When cancer spreads to bone, treatment may involve several specialists. Their work has connected goals: controlling the cancer, easing symptoms and helping you keep doing everyday activities. Medicines, radiotherapy and surgery each have a place, depending on what the affected bone needs.[1][2]
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What does “bone metastases” mean?
Bone metastases are cancer deposits that have spread to bone from another part of the body. The cancer keeps the identity of its original site. Breast cancer that spreads to bone, for example, remains metastatic breast cancer.[1]
Affected bone can become painful and weak. Sometimes it breaks during an ordinary activity or after a minor injury. Tell your care team about new or worsening symptoms.[2]
What is each treatment trying to achieve?
Your oncology treatment addresses the wider cancer. Treatment of a particular bone may instead focus on pain, stability and useful movement. For most people with bone metastases, these are ways of controlling the illness and its effects; an operation on one bone is not usually an operation that removes all the cancer from the body.[1][2]
Relieving a painful site
Radiotherapy treats a selected area. ASTRO recommends it for symptomatic bone metastases, including those in the spine.[3]
Supporting weakened bone
Surgery can support a bone that has broken or is at risk of breaking. Its goals include pain relief and restoring useful function.[2]
Bone medicines may also be discussed. Denosumab is one medicine used to prevent skeletal complications in people with bone metastases from solid tumours. It can cause low blood calcium and damage to the jaw bone, so treatment requires calcium monitoring and dental assessment. The choice and monitoring belong with your treating team.[6]
When is an orthopaedic assessment needed?
For metastases in the thigh bone, specialist guidance recommends considering pain together with imaging when assessing fracture risk. It also cautions that radiotherapy should not replace preventive stabilisation when that is needed.[4]
Pain relief and bone stability are separate questions. Evidence from radiotherapy studies of uncomplicated bone metastases cannot determine what to do when a bone is fractured, at risk of fracture or associated with spinal cord compression.[5]
More about the evidence
Many studies comparing conventional radiotherapy schedules excluded a fracture, impending fracture or spinal cord compression. This limits how the results apply to those more complicated situations.[5]
Surgery and radiotherapy may be parts of the same plan. ASTRO recommends radiotherapy after surgery for bone metastases outside the spine that require an operation. The surgical and radiation teams should explain the sequence and the purpose of each treatment.[3]
Walking, exercise and everyday movement
Advice about movement should account for the location of the bone deposits, symptoms, treatment and your current abilities. Expert consensus supports assessment before exercise and communication between the cancer team and an appropriately trained physiotherapist or exercise professional. Movement can then be adapted to the individual.[7]
Exercise research often excludes unstable or painful bone lesions, so a general programme cannot establish what your bone can safely tolerate. New pain during activity needs review.[7] Describe the movements you need at home: reaching the toilet, using steps or pushing yourself out of a chair. The plan should address those tasks and any help or aids needed.
Pain relief and support alongside cancer treatment
Palliative care can be involved while cancer treatment continues. It helps with symptoms such as pain, fatigue and poor sleep, and with the emotional or practical strain of illness. You do not have to wait until cancer treatment has stopped to ask for this support.[8]
For spinal metastases, NICE guidance calls for an individual pain assessment and a plan that is reviewed as symptoms change. Describe what pain stops you doing, whether it interrupts sleep and how well the current medicines work. Those details help make the conversation more useful.[9]
Symptoms that need urgent attention
If you have current or previous cancer, new limb weakness, difficulty walking, numbness, or new bladder or bowel problems need emergency assessment. These can indicate pressure on the spinal cord or its nerves. Seek emergency medical care immediately, even without back pain.[9]
New severe or worsening back pain, or back pain that disturbs sleep, also warrants urgent contact with your cancer team today.[9]
If you think your leg has broken, seek urgent medical care. Avoid putting weight on it while waiting for help.[10]
Questions to take to your appointment
- Which part of the plan treats the cancer, and which treats this painful bone?
- Does the bone need additional support?
- What movement is safe for me now?
- Who should I contact if pain or walking changes?
