Treating Bone Metastasis

Bone metastasis treatment can include pain management, radiation, surgery and medical.

Pain Management Therapy

Pain usually results when a tumor pushes on bones, nerves, or other organs in the body. Many different drugs or drug combinations can be used to treat bone metastasis pain. Sometimes medications are used along with surgery, radiation, or other treatments to provide relief. The side effects of the different drugs and drug combinations can vary. Some patients experience mild side effects while others have a more intense reaction. Your doctor will discuss with you the medication(s) that he/she feels will work best for you and the possible side effects.

Radiation Therapy

Radiation therapy, often called radiotherapy, involves the use of ionizing radiation. Ionizing radiation refers to the high-energy rays that are given off during treatment. The radiologist directs these rays to injure or destroy cancer cells in the area of the bone metastasis or tumor. Although some normal (non-cancer) cells are destroyed in the process, these cells can repair themselves and restore normal function. The goal of radiotherapy is to destroy cancer cells so that they cannot reproduce and grow. Patients also benefit from radiotherapy because it reduces bone pain and lessens the chance of fractures. Again, patients should discuss possible side effects of therapy with their doctor.

Surgical Therapy

In most cases, surgery can restore the function of the original bone. The type of surgery will depend upon the location and size of the bone metastasis tumor. Surgery usually involves removing all or part of the tumor and stabilizing the bone to prevent breakage. With fractures or impending fractures, surgery could include placement of metal plates, rods, screws, wires, nails, and/or pins, or prostheses.

The purpose of these tools is to strengthen or provide structure to the bone. The surgeon hopes that doing this will help the functional recovery of patients. Another option for surgery includes reconstruction of bones or joints. Reconstruction is a procedure where metal, plastic, allografts or a combination of these replaces the damaged bone in the area of the metastasis. Over time, this piece becomes part of the human skeleton.

Some patients may experience pain or be limited in their physical activity for a period of time after surgery. Therefore, it is important to be aware of the recovery time needed for the different surgical procedures. Although there are many surgical options that are available for bone metastasis patients, most patients do not need surgery. Your doctor can discuss the options that would be best for you.

Radiopharmaceutical Therapy

The purpose of radiopharmaceutical therapy is to deliver radiation to tumor cells without harming normal cells. This type of therapy involves the injection of active metals that give off radiation particles in the patient. Currently, these include the metals Samarium and Strontium. By providing radiation directly to the bone, these metals target and destroy the active cancer cells in the bone. Pain is also decreased or relieved entirely. This therapy has been shown to decrease platelet and white blood cell production in some patients as they undergo more treatments. However, most patients like radiopharmaceutical therapy because they experience very few side effects once treatment is completed.

Medical Therapy

Bisphosphonates are a class of medications shown to be effective in treating bone metastases in both breast cancer and myeloma patients. The kind of bisphosphonates given for bone metastases is usually given through an IV line (intravenously). Specifically, they decrease the risk of fractures and decrease pain from bone metastasis. They also reduce the number of future radiation treatments for these patients. Commonly, patients take bisphosphonates along with other forms of treatment.

Chemotherapy can be given at the same time as bisphosphonate therapy but they are not the same. If you are receiving bisphosphonates, your doctor will monitor your blood tests and ask you about the side effects you have experienced with treatment. You and your doctor will decide which treatment is best after considering a number of factors: site, size and extent of the bone metastasis, cancer stage, and the types of treatment you've had in the past. Your age, overall health, and symptoms will also play a part in the choice of treatments. Since each patient's case may be a little different, it is best that you work with your doctor to decide the best option for you. Also, remember that each patient may have a different reaction to these treatments. Some people have very few side effects while other people have many. Your doctor can help you learn what to expect.

At the U-M Rogel Cancer Center, treatment of bone metastasis takes place in the clinic where the originating cancer is treated. For example, if prostate cancer has metastasized into the bone, it is treated in the Urologic Oncology Clinic. Call the AnswerLine™ at 800-865-1125 for help finding the clinic you need. NOTE: Cancers of the spine are treated by our Spine Oncology Program.

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