Bone metastases

Overview

Once it develops, cancer can metastasize (spread) anywhere in the body, with bones being a common destination. Bone metastases (or bone mets) are most often found in the spine, followed by the hip bone (pelvis), upper leg bone (femur), upper arm bone (humerus), ribs and the skull.

The metastatic cells look and act like the malignant (cancerous) cells where the cancer began, and get the same care — breast cancer treatment for metastatic cells that have traveled from the breast, for example. Doctors call such cases “metastatic breast cancer” rather than “bone cancer.”

Doctors check for metastases if a patient is diagnosed with a primary tumor like breast cancer. They might also discover a metastasis that leads them to a previously undiagnosed cancer cell source. Even with proper treatment for an initial tumor, some original cancer cells can survive and later develop into a metastasis, a “distant recurrence.”

Given the need to accurately determine where the metastasis began and choose the right treatment, it’s important to see a medical team with extensive diagnostic experience. 

Our approach

Northwell Health doctors always check to see if cancer has spread from organs like the breast or prostate when treating patients. Other times, metastasized cancer is first discovered in the bones and then traced back to the organ where it first began growing.

In either case, the specialized physicians at Northwell Health have the expertise and advanced tools to recognize the warning signs, and to make a quick and accurate diagnosis. They use that determination to tailor a plan for treating the specific type of cancer in each patient’s bones, listening to all questions and concerns.

Some of the doctors form a special team dedicated to bone metastases treatment — the only team of its kind in the metro area. Most cancer centers don’t have a radiologist focused on muscles and bone or an oncologist specializing in orthopaedics. Northwell Health does.

Caring for Bone Metastases with a Team Approach

Bone metastases cases aren’t always straight-forward. That’s why top care requires a group of specially trained physicians like the one that makes up the multidisciplinary team for the management of bone metastases — the only such team in the metro area.

While a medical oncologist will oversee care, the multidisciplinary team includes a number of specialized physicians and brings together a tremendous amount of expertise. 

Risk factors

Doctors can’t always predict who will develop bone metastases — some patients with cancer do, while others don’t. There are some risk factors, though:

  • If breast or prostate cancers spread, they’re likely to travel to the bones. That’s also true for lung, thyroid and kidney cancers, though to a lesser degree.
  • If the original cancer has spread to other organs or the lymph nodes, it’s also more likely to metastasize in the bones.
  • Cells from larger, original tumors are more likely to gather in the bones.
  • For some cancer types, cells that look particularly abnormal or show specific genetic changes are more likely to spread to the bones.

While the best treatment for bone metastases is to catch the cancer before it has spread, there are still plenty of ways to get effective care. 

Symptoms

Metastasized cancer can cause a bone to start dissolving and weakening, forming holes (osteolytic or lytic lesions). It can also prompt excess bone formation, leading to hardened areas (osteoblastic or blastic lesions). This can lead to:

  • Pain that usually comes and goes at first, then may become worse and more continuous
  • Fractures, causing a sudden, sharp pain
  • Dangerous levels of released calcium in the blood (hypercalcemia), causing constipation, nausea, loss of appetite, excess thirst, increased urination, dehydration, fatigue, weakness, sleepiness or confusion

When cancer spreads to the spine, it can press on the spinal cord and cause nerve damage, or eventually paralysis if left untreated. If that happens, a patient may experience:

  • Trouble urinating
  • Pain
  • Numbness
  • Weakness
  • Paralysis

Just because a patient has these symptoms doesn’t necessarily mean they have metastasized cancer. See a doctor to determine what is causing any symptoms.

Diagnosis

Tools to diagnose bone metastases include:

  • Tumor Marker Tests - Examining the blood for signs of the original cancer, such as prostate-specific antigen (PSA) for prostate tumors
  • Other Blood Tests - Measuring for alkaline phosphatase or calcium to determine if bones are dissolving
  • Urine Tests - Looking for N-telopeptide and other substances released when bones are damaged
  • X-ray - Taking images of certain body areas to look for breaks, holes and growths in the bones
  • Bone Scan - Injecting low level radiation into the vein, then scanning the entire body with a special camera to see where it has settled in damaged bones
  • CT (CAT) scan - Overlapping X-rays from different angles, with dye sometimes injected into veins or swallowed to allow doctors to see delicate, tiny structures
  • PET (Positron Emission Tomography) scan - Injecting glucose (sugar) into the veins and using a rotating scanner to look for malignant cells throughout the body, not just at the original cancer site
  • MRI (Magnetic Resonance Imaging) - Using a magnet, radio waves and a computer to take detailed pictures of the inside of the body
  • Biopsy - Removing cells or tissue with a needle and examining them with a microscope

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