Bone metastases: causes, symptoms, diagnosis and treatment

Bone metastasis occurs when cancer cells spread from their original site in a bone.
Almost all types of cancer can spread (metastasize) to the bones. But some types of cancer are more likely to spread, such as breast and prostate cancer.
Bone metastases can occur in any bone, but occur most often in the spine, pelvis, and thigh. Bone metastases can be the first sign that you have cancer or they can appear years after cancer treatment.
Bone metastases can lead to bone pain and bone fractures. With few exceptions, cancer that has spread to the bones cannot be cured. Treatments can help reduce pain and other symptoms of bone metastases.

Symptoms

Sometimes bone metastases cause no signs and symptoms.
When they occur, the signs and symptoms of bone metastases are:
Bone ache
Bone fracture
urinary incontinence
intestinal incontinence
Weakness in the legs or arms
High level of calcium in the blood (hypercalcaemia), which can cause nausea, vomiting, constipation and confusion

When should you see a doctor?

If you experience persistent signs and symptoms that concern you, make an appointment with your doctor.
If you have had cancer treatment in the past, tell your doctor about your medical history and that you are concerned about your signs and symptoms.

Risk factors

Almost all types of cancer can spread to bone, but the types of cancer most likely to cause bone metastases are:
breast cancer
Kidney cancer
Lung cancer
lymphoma
Multiple myeloma
Prostate cancer
Thyroid cancer

Diagnosis

Imaging tests are used to investigate signs and symptoms that may indicate a bone metastasis. The tests you should have depend on your specific situation.
Tests may include the following:
X-ray.
Bone scan (bone scan).
CT.
Magnetic resonance imaging (MRI).
Positron emission tomography.
Biopsy.

Treatment

Common treatments for bone metastases include medications, radiation therapy, and surgery. The best treatments for you depend on the specifics of your situation.

Medicines

Some of the medications that patients with bone metastases receive are as follows:
Medicines to strengthen bones. Medicines that are often given to people with weak bones (osteoporosis) can also help people with bone metastases These medicines strengthen bones and relieve pain from bone metastases, reducing the need for stronger painkillers Medicines that strengthen bones also reduce the risk of developing a new bone metastasis These drugs can be given every few weeks via a drip in the arm or by injection These drugs can also be given by mouth, but are usually not as effective as intravenous or injectable forms and can cause gastrointestinal side effects Bone-strengthening drugs can cause temporary bone pain and kidney problems They also increase the risk of rare but serious damage to the bones of the jaw (osteonecrosis)
intravenous radiation. People with multiple bone metastases may be given radiopharmaceuticals through an IV, a type of radiation therapy Radiopharmaceuticals contain a small amount of a radioactive material that has a strong attraction to bone Once in the body, the particles are targeted at areas of the bone metastases and their radiation Radiopharmaceuticals help control pain caused by bone metastases Some of the side effects can be damage to the bone marrow, which can cause low blood cell counts
Chemotherapy. If the cancer has spread to more bones, your doctor may tell you to get chemotherapy Chemotherapy is given throughout the body to fight cancer cells Chemotherapy can be given by mouth, intravenously, or both Effects Side effects depend from specific chemotherapy drugs taken. For cancers sensitive to chemotherapy, this may be the best way to relieve pain from bone metastases.
Hormone therapy. For hormone-sensitive cancers in the body, hormone-suppressing treatment may be an option Breast cancer and prostate cancer are often sensitive to hormone-blocking treatments In hormone therapy, giving drugs to lower natural levels of hormones in the body or drugs that block the interaction between hormones and cancer cells Another option is surgery to remove the hormone-secreting organs: the ovaries and testicles
Analgesics. Painkillers can control pain from bone metastases These can be over-the-counter pain relievers or stronger prescription pain relievers It can take some time to determine which combination of pain relievers works best for you If you take medication but still have pain, tell your doctor A specialist in medicine pain reliever will be able to give you more options for pain relief.
Steroids. Steroids are drugs that often help relieve pain associated with bone metastases by decreasing swelling and inflammation around the site of the cancer. These steroids are different than those used by bodybuilders or athletes to grow muscle Steroids work very quickly to relieve pain and prevent some cancer related complications However, they should be used with great caution as they have side effects, especially when used for long periods of time
Targeted therapy. Targeted drug treatments target specific abnormalities within cancer cells. By blocking these abnormalities, targeted drug treatments can kill cancer cells Some cancers respond very well to these treatments For example, breast cancer cells with receptor overexpression HER2 can respond to some medications

external radiation therapy

Radiation therapy uses high-power energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy may be an option if your bone metastasis is causing pain that you can’t control with pain relievers or if the pain is limited to certain areas.
Depending on the situation, radiation to the bone can be given in one large dose or several smaller doses over several days. The side effects of radiation depend on the site being treated and its size.

Surgery

Surgical procedures can help stabilize a bone that is at risk of breaking or repair a broken bone.
Surgery to stabilize the bone. If the bone is at risk of fracture due to bone metastases, surgeons can stabilize it with metal plates, screws, and pins (orthopedic fixation) Orthopedic fixation can relieve pain and improve function Radiation therapy is often given after surgery surgical, when you are cured
Surgery to inject a bone with cement. Bone cement can be helpful for bones that can’t be easily strengthened with metal plates or screws, such as the pelvic bones and spine bones. Doctors inject bone cement into a bone that is fractured or damaged by metastases. Bone This procedure can reduce pain
Surgery to fix a broken bone. If bone metastasis has caused a bone to break, surgeons can work to repair it. This involves using metal plates, screws, and pins to stabilize the bone. Joint replacement, such as a hip replacement, may be another option Generally, bone fractures due to bone metastases are not repaired by placing a cast over the broken bone

Heating and freezing of tumor cells

Procedures that use heat or cold to kill cancer cells can help control pain. These procedures may be an option if you have one or two areas of bone metastases and other treatments aren’t helpful.
During a procedure called radiofrequency ablation, a needle with an electrical probe is inserted into the bone tumor. Electricity passes through the probe and heats the surrounding tissue. The tissue is allowed to cool and the process is repeated.
A similar procedure called cryoablation freezes the tumor and then allows it to thaw. The process is repeated several times.
Side effects can include damage to nearby structures such as nerves and bone damage, which can increase the risk of fractures.

clinical trials

Clinical trials are studies to test new treatments and innovative ways to apply existing treatments. If you sign up for a clinical trial, you’ll have the opportunity to try out the latest treatments. However, a cure is not guaranteed, and side effects of new treatments may be unknown. Talk to your doctor about available clinical trials.

Physiotherapy

Your physical therapist can work with you to design a plan to help you gain strength and improve mobility. Your physical therapist can suggest assistive devices to help you cope. Examples might include crutches or a walker to keep weight off the affected bone when walking, a cane to improve balance, or an immobilization device to stabilize the spine.
Your physical therapist can also suggest specific exercises to help you maintain strength and reduce pain.

With information from the Mayo Clinic

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