This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Treatment choices for people with bone mets depend on many things:

• what kind of main (primary) cancer you have
• which bones (and how many) the cancer has spread to
• whether any bones are weak or broken
• which treatments you have already had
• your overall state of health

Most doctors will treat bone metastasis by treating the cancer that caused it. This is usually done with chemotherapy ("chemo") or with hormone therapy. These are called systemic treatments because the drugs enter the bloodstream and reach cancer cells throughout the body. Also, drugs called bisphosphonates can help to make bones stronger and prevent breaks. They can be used along with chemo or hormone therapy. If these treatments work, then the symptoms of bone metastasis will go away and new symptoms are not likely to happen soon.

The doctor may also need to treat the bone problems to relieve pain or to keep the bones from breaking. Radiation might be used to kill cancer cells and relieve pain. Surgery is sometimes needed to reinforce a bone with some type of metal support to keep it from breaking. It is much easier to prevent a bone from breaking than try to fix it once it has broken.

Systemic treatments

Systemic treatments are those that go throughout the body. This section begins with a listing of the types of treatments used for people with metastatic cancer, followed by information about treating bone mets.

For more details about treatments for cancer that has spread from a primary cancer (for example, prostate cancer), please refer to each cancer type. You'll find this information in the sections on treatment of advanced cancer, stage IV cancer, or recurrent cancer in the documents written for each type of cancer.

Chemotherapy: Chemotherapy ("chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they reach throughout the body. Chemo is used as the main treatment for many types of metastatic cancers. In many cases, chemo can shrink tumors. This can help you feel better and reduce pain.

Chemo drugs kill cancer cells but also damage some normal cells. So it can cause some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long the treatment lasts. Some common side effects include:

• hair loss (hair grows back after treatment)
• mouth sores
• increased chance of infection (from a shortage of white blood cells)
• problems with bruising or bleeding (from a shortage of platelets)
• feeling weak or tired (from a shortage of red blood cells)
• loss of appetite
• nausea and vomiting
• diarrhea or constipation

If you have side effects, talk to your doctor or nurse about what can be done to help you control and prevent them. The good news is that most side effects will go away when your treatment ends. To learn more about chemo, please see Understanding Chemotherapy: A Guide for Patients and Families.

Hormone therapy: Some hormones promote the growth of certain cancers. For example, estrogen, a hormone made in a woman's ovaries, sometimes promotes the growth of breast cancer. Likewise, testosterone (made by a man's testicles) promotes the growth of most prostate cancers.

There are several ways to stop these hormones. One way is to remove the organs that make them: the ovaries in women or the testicles in men. More often, drugs can be used to stop the organs from making the hormones or to prevent the hormones from acting on the cancer cells. Side effects of these drugs can include hot flashes, blood clots, loss of interest in sex, and a higher risk of other cancers.

Immunotherapy: These methods help a patient's own immune system fight the cancer. Several types of immunotherapy are used to treat patients with metastatic cancer. These include cytokines, monoclonal antibodies, and tumor vaccines. Some of these have been used for a while, but others are still experimental.

Radiopharmaceuticals: These are a group of drugs that have radioactive elements. They are injected into a vein and settle in areas of bone that contain cancer. They kill the cancer cells and relieve some of the pain caused by bone mets. They are only used for cancer that has spread from another place to the bone. The major side effect of this treatment is a lower blood cell count (mainly white cells and platelets), which could put you at a higher risk for infections or bleeding. They can also cause a side effect known as "flare reaction," where the pain gets worse for a short time before it gets better.

Bisphosphonates: These are drugs used to treat weak bones (osteoporosis). They are also used to treat patients whose cancer has spread to their bones.

Bisphosphonates can help with cancer that has spread to the bones in several ways. They can:

• reduce bone pain
• slow down bone damage caused by the cancer
• reduce high blood calcium levels
• lower the risk of broken bones

Bisphosphonates tend to work better when x-rays show the metastatic cancer is making the bone thinner and weaker. They don't work as well for treating metastases where the bones become thicker.

Some bisphosphonates are taken by mouth, but when used as treatment for bone mets most are given by vein, usually every 3 to 4 weeks. The most common side effects are tiredness, fever, nausea, vomiting, low red blood cell count and bone or joint pain. But these problems might also be caused by the cancer itself or other drugs the patient is taking. Joint and muscle pain can often be relieved with a mild pain reliever.

Around 2003, doctors began to notice a very distressing side effect among some patients getting bisphosphonates. These patients had damage to the jawbone. Part of the upper or lower jaw had died. This can lead to tooth loss in that area or infections. Doctors don't know why this happens or how to prevent it. Stopping the bisphosphonate is the first step. Other treatments may include antibiotics and antibacterial mouth rinses. Surgery may be used if nothing else is working. Some doctors suggest that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates. If you are taking a bisphosphonate drug, take good care of your mouth by flossing, brushing, and having regular dental check-ups. Let your doctor know if you have any problems with your mouth or teeth.

Local treatments

Local treatments are those that are aimed right at the cancer rather than going throughout the whole body.

Radiation therapy: This type of treatment uses high-energy x-rays to kill cancer cells or to slow their growth. Radiation can be used to cure primary cancers that have not spread too far from the place where they started. When a cancer has spread to bones, radiation is used to relieve symptoms. If the bone is treated before it gets too weak, radiation may be able to help prevent a later fracture.

The most common way to give this type of treatment is to carefully focus a beam of radiation from a machine outside the body. This is known as external beam radiation. To reduce the risk of side effects, doctors figure out the exact dose and aim the beam carefully to hit the target.

Radiation treatment for bone metastasis can be given as a large dose at one time, or in smaller amounts over 5 to 10 treatments. Each treatment lasts only a few minutes. This method is a good choice if there are only 1 or 2 metastases that are causing symptoms. If there are many, though, the treatment is more complex.

For more information on radiation treatment, please see the American Cancer Society document Understanding Radiation Therapy: A Guide for Patients and Families.

Ablation methods: Putting a needle directly into a tumor and using heat, cold, or a chemical to destroy it is called ablation. For instance, radiofrequency ablation (RFA) uses a needle that carries electric current. The needle is placed into the bone tumor. Electric current given through the needle destroys the tumor. RFA is usually done while the patient is under anesthesia (deeply asleep).

Other methods are based on the same idea, but they use heat, cold, or chemicals to destroy the tumor.

Surgery: When surgery is used to treat bone mets (not a primary bone cancer) it is for relief of symptoms rather than cure. Bones can become weak, leading to breaks that don't heal very well. A metal rod might be used to support the bone and keep it from breaking. Or, if the bone is already broken, surgery can stabilize the bone and relieve pain.

If surgery is not an option because of poor health or for other reasons, a cast or splint might help to reduce pain so you don't have to stay in bed.

Bone cement: For some people, injections of a bone cement or glue can be used to strengthen a bone. This helps relieve pain in about 3 in 4 people. This method can be used for long bones as well as well as for spinal bones. Sometimes, the glue is used along with other treatments.

Pain medicines: If the treatments you are having do not relieve the pain or stop all the pain, tell your doctor or nurse right away. Getting good pain relief will help you feel better. It will make it easier for you to focus on the things that make you happy and are important in your life.

Medicine taken by mouth is the most common way to treat pain. Often 2 or more drugs are used together. Sometimes people don't want to take pain medicine because they think they will become addicted or that it will make them too sleepy. In fact, when taken to relieve pain, these drugs rarely cause addiction. And drowsiness can be controlled.

If you are in pain, take your medicines on a regular schedule. It is better to prevent pain rather than treat it once it starts. For more information about treating pain, please see the ACS document, Pain Control: A Guide for Those with Cancer and their Loved Ones.

When cancer threatens to paralyze, it's an emergency

Sometimes the cancer will spread to a bone in the spine. The cancer can grow enough to press against and squeeze the spinal cord. This can show up in different ways:

• back pain (pain may go down one or both legs)
• numbness of the legs or belly
• leg weakness or trouble moving the legs
• unexpectedly passing urine or stool (incontinence) or problems urinating

If you notice symptoms like this, call your doctor right away or go to the emergency room. If not treated right away, this can lead to life-long paralysis. If the cancer is just starting to press on the spinal cord, it may be treated with radiation along with drugs. Sometimes surgery is needed to relieve the pressure on the spinal cord. This can prevent paralysis as well as help relieve the pain.

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