Treating Problems Caused by Bone Metastases
There are many ways to treat pain caused by cancer spread to bone. 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 contact us to learn more about managing cancer pain.
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 (HI-per-kal-SEE-me-uh).
Early symptoms of having too much calcium in the blood 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.
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 (bis-FAHS-fun-ATE) 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.
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 too.
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 surgery is done while you’re 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. 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 happens, vertebroplasty (VUR-tuh-bro-PLASS-tee) may be used to support them. In this procedure a type of bone cement is injected into the damaged bones.
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, often along with a type of drug called a steroid or 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.
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: May 2, 2016 Last Revised: May 2, 2016