Bone metastasis

Cancer that has spread from the original (primary) tumor to the bone is called bone metastasis. It may not be possible to cure bone metastases, but there are still things that can be done to help you feel as good as possible for as long as possible. This care, aimed at relieving suffering and improving the quality of life, is called palliative care. The focus is on the patient and family rather than the disease. Palliative care treats the symptoms caused by bone metastases. It does not treat the cancer itself. Some health care providers call this supportive care.

Bone metastases may be found anywhere in the skeleton, but generally occur in the central parts. More than 90% of all metastases are found in the back, pelvis, upper leg, ribs, upper arm, and skull. Complications of bone metastases include pain, increased risk of fracture, raised calcium levels in the blood, and a decreased blood cell count.

Statistics on bone metastasis

Bone metastases are common, however, its true incidence is unknown, as it is dependent on the prevalence of certain types of cancers in the community which predispose to bone metastases.

Risk Factors for bone metastasis

Bone metastases are found more commonly in middle-aged to elderly people; they are uncommon in children. The major cancer types which tend to metastasize to bone include:

• Multiple myeloma,
• Breast, prostate,
• Lung,
• Kidney, and
• Thyroid cancers.

However, a number of factors are involved – the probability of bone metastasis can be assessed only by knowing the prevalence of the cancer and its preference for bone in a particular ethnic group.

Progression of bone metastasis

Bone metastases results in injury to bone tissue.

There are two types of bone lesions:

• Lytic lesions, which destroy bone material, and
• Blastic lesions, which fill up bone with extra cells.

Normal bone is in a constant state of remodeling – being broken down and rebuilt. Cancer cells that have spread to the bone disrupt this balance between the activity of cells that break down bone (osteoclasts) and cells that make bone (osteoblasts).

How is bone metastasis diagnosed?

Tests which may be done if bone metastases are suspected include:

• Blood tests.
• ECG (if the patient has an irregular heartbeat).
• X-rays.
• Whole body bone scan looking for metastases.
• CT scan / MRI scan to assess local disease.

Prognosis of bone metastases

Once cancer has spread to the bone, prognosis tends to be poor and treatment is generally aimed at minimizing symptoms and improving quality of life. Bone metastases often have a significant impact on a person’s quality of life by causing reduced mobility and pain, and complications such as high calcium levels, bone marrow suppression and fractures.

Here are some of the common problems caused by bone metastases. Not everyone will get all of these symptoms, and some of the information here may not apply to you. In some cases, these symptoms are not caused directly by the cancer in the bones or can have more than one cause. Your cancer care team can tell you the most about where the bone metastasis is and what symptoms it might cause.

Pain

There are many ways to treat pain caused by bone metastases. Almost any of the local or systemic treatments commonly used for bone metastases can be helpful in treating pain.

Pain medicines are also very helpful. There are many different kinds of pain medicines used to treat cancer pain. There are also a lot of ways the medicines can be taken, such as pills, patches, sprays, and pumps that let you put the medicine into your body when you need it.

You should never accept pain as a normal part of having cancer. All pain can be treated, and most pain can be controlled or relieved. Talk to your cancer care team.

High calcium levels (hypercalcemia)

As cancer cells damage the bones, calcium from the bones is released into the blood. This can lead to problems caused by high blood calcium levels. The medical word for high calcium levels is hypercalcemia.

Early symptoms of having too much calcium in the blood include:

• Constipation
• Passing urine very often
• Feeling sluggish or sleepy
• Feeling thirsty all the time and drinking lots of liquids

Late signs and symptoms can include muscle weakness, muscle and joint aches, confusion, coma, and kidney failure.

High calcium levels affect the kidneys, which can cause you to pass too much urine and become dehydrated. The dehydration gets worse as the calcium level goes ups. Because of this, giving large amounts of intravenous (IV) fluids is a main part of the treatment for hypercalcemia.

Bisphosphonate drugs are also used to bring blood calcium levels down quickly. These drugs are given into the vein by IV infusion and may be repeated monthly. Other drugs can be used if these don’t work.

Once the calcium level is back to normal, treating the cancer can help keep the calcium level from getting too high again.

Broken bones

When cancer spreads into bones, it can make them weak and more likely to break (fracture). The leg bones near the hip often fracture because these bones support most of your weight, but other bones can fracture too.

Cancer in the bone may cause severe pain for a while before the bone actually breaks. When possible, your doctor will try to prevent the fracture.

• If an x-ray shows an arm or leg bone is likely to break, surgery may be done to put a metal rod may be put through the weak part of the bone to help support it.
• If the bone has already broken, then something else will be done to support the bone. Usually surgery is done to put a steel support over the fractured area of the bone.
• Bones of the spine (the vertebrae) can also fracture. If this happens, vertebroplasty may be used to support them. In this procedure a type of bone cement is injected into the damaged bones.

Radiation treatments may be given after surgery to try to prevent any more damage. The radiation won’t make the bone stronger, but it may stop further damage.

Medicines you take or the cancer itself may make you confused, dizzy, or weak. This can lead to falls and accidents. Falls can cause fractures, especially in bones weakened by cancer. Talk with your cancer care team about safety equipment you can use at home, such as shower chairs, walkers, or handrails.

Spinal cord compression

• When cancer threatens to paralyze, it’s an emergency

If the cancer spreads to a bone in the spine, sometimes it can grow large enough to press against and squeeze (compress) the spinal cord. This can show up in different ways:

• Back pain (sometimes with pain going down one or both legs)
• Numbness of the legs or belly
• Leg weakness or trouble moving the legs
• Loss of control of urine or stool (incontinence) or problems passing urine

If you notice symptoms like these, call your doctor right away or go to the emergency room. If not treated right away, spinal cord compression can lead to life-long paralysis (inability to walk or even move).

If the cancer is just starting to press on the spinal cord, treatment can help prevent paralysis and help relieve the pain. Radiation is often used as part of the treatment, sometimes along with a type of drug called a steroid or corticosteroid. The radiation often is started within the first 12 to 24 hours.

If the spinal cord is already showing signs of damage (such as weakness in the legs), immediate surgery followed by radiation may be the best treatment. This may allow a patient to walk and function better than if they get radiation alone. People with very advanced cancer or other serious medical problems may not be able to have this kind of surgery.

How is bone metastasis treated?

The goal of treatment for bone metastases is to relieve pain and reduce the risk of fracture. Treatment may consist of surgery, radiation therapy, pain medications, and/or bisphosphonate drugs.

• Surgery may be required if there is immediate risk of fracture. Metal rods, plates, screws, wires, nails, or pins can be inserted to stabilize the bone at risk.
• Radiation Therapy: For metastatic lesions without immediate risk of fracture, radiation is effective for reducing localized bone pain and progression of the cancer.
• Medications: A groups of drugs called ‘bisphosphonates’ have been shown to reduce the risk of fractures caused by metastatic bone lesions, as well as treating bone pain and controlling raised calcium levels. Painkillers may be required if bone pain is interfering with the patient’s quality of life.

Breast cancer metastasis to bone

Breast cancer metastasis to bone survival rate

Metastatic or stage IV breast cancers, have a 5-year relative survival rate of about 22% ¹⁾.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual. We understand that these statistics can be confusing and may lead you to have more questions. Talk to your doctor to better understand your specific situation.

Lung cancer metastasis to bone

Non-Small Cell Lung Cancer Survival Rate

The 5-year survival rate for Non-Small Cell Lung Cancer stage IVB the 5-year survival rate is less than 1% ²⁾. Still, there are often many treatment options available for people with these stages of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. Talk to your doctor to better understand your situation.

Non-Small Cell Lung Cancer Stage IVB: The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). It has spread as more than one tumor outside the chest, such as to distant lymph nodes and/or to other organs such as the liver, bones, or brain (M1c).

Small Cell Lung Cancer Survival Rate

The 5-year survival rate for Small Cell Lung Cancer stage IV the 5-year survival rate is about 2% ³⁾. Still, there are often many treatment options available for people with these stages of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. Talk to your doctor to better understand your situation.

Lung Carcinoid Tumor Survival Rate

The 5-year survival rate for Lung Carcinoid Tumor stage IVB the 5-year survival rate is about 57% ⁴⁾. Still, there are often many treatment options available for people with these stages of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. Talk to your doctor to better understand your situation.

Lung Carcinoid Tumor Stage IVB: The cancer can be any size and may or may not have grown into nearby structures (any T). It may or may not have reached nearby lymph nodes (any N). It has spread either as a single tumor (M1b) as more than one tumor outside the chest, such as to distant lymph nodes and/or to other organs such as the liver, bones, or brain (M1c).

Prostate cancer metastasis to bone

Prostate cancer metastasis to bone life expectancy

Prostate Cancer Survival Rate

The 5-year survival rate for Lung Carcinoid Tumor stage IVB the 5-year survival rate is about 29% ⁵⁾. Still, there are often many treatment options available for people with these stages of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. Talk to your doctor to better understand your situation.

Prostate Cancer Stage IVB: The cancer might or might not be growing into tissues near the prostate [any T] and might or might not have spread to nearby lymph nodes [any N]. It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs [M1]. The Grade Group can be any value, and the PSA can be any value.