About Bone Cancer

Each year, over 100,000 cases of metastatic cancer to bone are reported in the United States.

Bone is the third most common location where cancer cells metastasize after liver and lung. Once cancer has spread to bone it rarely can be cured. Doctors treat the disease to slow its growth and focus on controlling the symptoms of the disease.

Facts About Bone Metastasis

  • The majority of cancer involving the bones is metastatic disease from other remote cancers (most commonly breast, prostate and lung).
  • Primary bone cancer is much less common with 2-3000 cases reported per year. Primary bone tumors occur most commonly in children and adolescents and are less common in adults.
  • 30-70% of people with metastatic disease will have tumor spread to spine.

Symptoms of Bone Cancer

  • Pain affects 70% of patients with bone metastases.
  • Pain may occur with weight bearing or at rest.
  • Bone loss from tumor can result in fracture. 10-30% of patient’s with bone metastasis will experience a fracture.
  • Tumors within the vertebrae can cause spinal cord compression resulting in numbness or weakness.

Imaging Exams for Detecting Bone Metastasis

  • Bone tumors are most commonly discovered during work up or treatment of primary cancers.
  • X-Rays, CT, MRI, PET and bone scan may be used to identify tumors.
  • Your physician may request a biopsy of the tumor.

Treatments for Bone Metastasis

Standard therapies for bone metastases include medical, surgical, radiation and interventional treatments. Ultimately, a combination of these therapies will likely be employed to treat the disease as well as the pain related to the tumors.

Surgery: Metastatic disease to bone is usually treated with surgery in the case of recent or impending pathologic fracture. For primary bone cancer the goal of surgery is usually to remove the entire tumor and a surrounding area of normal bone.

Medical: Many patients with metastatic disease to bone will be treated with chemotherapy or hormonal therapy.

  • Chemotherapy is used to kill cancer cells throughout the body and is common for treatment for metastatic disease. These treatments vary based on tumor type.
  • Bisphosphonates are used to treat pain and reduce bone loss from tumors. They also help reduce the incidence of fracture from tumors.

Radiation: Radiation is the standard treatment for painful bone metastasis.

  • Radiation therapy is effective for pain control of 50-85% of bone lesions with pain relief occurring within 4 weeks after treatment.
  • The radiation is delivered in numerous doses or “fractions” to reduce damage to the surrounding tissues.
  • Because of limitations in normal tissue tolerance and toxicity, recurrent pain at a previously irradiated metastatic site may not be possible to with additional RT.

Minimally invasive therapies: Various treatments are administered by interventional radiologists to treat painful bone metastasis. These treatments are usually performed as outpatient procedures with short recovery time.

  • Ablation: Percutaneous ablation is performed with small needles placed through the skin into bone tumors that create heat or cold to kill tumor cells. This treatment is usually prescribed for painful bone tumors that did not improve or minimally improved after radiation. Patients usually experience rapid pain relief within 1 week of ablation.
  • Stabilization: Bone tumors can cause the bones to become weak resulting in pain or fracture with weight bearing.
    • The majority of bone metastases occur in the spine. Vertebroplasty/Kyphoplasty can be used in conjunction with ablation and involves injecting bone cement to fill the weakened bone after the tumor has been killed.
    • Stabilization can also be performed in the pelvis and peripheral bones to treat pain from instability.
  • Nerve blocks/neurolysis: Tumors may compress nerves resulting in pain. Nerve blocks or neurolysis (destruction of the nerve) is performed with tiny needles under local anesthesia to treat pain.
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