Prostate-Specific Antigen Testing: Overview, Physiologic Characteristics of PSA, Other Prostate Cancer Markers
Treating Bone Metastasis
Many different treatments can help if your cancer has spread to bone, commonly called bone metastasis or bone "mets." Treatment can't cure bone metastasis, but it can relieve pain, help prevent complications, and improve your quality of life.
When breast cancer spreads to other parts of your body (metastatic breast cancer), it's more likely to spread to your bones than any other organ. More than half of those with stage IV breast cancer will have bone metastasis, most often in the spine, pelvis, ribs, arms, and legs.
Doctors use two types of treatments for metastatic cancer in the bones. Systemic treatments can reach cancer cells throughout the body. Local treatments directly target the cancer in the bone.
The treatment you get will depend upon:
Let your doctor know if your treatment isn't easing your pain and other symptoms. You may find that other approaches work better for you.
Chemotherapy is a common systemic treatment for bone metastasis. Your doctor will use a type of chemo that is effective against your primary tumor. So if you have metastatic lung cancer, for example, your doctor will use drugs that are effective against lung cancer.
How it works. Cancer medications target and curb cancer growth. In most cases, you take chemo by mouth or through a vein (by IV). This can often shrink the tumors, which will ease your pain and help you feel better.
Possible side effects. Chemo can kill normal cells in addition to cancer cells. The side effects you might have will depend on:
Common side effects of chemotherapy include:
Your doctor can help you prevent or manage these. Most side effects go away once you stop treatment.
Some types of breast and prostate cancers may be sensitive to hormones in the body. This still holds true when those cancers spread to the bones.
In some cases, your doctor may prescribe medications to block the interaction between certain hormones and cancer cells. In other cases, your doctor may suggest removal of hormone-making organs like the ovaries.
These drugs help prevent bone loss and fractures and treat damage to your bones from bone cancer tumors. They may also help with pain due to these tumors. There are two main types that doctors recommend for metastatic breast cancer: bisphosphonates and denosumab.
Bisphosphonates – ibandronate (Boniva), pamidronate (Aredia), and zoledronic acid (Zometa) – prevent bone loss or osteoporosis from endocrine treatments given for breast cancer. You take bisphosphonates by mouth or IV infusion, typically every 3 to 4 weeks. These drugs help by:
Side effects include:
A rare and serious side effect is bone death (osteonecrosis) of the jaw. Ask your doctor about precautions to take before beginning this treatment. Osteonecrosis may cause:
Denosumab (Prolia, Xgeva) is a type of medicine called a monoclonal antibody. Scientists make monoclonal antibodies in a lab. They work like the natural antibodies your body makes to fight illness. Monoclonal antibodies go into your body to identify and attack germs or cancer cells. Denosumab in particular is a "RANKL inhibitor." It blocks a protein called RANKL that breaks down bone.
Your doctor will inject the drug under the skin. It may take some months before any bone tumors start to shrink.
Denosumab may work as well as or better than bisphosphonates to prevent fractures. But it also can cause osteonecrosis, as well as low calcium levels in the blood.
Both denosumab and zoledronic acid also prevent spinal compression in women with cancerous growths (metastatic lesions) on the spine.
These drugs contain radioactive elements that target cancer cells. Doctors tend to use this systemic treatment when the metastasis is stimulating new bone growth. This is more common with prostate cancer.
If your cancer has spread to many bones, these drugs may be a better option than standard radiation, which uses a beam to aim radiation at each bone metastasis. However, sometimes doctors combine radiopharmaceuticals and standard radiation.
How it works. The doctor injects a single dose of the drug into a vein. It then travels to the areas of bone with cancer and gives off radiation to kill the cancer. This single dose may be effective against pain for several months. You can receive another treatment later.
Possible side effects. The most common ones include:
This systemic treatment helps your immune system spot and more effectively kill cancer cells. Some methods of immunotherapy have been used for a while, and some are still experimental.
How it works. Immunotherapy works in one of two main ways:
Examples of immunotherapy for cancer include:
Possible side effects. Side effects vary, depending upon the type of immunotherapy. They may include:
Radiation is a "local treatment" because it does not affect your entire body. It uses high-energy X-rays or particles to destroy or slow the growth of cancer cells in the bone. It helps most if you have only one or two bone metastases. You may get it alone or combined with other types of treatment.
How it works. A machine focuses a beam of radiation on the bone metastasis. This treatment, called external beam radiation, lasts only a few minutes. You may receive radiation in one large dose or in smaller amounts over several treatments.
Possible side effects. Early, temporary side effects depend on the location being treated, but may include:
Surgery can often help relieve bone metastasis symptoms.
How it works. If a bone is broken, surgery may help relieve pain quickly. Surgery can also help stabilize a weak bone to keep it from breaking. The surgeon may insert:
Possible side effects. These include the usual risks of any surgery, such as infection.
If surgery is not an option, your doctor may use a cast or splint, or inject bone cement to help you move better and relieve pain.
With this local treatment, a needle or probe is put into the tumor to destroy it. Though used more often for other types of metastasis, ablation can help if you have a problem with one or two bone tumors.
How it works. Some methods of ablation use chemicals or alcohol to kill the tumor. Two common methods include:
Afterward, the doctor may fill the space created by ablation with bone cement to help stabilize the bone.
Possible side effects. This procedure is generally safe but may cause some temporary soreness, swelling, and bruising.
This noninvasive procedure uses ultrasound energy and imaging technology to provide pain relief by destroying nerve endings in the area of the tumor. Because there is no incision, and no probe is inserted, the procedure is typically done on an outpatient basis with a local anesthetic rather than general anesthesia. While complications are possible, they are rare.
How it works. A specialist uses imaging to target the specific area to be treated with ultrasound. Then, heat that's made when ultrasound penetrates the targeted tissue destroys nerve endings in the bone around the tumor. The destruction of nerve endings results in pain relief.
Possible side effects. Possible complications include skin burns and damage to heat-sensitive organs that are next to the treated area.
Bone Cancer
Bone cancer is when unusual cells grow out of control in your bone. It destroys normal bone tissue. It may start in your bone or spread there from other parts of your body (called metastasis).
Bone cancer is rare. Most bone tumors are benign, which means they aren't cancer and don't spread to other areas of your body. But they may still weaken your bones and lead to broken bones or other problems. There are a few common types of benign bone tumors:
Primary bone cancer, or bone sarcoma, is a cancerous tumor that starts in your bone. Experts aren't sure what causes it, but your genes may play a role. Some of the most common types of primary bone cancer are:
Although it happens in your bones, multiple myeloma is not a primary bone cancer. It's a cancer of your marrow, the soft tissue inside bones.
Cancer in your bones usually started elsewhere in your body. For example, if lung cancer has spread to your bones, that's secondary bone cancer. Any cancer that moves from one part of your body to another is called metastatic cancer.
Cancers that commonly spread to bone include:
Things that might make you more likely to get bone cancer include:
You may not notice symptoms of a bone tumor, whether it's cancer or not. Your doctor might find it when they look at an X-ray of another problem, such as a sprain. But symptoms can include pain that:
An injury won't cause a bone tumor.
Other symptoms related to bone tumors include:
Your doctor will ask about your symptoms and medical history and do a physical exam. They'll look at pictures of your bones through imaging tests such as:
Your doctor might also do blood tests to look for two enzymes that can be signs of blood cancer.
A procedure called a biopsy can confirm a diagnosis. Your doctor takes a sample of the tumor with a needle or through a cut in your skin. A trained technician looks at the tissue or cells under a microscope. They can tell if your tumor is benign or a primary or secondary cancer. They can also get an idea of how fast it's growing.
If you have a benign tumor, your doctor will treat it with medication or might just watch it for changes. They may take out benign tumors that are more likely to spread or become cancer. In some cases, tumors come back, even after treatment.
Cancerous tumors need stronger treatment and care from a number of specialists. Your treatment will depend on several things including how far it's spread, which experts use to determine its stage. Cancer cells that are only in the bone tumor and the surrounding area are at a "localized" stage. Those that spread to or from other areas of your body are more serious and harder to treat.
Common treatments for bone cancer include:
Limb salvage surgery. Your doctor removes the part of the bone with cancer but not nearby muscles, tendons, or other tissues. They put a metallic implant in place of the bone.
Amputation. If a tumor is large or reaches your nerves and blood vessels, your doctor might remove the limb. You may get a prosthetic limb afterward.
Radiation therapy. This kills cancer cells and shrinks tumors with strong X-rays. Doctors often use it along with surgery.
Chemotherapy. This kills tumor cells with cancer drugs. Your doctor might use it before surgery, after surgery, or for metastatic cancer.
Targeted therapy. This drug treatment targets certain genetic, protein, or other changes in or around cancer cells.
You might want to join a clinical trial that's testing new treatments.
Bone cancer treatments can cause problems over time with your heart, lungs, brain, hearing, bones, or fertility. It's important to have regular checkups with your doctor to watch for these complications and to make sure the bone cancer doesn't come back.
Your recovery from bone cancer depends on its type and stage. Overall, more than 78% of people who have it live at least 5 years after diagnosis.
Signs Breast Cancer Has Spread To The Bones (Metastasis)
Like any cancer, breast cancer can spread to other parts of the body. Breast cancer that has invaded bone can have a significant effect on quality of life, but there are treatments to help manage symptoms and slow disease progression.
Read on to learn more about metastatic breast cancer in bones, including symptoms and what you can expect from treatment.
"Metastasis" describes the spread of cancer from where it started to another part of the body. This happens when cancer cells break from the primary tumor and enter the lymph system or bloodstream. From there, they can travel throughout the body and form new tumors.
Metastatic breast cancer in bones is not the same as bone cancer. It's made up of breast cells, not bone cells. It's also called stage 4 or advanced breast cancer.
According to a 2020 study, bone is the most common site of breast cancer metastasis.
Breastcancer.Org says that for more than half of women with metastatic breast cancer, bones are the first site of metastasis. The bones most likely to be affected are the:
Other common sites of breast cancer metastasis include your liver and lungs.
Signs and symptoms vary depending on where the cancer has spread and how big the tumors are. They may include:
PainBone pain from breast cancer metastasis tends to be constant. It may get worse when you're active and typically doesn't let up when you rest. This can make it difficult to sleep well.
Bone fractureCancer weakens bone, making it fragile and susceptible to fracture. Sudden, severe bone pain can be due to a fracture, even after a minor injury.
Compressed spinal cordCancer in your spine puts pressure on nerves. This can lead to back or neck pain. It can also cause numbness or weakness in your legs as well as bladder and bowel concerns.
Learn more about the symptoms of late stage metastatic breast cancer.
HypercalcemiaCancer can cause bones to break down and release calcium into the bloodstream. Hypercalcemia is a condition in which you have a high level of calcium in your blood. Symptoms can include:
Your doctor will likely start with a discussion of your symptoms and a physical examination.
Diagnostic testing may include blood tests to find out whether your blood has too much calcium or alkaline phosphatase (ALP), either of which can be elevated because of bone metastasis.
But this can also be due to other conditions. Blood tests alone can't confirm metastatic breast cancer in bones or pinpoint the location.
Sometimes, an X-ray can reveal bone metastasis. Other times, your doctor may order one or more of the following imaging tests to look for signs that cancer has reached bone:
Breast cancer isn't a single disease. It's a group of diseases. So, treatment is personalized to reflect your:
Depending on your level of pain, medications may include acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Your doctor may also prescribe opioids to manage severe pain.
Localized treatmentLocal treatment depends on which bones are affected and how weak they've become. Treatment may include:
Your options for systemic treatment vary according to the characteristics of the cancer. This includes hormone and human epidermal growth factor receptor 2 (HER2) status as well as other specific tumor markers or genetic mutations.
Your doctor will consider any previous cancer treatments and adjust if necessary.
Systemic treatments may include:
Clinical trials are studies that research the effectiveness of new therapies. By participating in a trial, you may have access to innovative treatments that aren't available anywhere else.
If you're interested, ask your doctor for information about clinical trials that might be a good match. You can also search ClinicalTrials.Gov.
Treatment for bone metastasis can effectively manage metastatic breast cancer for some time.
Many people with bone metastasis continue to have a good quality of life and live for many years.
That said, treatment for metastatic cancer doesn't usually eliminate all cancer cells. Eventually, these cells become resistant to therapy.
According to the American Cancer Society, the 5-year relative survival rate for metastatic breast cancer is 31% for women and 20% for men.
It's important to note that cancer survival statistics are based on people who received diagnoses and treatments at least 5 years ago. That means the statistics don't reflect the effectiveness of the newest treatments — and treatments are improving every year.
It's also worth noting that survival rates for metastatic cancer are very diverse and depend on the individual and the type of cancer they have.
For example, people with hormone receptor-positive cancers and HER2-positive breast cancers may do well for a long time, compared with those who have triple-negative breast cancers. So, lumping all forms of metastatic cancer into one statistic can be misleading.
Regardless of the type of breast cancer you have, early diagnosis and treatment are crucial, as survival rates are higher in the early stages of breast cancer. And remember, the right treatment for stage 4 breast cancer can improve quality of life and longevity.
Below are some commonly asked questions about metastatic breast cancer in bones.
How long can you live with metastatic breast cancer in bones?Some studies suggest people with breast cancer that has metastasized to the bones live 19–25 months on average.
However, the American Cancer Society states the 5-year relative survival rate for metastatic breast cancer is 31% for women and 20% for men.
All in all, your outlook depends on several factors, including the extent of metastasis, the type of breast cancer, previous treatments, and your age and overall health.
What happens when breast cancer spreads to the bones?When breast cancer spreads to the bones, you may experience pain, bone fracture, a compressed spinal cord, and high levels of calcium in your blood.
What are the final stages of metastatic breast cancer?End stage metastatic breast cancer may eventually stop responding to treatment. This means your care team will start focusing on keeping you comfortable and treating your symptoms.
These symptoms may include:
Metastasis breast cancer most commonly spreads to the bones. Some signs include constant bone pain, fractures, compressed spinal cord, and hypercalcemia.
A doctor usually diagnoses metastasis breast cancer in bones using a variety of imaging tests and sometimes a bone biopsy.
Treatment options are personalized based on factors like your cancer type, extent of metastasis, and previous treatments.
While treatments can effectively manage the cancer and improve your quality of life, complete elimination of cancer cells is rare. Survival rates vary depending on your individual factors and cancer type.
Early diagnosis and tailored treatment are crucial for better outcomes, as newer treatments continue to improve survival rates over time.
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