Bone Metastasis

What is Bone Metastasis

Bone metastasis is cancer that spreads to the bones from another part of the body. A person may have bone metastasis in one bone or in more than one bone.

Cancer that spreads to the bones is different from cancer that starts in the bones (primary bone cancer). Bone metastasis is more common than primary bone cancer.

The spine is the most common area for bone metastasis. Other common areas include:

  • Hip bone (pelvis).
  • Ribs.
  • Skull.
  • Long bones of the arm or leg.

Bone metastasis is painful, and it damages the bones. Bone metastasis damages and weakens bones in two ways. A person may have bone destruction (osteolytic damage) or abnormal bone growth (osteoblastic destruction). Both of these conditions can make bones so weak that they break (pathologic fracture) even from a minor injury.

What are the causes?

This condition is caused by cancer cells that spread to bone. These cells can get into your bloodstream and spread through your body. They can also get into the vessels that are part of your lymphatic system (lymph vessels) and spread that way.

What increases the risk?

This condition is more likely to develop in people who have an advanced type of cancer that is known to spread to bone. Cancers that often spread to bone include:

  • Breast cancer.
  • Prostate cancer.
  • Lung cancer.
  • Thyroid cancer.
  • Kidney cancer.

What are the signs or symptoms?

The most common symptom of this condition is bone pain, especially while you are resting. Other symptoms include:

  • A broken bone (fracture) that happens with little or no trauma.
  • Low number of red blood cells (anemia). Bone destruction may damage the spongy tissue (bone marrow) in the center of some bones where red blood cells are produced. Anemia can cause:
    • Weakness.
    • Shortness of breath.
    • Headache.
    • Dizziness.
  • Back or neck pain with numbness or weakness, especially if you have bone metastasis in your spine.
  • High levels of calcium in your blood (hypercalcemia). When bone is destroyed, calcium is released into your blood. Symptoms of hypercalcemia include:
    • Constipation.
    • Thirst.
    • Nausea.
    • Sleepiness.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms and medical history. Your health care provider may suspect this condition if you are being treated for cancer or have had cancer treatment in the past.
  • A physical exam.
  • Imaging studies, such as:
    • Bone X-rays, especially in the area where you have pain.
    • CT scan.
    • Bone scan.
    • MRI.
  • Blood tests to check for anemia or hypercalcemia.
  • A procedure to remove a piece of bone so it can be examined under a microscope (biopsy).

How is this treated?

Treatment for this condition depends on your overall health, the type of cancer you have, and how much the cancer has spread. You will work with a team of health care providers to determine which treatment is best for you. Treatment will focus on managing pain, preventing bone weakness, and slowing the spread of the cancer. Treatment may include:

  • Radiation therapy. This treatment uses X-rays to kill cancer cells. It is most effective for reducing pain, stopping tumor growth, and lowering the risk of fractures.
  • Radioisotope therapy. This treatment uses a radioactive medicine that is injected into your blood. The medicine travels to areas where cancer cells are active and kills them.
  • Chemotherapy. For this treatment, you are given cancer-killing drugs. You may have chemotherapy in cycles, with rest periods in between.
  • Medicines to block cells that destroy bone (bisphosphonatesand denosumab). These medicines are used to control bone pain. They may help to reduce hypercalcemia.
  • Medicines to reduce pain (opiates).
  • Endocrine therapies. These therapies slow cancer growth by blocking specific chemical messengers (hormones). Some types of cancer, including breast and prostate cancers, depend on hormones.
  • Targeted therapies. These therapies involve the use of drugs that block the growth and spread of cancer. This treatment is different from standard chemotherapy.
  • Immunotherapies. These therapies use the body’s defense system (immune system) to fight cancer cells.
  • Surgery. You may have surgery to remove bone cancer or to prevent or repair a fracture.

Follow these instructions at home:

Take medicines only as directed by your health care provider.

  • Do notdrive or operate heavy machinery while taking pain medicine.
  • Take the following steps to help prevent constipation, which can result from some pain medicines.
    • Include plenty of fruits and whole grains in your diet.
    • Drink enough fluid to keep your urine clear or pale yellow.
    • Ask your health care provider about taking a laxative if needed.
  • Keep all follow-up visits as directed by your health care provider. This is important.

Contact a health care provider if:

  • Your pain medicine is not helping.
  • You are too weak to care for yourself at home.

Get help right away if:

  • You fall and have pain or an injury.
  • You have trouble walking.
  • You have numbness or tingling in your legs.
  • Your pain suddenly gets worse.
  • You lose control of your bowels or your bladder.
  • You are very sleepy or confused.
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