9 July 2011
Craig Ricker of San Diego, CA writes:
What is the most painful type of cancer?
What an objective question for a tantalizingly subjective measure! I love it. Humanities meets Science!
Pain is hard to quantify and compare, and there are many type of cancer, as there are many types of pain. How would one say that one patient’s pain is worse than another? This is a question to which I do not know how to answer. Though with science, it’s very dangerous to say that it will never be answered or that it will never be quantified.
But for now, I will propose a candidate for such a dubious distinction: Bone Metastasis, or the spread of cancer to the bones, followed by the growth of tumors in the bone.
(Image above: the bone is rarely the site of primary tumor growth. Rather, tumors will often begin in another location and migrate to the bone. The two patients above have undergone a bone scan. The brighter spots indicate bone metastases)
Growing tumors will literally eat away at the bone, causing it to weaken and become brittle. I’ve heard cancer patients describe the pain as the worst cavity you’ve ever had, or like having fractures all over your body. The pain is unrelenting. It is so bad that morphine can often have no effect. Unchecked bone metastasis can actually cause fractures. Unlike fractures from blunt trauma, the bone will slowly chip away. It is akin to slowly removing a sticky bandage on a hairy forearm rather than quickly tearing it off, except it’s amplified on the pain scale of broken bones.
It’s a very morbid image, I admit. Cancer metastasis to the bone is my nomination for most painful “type” of cancer.
Cancer metastasis to the bone is not a specific type of cancer, but it is part of several late-stage cancers. Bone metastasis is particularly common in breast cancer, which accounts for close to one of every three cancers diagnosed in women in the US. (1) Despite continued efforts in early detection and screening, many women will develop metastases from their breast cancer, and the most common site of metastasis from breast cancer is bone (2). Bone metastasis can be exceptionally painful, affecting nearly 90% of patients with metastatic breast cancer (3).
So there you have it. I hope this helps to underscore a recurring theme in my scientific pulpit: It’s exceptionally important to catch cancer early before it spreads. Or, to prevent cancer and not get it at all.
-Ryon
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References: 1. American Cancer Society. Breast Cancer Facts and Figures 2003-2004. Atlanta, GA: American Cancer Society; 2003. 2. Hillner BE, Ingle JN, Berenson JR, et al. American Society of Clinical Oncology guideline on the role of biphosphonates in breast cancer. J Clin Oncol. 2000;18(6):1378-1391. 3. Diel IJ, Mundy GR. Biphosphonates in the adjuvant treatment of cancer: experimental evidence and first clinical results. Br J Cancer. 2000;82(8):1381-1386.