Bone metastasis

To diagnose bone metastasis, your healthcare professional may suggest imaging tests. Tests may include:

• X-ray.
• Bone scan, also called bone scintigraphy.
• Computerized tomography scan, also called CT scan.
• Magnetic resonance imaging scan, also called MRI scan.
• Positron emission tomography scan, also called PET scan.

To confirm the diagnosis, your healthcare professional might suggest a biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

Common treatments for bone metastasis include medicines, radiation therapy and surgery. Your healthcare team selects the treatments that are best for you based on your situation.

Bone-building medicines

Bone-building medicines help strengthen the bones. They're often used to treat thinning bones, a condition called osteoporosis. Bone-building medicines also help treat bone metastasis.

Bone-building medicines can strengthen the bones and reduce the pain caused by bone metastasis. This lowers the need for strong pain medicines. Bone-building medicines also may lower the risk of getting new bone metastasis.

Bone-building medicines are given every few weeks through a vein in the arm or through a shot. These kinds of medicines also come in pill form, but this form of the medicines may not work as well for bone metastasis.

Bone-building medicines can cause kidney problems and short-term bone pain. They also increase the risk of a rare but serious jawbone condition called osteonecrosis.

Radiopharmaceutical medicines

Radiopharmaceuticals are medicines that contain a low level of radioactive material. These medicines are given through a vein. Once in the body, the medicines travel to the cancer in the bones and deliver the radiation. For bone metastasis, these medicines may help relieve bone pain. Radiopharmaceutical medicines that target the bones might be an option when there is more than one bone metastasis.

Side effects can include damage to the bone marrow. This can lead to low blood cell counts.

Chemotherapy

Chemotherapy treats cancer with strong medicines. If cancer has spread to more than one bone, your healthcare professional may suggest chemotherapy.

Hormone therapy

Hormone therapy for cancer blocks certain hormones in the body. Some cancers use the body's hormones to help them grow. For these cancers, hormone-blocking treatments may help control the cancer. Breast cancers and prostate cancers often are sensitive to hormone-blocking treatments.

Hormone therapy can involve taking medicines to lower hormone levels or medicines that block the action between hormones and cancer cells. Another choice is surgery to remove organs that make the hormones that cancer cells use. These organs include the ovaries and the testes.

Pain medicines

Pain medicines work to control the pain bone metastasis causes. You might take pain relievers you can get without a prescription or stronger prescription pain relievers.

It may take time to find the mix of pain medicines that works best for you. If you take pain medicines but still have pain, tell your healthcare professional. A pain specialist may be able to offer more choices for pain relief.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Your cancer cells may be tested to see if targeted therapy is likely to work for you. Side effects of targeted therapy medicines depend on which medicine you receive.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy can treat one or a few areas of bone metastasis. But it typically isn't used if there are many areas. Radiation can't rebuild bone weakened by cancer. But it can help ease pain and control the growth of the bone metastasis.

Radiation to the bone can be given in one treatment or several treatments over many days. Side effects of radiation depend on the site being treated and its size.

Stereotactic body radiotherapy

Stereotactic body radiotherapy is a highly precise, intense radiation treatment. This treatment aims beams of radiation from many angles at the cancer. Stereotactic body radiotherapy most often is done in one or a few treatments.

This treatment might be used for bone metastasis in the spine bones. It allows healthcare professionals to target the treatment to the cancer without hurting the spinal cord.

Surgery

Surgical procedures can help a bone that is at risk of breaking or repair a broken bone. Operations used for bone metastasis include:

• Surgery to make the bone more stable. If a bone is in danger of breaking due to bone metastasis, surgeons can make it more stable. This may involve using metal plates, screws and rods. This procedure is called orthopedic fixation.
• Surgery to inject cement into a bone. Bone cement might help broken bones that can't be made stable with metal plates or screws. These include pelvic bones and bones in the spine.

• Surgery to repair a broken bone. If bone metastasis causes a bone to break, surgeons may work to repair the bone. This may involve using metal plates, screws and nails to make the bone stable. Joint replacement, such as a hip replacement, may be another choice. Most often, putting a cast on a bone broken by bone metastasis doesn't help.

Ablation therapy

Ablation therapy procedures apply treatment directly to the cancer cells. These procedures include treatments that use heat or cold to kill cancer cells. Ablation therapy may help control pain caused by bone metastasis. It may be a choice if you have one or two areas of bone metastasis that other treatments haven't helped.

During an ablation therapy procedure called radiofrequency ablation, a needle with an electric probe is put into the cancer. Electricity passes through the probe and heats the tissue around it. After the tissue cools, the process is done again.

An ablation therapy procedure called cryoablation freezes the cancer and then lets it thaw. After the tissue thaws, the process is done again.

Side effects can include damage to nearby structures, such as nerves, and damage to bones that can increase the risk of a broken bone.

Clinical trials

Clinical trials are studies of new treatments and new ways of using existing treatments. Taking part in a clinical trial gives you the chance to try the latest treatments. But a cure isn't guaranteed. The side effects of new treatments may not be known. Ask your healthcare professional whether clinical trials may be an option for you.

Physical therapy

A physical therapist can work with you to make a plan that will help you get stronger and move better. A physical therapist may suggest assistive devices to help you cope. Examples might include crutches or a walker to take weight off a bone while walking, a cane to improve balance, or a brace to keep the spine stable.

A physical therapist also may suggest exercises to help you keep your strength up and reduce your pain.

Coping with bone metastasis involves more than coping with bone pain. It also involves coming to terms with the news that your cancer has spread.

Treatments for bone metastasis can slow the growth of the cancer and may extend your life. But cancer that spreads can be hard to cure. Your healthcare team will work to ease your pain and keep you comfortable so that you can focus on what's important to you.

People find their own way to cope with a cancer diagnosis. Until you find what works best for you, here are some things you can try.

Find out enough about bone metastasis to help decide about your care

Ask your healthcare team about the details of your cancer and your treatment choices. Ask about where you can get more information. Good places to start are the U.S. National Cancer Institute and the American Cancer Society.

Find someone to talk with

A close friend or family member who is a good listener might be a good person to talk with about any fears or worries. Sometimes friends and family members may have trouble coping with your diagnosis, so you might choose to talk with a professional. Talking with a counselor, medical social worker, or a pastoral or religious counselor can be helpful.

Connect with other cancer survivors

You may find comfort in talking with other people who have cancer. Contact your local chapter of the American Cancer Society to find cancer support groups in your area.

Work towards accepting your diagnosis

It can be hard to accept that your cancer may not have a cure. For some people, having a strong faith or a sense of something greater than themselves makes this process easier.

Others want to talk with someone who knows about life-threatening illnesses. This could be a medical social worker, a psychologist or a chaplain.

Make end-of-life choices

Some people find comfort in planning ahead for difficult times. You may choose to review your end-of-life wishes with your healthcare professional. Write down your wishes and share them with your loved ones.

Think about hospice care

If cancer therapies no longer work or if you no longer want them, you might find comfort in hospice care. Hospice care provides medical, emotional and spiritual support. Hospice care focuses on keeping you comfortable and easing your physical and emotional pain.

Start by making an appointment with a doctor or other healthcare professional if you have symptoms that worry you. Tell your healthcare professional if you were treated for cancer in the past, even if the treatment was many years ago. If you're diagnosed with bone metastasis, your health professional may refer you to a specialist. Often this is a doctor who treats cancer, called an oncologist.

Here's some information to help you get ready for your appointment.

What you can do

• Ask about pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that don't seem linked to the reason for the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you take, including doses.
• Think about taking a family member or friend along. Someone who goes with you can help you take in the information you get.
• Write down questions to ask your healthcare professional.

For bone metastasis, some basic questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatments are there? Which do you suggest?
• What's my prognosis?
• Are there experimental treatments or clinical trials I can try?
• I have other health conditions. How will those affect my treatment?
• Are there brochures or other printed material that I can have? What websites do you suggest?
• Will I need a follow-up visit?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• When did your symptoms begin?
• Have your symptoms been ongoing, or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• Does anything make your symptoms worse?