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When the cancer cells have spread into the bones, this condition is called bone metastasis. The cause of the spread of some cancers is uncertain and it’s still unknown why they invade the bones (not the liver where metastasis commonly occurs).
Bone metastasis can be a sign that you currently have cancer or it may occur in later years after treatment. Almost all types of cancer can metastasize to the bones but those that are most likely may spread to the bones are breast cancer and prostate cancer. Cancer cells invading bone commonly spread to the spine, pelvis and thigh bones but generally, it can spread to any bones in the body.
Bone metastasis often causes bone pain and fracture. Most of the time, a cancer that has metastasized into the bones in later stages cannot be cured but can only be treated by alleviating the pain and symptoms.
Symptoms
Although bone metastasis may not have any signs and symptoms every so often, the following may indicate to have the condition:
- Pain in the bones
- Bone fracture
- Involuntary urination
- Inability to control bowel movement
- Legs or arms weakness
- Nausea, vomiting, constipation or confusion due to high blood calcium levels.
If you are worried that you have any of these symptoms, consult a doctor for proper medical history taking (inform your doctor of any past cancer treatment), diagnosis, and treatment.
Risk factors
These are common types of cancer most likely lead to bone metastasis:
- Thyroid cancer
- Breast cancer
- Lung cancer
- Kidney cancer
- Prostate cancer
- Lymphoma
- Multiple myeloma
Diagnosis
The following diagnostic tests may be done to detect bone metastasis:
- X-ray
- Bone scan (bone scintigraphy)
- Computerized Tomography (CT) scan
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET)
- Biopsy
Treatment
Medications
The following treatment may be used for bone metastasis:
- Bone-building medications. Bone metastasis may be treated with the same medications taken for osteoporosis in order to strengthen the bones and alleviate the pain which lessen the chance of taking strong pain relievers. It also helps to avoid new bone metastasis build up. This medication may be administered orally or intravenously but some do have side effects such as short-term bone pain, kidney issues and even a rare but serious jawbone degeneration (osteonecrosis).
- Intravenous radiation. Radiopharmaceuticals (a form of radiation) are injected in people with multiple bone metastasis. It has a low level radioactive substance that attracts the bones and releases radiation on the affected bone once administered for pain management.
- Chemotherapy. Chemotherapy is prescribed to eradicate cancer cells that has metastasized to multiple bone areas. It may be administered orally, intravenously or both. The side effects depend on the chemotherapy medications used. Chemotherapy is the most recommendedtreatment for metastasized cancers that are responsive to it.
- Hormone therapy. Hormone suppression treatment may be effective for cancers that react to certain hormones such as breast and prostate cancer.
- Pain reliever. Over-the-counter or prescription pain medications may be taken to alleviate the pain.
- Steroids. Steroids can quickly reduce inflammation and swelling on the location of cancer which results to pain relief. But, it should be utilized cautiously due to some serious long-term side effects.
- Targeted therapy. The drugs used in targeted therapy focus on certain cancer cell abnormalities. They hinder the abnormalities which kills the cancers cells. Specific types of cancer can be very reactive to this treatment such as HER2 positive cancer cells.
External radiation therapy
Strong energy beams involving x-rays and protons target cancer cells to die. It may be used if your bone metastasis pain is not responding to pain medications or the pain is at a few locations in the body. It may be administered in a single large dose or at a fewer dosage over several days. The side effect depends on the location and size of the affected part.
Surgery
The goal of performing surgery is to avoid fracture or fix the fractured bone.
- Surgery to stabilize the bone. Metal hardware (plates, screws and nails) are used to stabilize the bones called orthopedic fixation. It alleviates the pain and enhance functionality of the bone area. Radiation is often done after surgery to eradicate tumor cells.
- Surgery to inject a bone with cement. Bone cement can be injected on broken or destructive bone metastasis areas (e.g., pelvic bones and spinal bones) where metal hardware are hard to install to alleviate the pain.
- Surgery to repair a broken bone. Metal hardware are used to repair and stabilize the broken bones. Furthermore, hip replacement is also an alternative choice.
Heating and freezing cancer cells
The procedures may be helpful in patients who have one or two sites of bone metastasis which other treatments are not helpful. Heat and cold utilization to target cancer cells may be able to manage the pain.
Radiofrequency ablation uses a needle with an electric probe and inserts it into the bone tumor directly which heats up the tissues around it. Once the tissue cools down, the same process can be done repeatedly.
Cryoablation is another procedure that freezes the tumor and then thaws it. The procedure is also done repeatedly for a couple of times.
The use of heating and freezing method can have side effects such as damage to the nerves of the nearby tissues or damage to the bones causing fracture.
Physical therapy
The purpose of physical therapy is to alleviate pain and improve bone strength and motility. The physical therapist will help you plan your exercises, physical rehabilitation and may recommend assistive devices such as crutches, braces, a can or a walker to avoid weight bearing on the affected bone area. Hence, it will improve your stability while walking.
