Diagnosing Bone Metastasis

The bone is a common location to which cancer metastasizes. Some cancers that commonly spread to bones include: breast, lung, prostate, thyroid, and kidney cancers. Rarely, cancer forms in the cells of the bone (called primary bone cancer).

To determine if your bone pain is due to metastases, your doctor may order a bone scan. In a bone scan, a small dose of radioactive material in injected into a vein and travels through the bloodstream, where it then gathers in the bones and is detected by a scanner through nuclear imaging. Other tests, such as X-rays, MRIs, and CT/PET scans, can be used to monitor the effects of the metastases over time.

Treatment for Cancer-Related Bone Pain

Treatment for cancer-related bone pain depends on many factors. Some treatments help to reduce pain by shrinking the tumor. Others aim to reduce the risk of bone fractures and complications from bone metastases.

Because of the complex nature of cancer-related pain, successful pain management usually involves a combination of techniques, such as the following:

• Surgery: Orthopedic surgery can help to stabilize weakened bones and prevent or repair fractures. Your doctor may place metal rods in bones to prevent them from breaking. In addition, kyphoplasty and vertebroplasty (which use image guidance to inject a cement-like material directly into a fractured bone through a hollow needle) can help rebuild collapsed vertebrae, restore height, and relieve pain.
• Radiation therapy: External beam radiation therapy uses X-rays to target bone metastasis and destroy cancer cells that have settled in the bones. Radiopharmaceutical therapy involves the injection of radioactive drugs (e.g., Quadramet®) through a vein to destroy cancer cells in a specific area of bone.
• Pain medications: Depending on the cause of your pain, your doctor may recommend various medications, such as anti-inflammatory agents, opioids, antibiotics, antidepressants, and steroids. Your pain specialist will strive to seek a balance between pain control and quality of life.
• Bisphosphonate drugs: These drugs (e.g., Zometa^®) are typically given intravenously and can help prevent or delay bone destruction, normalize blood calcium levels, and reduce pain. Other bisphosphonate drugs may be given in pill form (e.g., Fosamax^®) to prevent or slow bone loss during hormone therapy.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SYMPTOMS OF CANCER-RELATED BONE PAIN TO YOUR PHYSICIAN IMMEDIATELY.

Tips for Managing Cancer-Related Bone Pain

• Clear up misconceptions. Discussing your pain is not a sign of weakness. You have a right to pain relief and you should insist on it. If you have fears about taking pain medication, talk with your doctor about the differences between addiction, physical dependence, and tolerance. Remember, untreated bone pain can interfere with your ability to battle the disease.
• Find a pain specialist. While your oncologists are focused on treating the disease, it helps to have a clinician focused purely on addressing your pain. A pain specialist can help develop a pain management plan that meets your needs. If you are seeing providers in different locations, be sure all members of your health care team are aware of the medications you are taking.
• Track your pain. You may find it difficult to communicate your pain experience to your doctor. To help describe your pain, keep a record that includes the location of your pain, what makes it feel better or worse, the effectiveness of your pain treatment, and any other pain relief methods you use. This information will help you better communicate your pain experience to your doctor.
• Keep your doctor informed. Only you know where your pain is located, how it feels, how much it hurts, and what makes it better. Let your doctor know right away if you have any new pain, if your pain is getting worse, or if your pain medication is not working. Understanding the details of your pain will help your doctor determine what method of pain control works best for you.
• Stay on top of your pain. Pain is best managed and relieved when treated early, rather than waiting until it becomes severe. Take your pain medication as instructed by your doctor, which usually means taking it on a regular schedule even when you are not feeling pain, and not skipping doses. Pain may get worse if you wait, and it may take longer or require larger doses of medication to get relief.
• Pay attention to side effects. Pain medication, like all other medications, has its own set of side effects, such as constipation, nausea, dizziness, and drowsiness. Discuss potential side effects with your doctor so you know what to expect, and how you will manage side effects if they occur.
• Try complementary therapies. Your health care team may suggest other pain control methods, such as the following: relaxation techniques, meditation, guided imagery, distraction, deep breathing, massage, physical therapy, hot/cold applications, acupressure, Auriculotherapy, and acupuncture. In addition, emotional counseling and spiritual support may help to reduce pain and promote your overall well being.
• Eat a healthy diet and stay hydrated. A healthy, well-balanced diet is important for bone health. Sufficient calcium and vitamin D can help protect your bones. Protein is important for healing fractures and proper immune system functioning. Increasing your daily intake of fiber and drinking plenty of fluids can help prevent constipation. You may also want to limit sodium, which interferes with calcium retention. A registered dietitian can help develop a meal plan that works for you.
  
• Try strength-building exercises. To strengthen bones and minimize bone loss, try exercising regularly. Under the supervision of your health care team, you may try walking, dancing, and stair climbing, which build bone mass. Swimming and yoga may help to stretch muscles and reduce pain. A rehabilitation therapist can help determine the type and level of physical activity that is safe and appropriate for you.
• Use assistive devices, if needed. Assistive devices (e.g., canes, walkers, braces, splints, orthopedic shoes, grab bars, handrails, etc.), may help to reduce the risk of falls, enhance balance, and lessen bone pain. These devices can also promote your independence by making it easier for you to perform everyday activities. Your health care team can recommend appropriate assistive devices for your needs.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING CANCER-RELATED BONE PAIN.

Cancer Treatment Centers of America (CTCA) is a network of cancer hospitals unlike any other.

CTCA doctors specialize in treating many forms of cancer, including complex and advanced cases. They work as a team, alongside cancer experts across multiple disciplines, to keep patients strong in body, mind and spirit.

CTCA care team members listen to patients and provide clear, well-defined choices. They work together to develop a comprehensive treatment plan based on each patient’s unique diagnosis and needs.

Using the latest technologies and advanced tools to fight cancer, our cancer experts provide a powerful combination of treatments. While our oncologists help patients fight cancer, other clinicians provide supportive therapies to help patients tolerate treatment, manage side effects, and enjoy a good quality of life.

The Pain Management Department at CTCA takes a proactive approach to managing pain during cancer treatment so patients can continue to participate in activities they enjoy most. Visit the full website to learn more.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.