, surgery is invasive (risk of infection, hospital stay, post-surgical pain) and radiation is slow-acting; patients who have already had radiation treatments for their cancer may not be candidates for more radiation.

Fortunately, there is a revolutionary new treatment called MR-guided Focused Ultrasound (MRgFUS). Using MRI guidance to identify the exact source of bone pain allows the physician to plan noninvasive targeted delivery of ultrasound (sound waves) to the bone mets lesion. When the soundwaves are directed from several different directions to the lesion, they generate lethal heat at the point where they meet. This heat destroys (ablates) the metastatic bone tumor, and deadens the nerves that send pain messages to the brain.

With 3-7 days after treatment, most patients have significant pain reduction – in some cases, almost zero pain.

Advantages of MRgFUS

Patients who are candidates for palliative surgery or radiation for pancreatic cancer bone mets are also candidates for MRgFUS. In fact, when given a choice, most patients choose MRgFUS because it offers the following advantages:

• Noninvasive procedure done inside the MRI equipment
• No surgery, no risk of infection
• No exposure to radiation
• Outpatient procedure
• Return to normal activity in a few days
• Pain control results in a week or less
• Competitive, if not better, results when compared with surgery and radiation
• Significant pain relief that is as durable, if not more so, than radiation

If you or a loved one has been diagnosed with pancreatic cancer, the Sperling Medical Group offers state-of-the-art magnetic resonance imaging to scan for bone mets. If the presence of bone mets becomes painful, our Center offers the Exablate MRgFUS to relieve pain that does not respond to medication. For more information, contact our Center, or visit our website.

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¹ Board M, Saadati H, Lakshmipathy A, Campbell E, et al. Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J. Biol Med. 2009 Mar; 82(1):1-6.
² Ibid.