Bone Metastasis

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Treating problems caused by bone metastases

Pain

There are many ways to treat pain caused by cancer spread to bone. Almost any of the treatments mentioned in earlier sections can be helpful in treating pain.

Pain medicines are often very helpful. Treating the cancer, such as with chemotherapy (chemo) or hormone therapy, can also help. Radiopharmaceuticals may be a good choice if the cancer is widespread in the bones (these were discussed in the section about systemic treatments). If there’s only one or a few areas of cancer causing bone pain, local treatments like radiation therapy or ablation can give pain relief. If the pain is caused by a broken bone, treating the fracture with surgery helps a lot. Keeping the bones strong with bisphosphonates (zoledronic acid/Zometa or pamidronate/Aredia) or denosumab/Xgeva can also help.

Hypercalcemia

Early symptoms of having too much calcium in the blood (hypercalcemia) include:

  • Constipation
  • Passing urine very often
  • Feeling sluggish or sleepy
  • Feeling thirsty all the time and drinking large amounts of fluid

Late signs and symptoms can include muscle weakness, muscle and joint aches, confusion, coma, and kidney failure.

High calcium levels affect the kidneys, leading to patients passing too much urine and becoming dehydrated. The dehydration worsens the high calcium levels. That is why giving large amounts of intravenous (IV) fluids is a main part of the treatment for hypercalcemia. Bisphosphonate drugs like pamidronate or zoledronic acid are also used to bring blood calcium levels down quickly. These drugs are given into the vein by IV infusion and may be repeated monthly. Other drugs can be used if these don’t work. Once the calcium level is back to normal, treating the cancer (with chemo, hormone therapy, targeted therapy, etc.) can help keep the calcium level from getting too high again.

Broken bones

When cancer moves into bones, it can make them weak and more likely to break (fracture). The leg bones near the hip often fracture because these bones support most of your weight, but other bones can fracture as well. Cancer in the bone may cause severe pain for a while before the bone actually breaks. If an x-ray is taken at that time, it may show that the bone is likely to break.

When possible, your doctor will try to prevent the fracture. For arm and leg bones, a metal rod is put through the weak part of the bone to help support it. This is done while you are under general anesthesia (in a deep sleep and unable to feel pain).

If the bone has already broken, then something else will be done to support the bone. Usually a steel support is put over the fractured area of the bone.

Radiation treatments may be given after surgery to try to prevent any more damage. Usually about 10 treatments are needed, but some doctors give the total dose of radiation in only 1 or 2 treatments. The radiation will not make the bone stronger, but it may stop further damage.

Bones of the spine (the vertebrae [ver-tuh-bray]) can also fracture. If this occurs, vertebroplasty ([VUR-tuh-bro-plass-tee] discussed in the section “Local treatments for bone metastases”) may be used to support them. In this procedure a type of bone cement is injected into the damaged bones. The area is numbed first and an imaging scan, such as a CT scan, is used to guide the needle to the right place. Vertebroplasty often reduces pain right away and can be done in an outpatient setting.

Medicines you take or the cancer itself may make you confused, dizzy, or weak. This can lead to falls and accidents. Falls can cause fractures, especially in bones weakened by cancer. Talk with your cancer care team about safety equipment you can use at home. Some things that you might find helpful are shower chairs, walkers, and handrails.

Spinal cord compression: When cancer threatens to paralyze, it’s an emergency

Sometimes the cancer will spread to a bone in the spine. The cancer can grow large enough to press against the spinal cord, causing the spinal cord to be squeezed (compressed). This can show up in different ways:

  • Back pain (with pain that may go down one or both legs)
  • Numbness of the legs or belly
  • Leg weakness or trouble moving the legs
  • Incontinence (loss of control of urine or stool) or problems urinating

If you notice symptoms like these, call your doctor right away or go to the emergency room. If not treated right away, they can lead to life-long paralysis (inability to walk or even move).

If the cancer is just starting to press on the spinal cord, treatment can help prevent paralysis and help relieve the pain. Radiation is often used as part of the treatment, often along with a type of drug called a corticosteroid. Often the radiation is started within the first 12 to 24 hours. If the spinal cord is already showing signs of damage (such as weakness in the legs), immediate surgery followed by radiation may be the best treatment. This may allow a patient to walk and function better than if they get radiation alone. People with very advanced cancer or other serious medical problems may not be able to have this kind of surgery.


Last Medical Review: 02/07/2014
Last Revised: 02/17/2014