Typically, bone pain is the first sign that cancer has spread to the bone. In some cases, however, bone metastases cause little or no symptoms, and it takes a routine scan or fracture from a minor fall or injury to uncover the bone cancer. “A fracture is one of the worst case scenarios, and one we try to avoid,” says Dr. Huston. While these secondary cancers in the bone are difficult to cure, many new and advanced treatments are available to lessen the symptoms and lengthen a person’s life. What’s more, finding and treating bone metastases early on can be critical in preventing problems later.
Bone pain Pain is the most common symptom of bone metastasis. The pain may come and go at first, be worse at night, and feel better with movement. Later on, it may become constant and worsen during physical activity, according to the American Cancer Society (ACS). It’s important to tell your cancer care team about any new, unexplained pain that doesn’t resolve with rest, says Huston. If the pain is due to a tumor in the bone, that bone may be weak and at risk of fracture, which can be prevented if the metastasis is found and treated early.Broken bones Because metastases can eat away areas of bone or stimulate abnormal bone growth, they can cause the bones to be weak and unstable, making them more likely to fracture. The most common sites of fracture are the spine and the long bones of the arms and legs, notes Huston. A fracture can happen from a fall, trauma, or, if a bone is significantly weakened, everyday activities. Alert your doctor immediately if you experience sudden, severe bone pain, as this can be a sign of a fracture.Spinal cord compression When cancer spreads to the bones of the spine, it can squeeze or press on the spinal cord. This can cause weakness in the legs, numbness in the belly or legs (or elsewhere in the body), difficulty urinating, and constipation, says Huston. If you have any of these symptoms, you should tell a doctor or nurse right away. Left untreated, spinal cord compression can lead to paralysis.Extreme thirst, loss of appetite, and sluggishness These are signs of hypercalcemia, or high levels of calcium in the blood, cautions the ACS. Bone metastases can cause a release of calcium into the bloodstream that, if left untreated, can lead to coma. If you experience these symptoms, alert your medical team right away.
If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam, blood tests, and a bone scan to check for bone metastasis. Depending on the results and where or how severe the bone pain is, he or she may also order an X-ray, PET scan, or CT scan. In some cases, a tissue biopsy is also done to confirm the diagnosis.
Getting Back on Track: How Bone Metastases Are Treated
Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself, including:
Systemic cancer treatment Addressing the underlying breast cancer is the most important step in the treatment of bone metastases, says Huston. Depending on the type of tumor, this may include chemotherapy, hormone therapy, or targeted medications.Bone-modifying medications Bisphosphonates — a class of drugs used to prevent and treat bone loss — such as zoledronic acid are very effective in reducing pain and lowering the risk of fracture and further bone metastases, Huston says. They are also used to bring blood calcium levels down quickly. Denosumab, a medication that prevents the breakdown of bone, can also be effective in treating bone metastases.Surgery Surgery may be recommended to remove most of the tumor or stabilize the bone to prevent or manage a fracture. If a bone is very weak or a fracture seems imminent, an orthopedic surgeon may insert a rod or pin to stabilize the bone. Spinal fractures are sometimes treated with an outpatient procedure called vertebroplasty, in which bone cement is injected into a collapsed vertebra to build it back up and improve back pain.Radiation Radiation therapy, which uses high-energy ionizing radiation to hurt or destroy cancer cells, may be used to help prevent fractures and treat spinal cord compression to help alleviate symptoms of pain or numbness, says Huston.Pain medications These can include narcotics and NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen, which blocks the production of prostaglandins, substances that the body releases in response to illness or injury.
Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses; practicing relaxation methods like meditation, physical therapy, or yoga; and doing other gentle forms of exercise. Ask your health care team about programs that can help keep you safely active. “Strong muscles protect bones,” stresses Huston, “and being active makes you feel better both physically and psychologically.”
