Understanding Bone Metastasis
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 chemo or hormone therapy, can also be helpful. Radiopharmaceuticals may be a good choice if the cancer is widespread in the bones. If there is only one or a few areas of cancer causing bone pain, radiation therapy or ablation can give pain relief. If the pain is caused by a broken bone, treating the fracture with surgery helps greatly with the pain. Keeping the bones strong with bisphosphonates or denosumab can also help.
Early symptoms of having too much calcium in the blood (hypercalcemia) include:
- 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.
Giving fluids and bisphosphonate drugs can often bring blood calcium levels down quickly. These are usually given into the veins by IV (intravenous) infusion. Other drugs can be used if these don't work.
When cancer moves into bones, it can make them weak, so that they are more likely to break (fracture). Fractures occur most often in the leg bones near the hip because these bones support most of your weight. 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, the best approach is to prevent the fracture. This is usually done with surgery to put a metal rod 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 surgery is done to put a steel support 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.
If bones of the spine (the vertebrae) are fractured, vertebroplasty 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 (unexpectedly passing urine or stool) 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, 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. Some patients get radiation right away. If the spinal cord is already compressed, 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: 05/03/2012
Last Revised: 05/03/2012