Sometimes bone mets are found before they have a chance to cause any symptoms. When you are first diagnosed with cancer, your doctor may order tests (such as x-rays or bone scans) to see how far the cancer has spread. These tests may show bone mets. Or signs of bone mets may be found during a routine check-up after treatment is finished.

Symptoms of bone metastasis

The symptoms of bone metastasis can be mild at first. For instance, you may notice you don't feel like eating and may have trouble sleeping because you are uncomfortable. These symptoms can make it hard to carry out your daily routines.

Bone pain: Bone pain is often the first symptom of cancer that has spread to the bone. The pain often comes and goes at first. It tends to be worse at night, and it may be relieved by movement. Later on, it becomes constant and may be worse during activity. If you have cancer and begin to have pain in a bone, you should tell your doctor right away. The bone might be so weak that it will break. This can often be prevented if the bone metastasis is found early. Of course, other problems, such as bone infections, arthritis, or just being very active, can also make bones hurt.

Broken bones (fractures): Bones can break, causing severe pain and keeping you from moving much at all. The bones most likely to break are the long bones of the arms and legs and the bones of the spine. Sudden pain in the middle of the back is sometimes a sign of a bone breaking.

Pressure on the spinal cord: Cancer in the back bones can press on the spinal cord. This is a serious problem. Not only does it cause pain, but the pressure can damage the spinal cord so that the arms and legs become numb or even paralyzed. Sometimes the first symptom of this problem is trouble urinating because nerves from the spinal cord control the bladder.

High blood calcium: High levels of calcium (hypercalcemia) are caused by release of calcium from bones. This can cause loss of appetite, nausea, extreme thirst, confusion, and tiredness. It can lead to a coma if not treated.

Tell your doctor right away if you have symptoms

It is important to report any new bone symptoms or changes in old symptoms to the doctor or nurse right away. Finding and treating these symptoms early can help reduce the chances of further problems later on.

Tests to find bone metastasis

X-rays: X-rays of the bone can show signs that the cancer has spread. X-rays can also find breaks in bones that have been weakened by metastasis.

Bone scan: This test helps show if a cancer has spread to the bones. A radioactive substance is put into a vein and collects in diseased bone cells throughout in the body. These areas can be seen on the scan and are called "hot spots." But arthritis, infection, or other bone diseases can also cause hot spots. Bone scans can often find metastases much sooner than normal x-rays.

CT scans: The CT scan (computed tomography) uses an x-ray beam to take a series of pictures of the body from many angles. A computer combines the pictures to form a detailed image. If bone scans or x-rays do not show metastases, this test can help tell if the cancer has spread into your bones. CT scans can also be used to guide a needle into an area that might be metastasis. The needle is used to take out a sample of tissue that can be looked at under a microscope to see if cancer cells are present.

CT scans take longer than x-rays and you need to lie still on a table for 15 to 30 minutes while they are being done. But they are getting faster all the time. Often after the first set of pictures is taken you will get an injection of a "dye" that helps better outline structures in your body. A second set of pictures is then taken. You might feel a bit confined by the ring-like machine that rotates around you while the pictures are being taken.

MRI scans: Like a CT scan, the MRI shows a cross-sectional picture of the body. But the MRI uses radio waves and strong magnets instead of x-rays. MRI scans are especially useful for looking at the spine and spinal cord. MRI scans take longer than CT scans, often up to an hour. For this test you have to be put inside a tube-like machine, which can upset people with fear of enclosed spaces. The machine makes a thumping noise that might bother you. Some places will give you headphones with music to block this out.

PET scan: PET (positron emission tomography) uses a radioactive form of sugar that is injected into a vein. Cancer cells in the body quickly absorb it. A special camera is used to show the areas where the sugar collects. This test can find groups of cancer cells that are too small to see with other tests. It is also helpful when the doctor thinks the cancer has spread but doesn't know where.

Blood and urine tests: Some types of cancer release certain substances (tumor markers) into the blood or urine. The cancer can also cause organs to make high levels of certain chemicals. Blood and urine tests can help find these problems.

Tissue and cell sampling tests used to find bone metastasis

If you have had cancer in the past, your doctor may be able to tell if you have bone mets based on how the bone scans or other x-rays look. But if the results are not clear, your doctor will need to take a sample of tissue to find out if it is cancer. This is called a biopsy.

For a biopsy a small sample of cells or tissue is removed and sent to the lab to be looked at under a microscope. There are 2 main types of needle biopsies: fine needle and core needle.

Fine needle biopsy: For a fine needle biopsy, a very thin needle is used to take a small amount of fluid and pieces of tissue from the tumor. The biopsy is done after numbing the area. It may be uncomfortable, but is not very painful.

Core needle biopsy: This type of biopsy is like a FNA except a larger needle is used.

Last Medical Review: 03/20/2007
Last Revised: 05/06/2009