Bone Metastases

Cancerous growths can begin in any part of the body. The original site of cancer is called the primary tumor or primary cancer (for example, breast cancer). After cancer has developed in one area of the body, cancerous cells from that area can break away and travel through the body's bloodstream. If these cancerous cells begin growing in another place in the body, they are called metastases. Bone metastases are cancer cells that have spread to the bone (which is different from a cancer that starts in the bone).

These secondary growths are like the original tumor. For example, if a prostate cancer spreads to bone it is called metastatic prostate cancer, or prostate cancer metastatic to bone, but not bone cancer. Cancers can spread to almost any bone; the spine and pelvis are often involved.

Any type of cancer can spread to the bone, but the most common are breast, lung, kidney, thyroid and prostate cancers. Sometimes the primary tumor is not discovered until there are bone problems. If the primary cancer location cannot be discovered, the cancer is called cancer of unknown primary location.

SYMPTOMS

Pain in the bones is the main symptom of bone metastases. Some other problems may occur first including:

  • Decreased appetite.

  • Nausea.

  • Muscle weakness.

  • Confusion.

  • Unusual sleep patterns due to discomfort.

  • Overly tired (fatigue).

  • Restlessness.

Frail or brittle bones may lead to broken bones (fractures) that lead to learning what is wrong (diagnosis). A tumor often weakens the bones.

DIAGNOSIS

Metastatic cancers may be found months or years after or at the same time as the primary tumor. When a second tumor is found in a patient who has been treated for cancer, it is more often a metastasis than another primary tumor.

The patient's symptoms, physical examination, X-rays and blood tests may suggest a bone metastases. In addition, an examination of tissue or a cell sample (biopsy) is usually done to find the cancer. This sample is removed with a needle. This tissue sample must be looked at under a microscope to confirm a diagnosis.

TREATMENT

Options generally include treatments that give relief from symptoms (palliative) or curative. Those with advanced, metastasized cancer may receive treatment focused on pain relief and prolonging life. These treatments depend on the type of cancer and its location.

Treatment for cancer depends on its type and location. Some of these treatments are:

  • Surgery to remove the original tumor and/or to remove parts of the body that produce hormones and other chemicals that make cancer worse.

  • Treatment with drugs (chemotherapy).

  • Bone marrow transplantations on rare occasions.

  • Radiation therapy (radiotherapy).

  • Hormonal therapy.

  • Pain relieving medications.

Your caregiver will help you understand the likelihood that any particular treatment will be helpful for you. While some treatments aim to cure or control the cancer, others give relief from symptoms only. If you have bone metastases, radiation therapy may be recommended to treat pain (if it is in one main location). Pain medications are available. These include strong medicines like morphine. You may be instructed to take a long-acting pain medication (to control most of your pain) and a short-acting medication to control occasional flares of pain. Pain medication is sometimes also given continuously through a pump.

HOME CARE INSTRUCTIONS

  • Take medications exactly as prescribed.

  • Keep any follow-up appointments.

  • Pain medications can make you sleepy or confused. Do not drive, climb ladders, or do other dangerous activities while on pain medication.

  • Pain medications often cause constipation. Ask your caregiver for information on stool softeners.

  • Do not share your pain medication with others.

SEEK MEDICAL CARE IF:

  • Your bone pain is not controlled.

  • You are having problems or side effects from your medication.

  • You have excessive sleepiness or confusion.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You fall and have any injury or pain from the fall.

  • You have trouble walking.

  • You have numbness or tingling in your legs.

  • You develop a sudden significant worsening of your pain.