Managing Symptoms of Bone Metastases

When cancer spreads to your bones from where it started, it’s called bone metastasis. It may not be possible to cure bone metastases, but there are still things that can be done to help you feel as good as possible for as long as possible. This care, aimed at relieving suffering and improving the quality of life, is called palliative care. The focus is on the patient and family rather than the disease. Palliative care treats the symptoms caused by bone metastases. It does not treat the cancer itself. Some health care providers call this supportive care.

Here are some of the common problems caused by bone metastases. Not everyone will get all of these symptoms, and some of the information here may not apply to you. In some cases, these symptoms are not caused directly by the cancer in the bones or can have more than one cause. Your cancer care team can tell you the most about where the bone metastasis is and what symptoms it might cause.

Pain

There are many ways to treat pain caused by bone metastases. Almost any of the local or systemic treatments commonly used for bone metastases can be helpful in treating pain.

Pain medicines are also very helpful. There are many different kinds of pain medicines used to treat cancer pain. There are also a lot of ways the medicines can be taken, such as pills, patches, sprays, and pumps that let you put the medicine into your body when you need it.

You should never accept pain as a normal part of having cancer. All pain can be treated, and most pain can be controlled or relieved. Talk to your cancer care team or see Cancer Pain to learn more.

High calcium levels (hypercalcemia)

As cancer cells damage the bones, calcium from the bones is released into the blood. This can lead to problems caused by high blood calcium levels. The medical word for high calcium levels is hypercalcemia.

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

  • Constipation
  • Passing urine very often
  • Feeling sluggish or sleepy
  • Feeling thirsty all the time and drinking lots of liquids

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

High calcium levels affect the kidneys, which can cause you to pass too much urine and become dehydrated. The dehydration gets worse as the calcium level goes ups. Because of this, giving large amounts of intravenous (IV) fluids is a main part of the treatment for hypercalcemia.

Bisphosphonate drugs 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 can help keep the calcium level from getting too high again.

Broken bones

When cancer spreads 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 too.

Cancer in the bone may cause severe pain for a while before the bone actually breaks. When possible, your doctor will try to prevent the fracture.

  • If an x-ray shows an arm or leg bone is likely to break, surgery may be done to put a metal rod may be put through the weak part of the bone to help support it.
  • 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.
  • Bones of the spine (the vertebrae) can also fracture. If this happens, vertebroplasty may be used to support them. In this procedure a type of bone cement is injected into the damaged bones.

Radiation treatments may be given after surgery to try to prevent any more damage. The radiation won’t make the bone stronger, but it may stop further damage.

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, such as shower chairs, walkers, or handrails.

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

If the cancer spreads to a bone in the spine, sometimes it can grow large enough to press against and squeeze (compress) the spinal cord. This can show up in different ways:

  • Back pain (sometimes with pain going down one or both legs)
  • Numbness of the legs or belly
  • Leg weakness or trouble moving the legs
  • Loss of control of urine or stool (incontinence) or problems passing urine

If you notice symptoms like these, call your doctor right away or go to the emergency room. If not treated right away, spinal cord compression 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, sometimes along with a type of drug called a steroid or corticosteroid. The radiation often 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. 

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chow E, Finkelstein JA, Sahgal A, Coleman RE. Metastatic cancer to the bone. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011: 2192-2204.

Coleman RE, Holen I. Bone metastasis. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014: 739-763.

von Moos R, Body JJ, Egerdie B, et al. Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases. Support Care Cancer. 2016;24(3):1327-1337.

Last Medical Review: December 16, 2016 Last Revised: December 16, 2016

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