Secondary cancer in the bones | Cancer Research UK
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Where a cancer starts is called the primary cancer. If some cells break away from the primary cancer and move to another part of the body they can form another tumour – a secondary cancer. Cancer that has spread into the bone from another part of the body is called a secondary bone cancer.

Symptoms of secondary bone cancer may include 

  • Pain due to breakdown of the bone
  • Weakened bones
  • Raised blood calcium levels, which can cause dehydration, confusion, vomiting, abdominal pain and constipation
  • Low levels of blood cells, causing anaemia, an increased risk of infection, and bruising or bleeding

Tests for secondary bone cancer include a bone scan. You may also have an MRI scan, a PET scan and X-rays.

The aim of treatment is usually to control the cancer and any symptoms, and to prevent problems developing. This is called palliative treatment. Deciding about treatment can be difficult when you have an advanced cancer. You need to understand what the treatment can do for you. You may also want to think about your quality of life during treatment.

Treatment may include 

Coping with a secondary bone cancer can be difficult. Finding out you have secondary cancer is likely to bring up many feelings. You may be frightened, angry, shocked or numb. Support to help you cope is available at the hospital, from your GP and specialist nurses, and from support groups or online forums.

Research is going on all the time into improving treatments for secondary bone cancer and helping people to cope with symptoms. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

 

Secondary bone cancer

Where a cancer starts is called the primary cancer. If some cells break away from the primary cancer they can move through the blood stream or lymph system to another part of the body, where they can form a new tumour. This is called a secondary cancer. Secondary cancers are also called metastases (pronounced met-ass-ta-sees).

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The secondary cancer is made of the same type of cells as the primary cancer. So, for example, if your cancer started in your lung and has spread to your bones, the areas of cancer in the bone are made up of lung cancer cells.  This is different from having a cancer that first started in the bone (a primary bone cancer). In that case, the cancer is made up of bone cells that have become cancerous. This is important because the primary cancer tells your doctor which type of treatment you need.

This page has information about secondary bone cancer, treatment and coping, including where you can get help and support.

 

Having secondary cancer

Finding out that your cancer has spread is likely to bring up many different feelings. You may be frightened, angry, shocked or numb or all of these. Most people have already had treatment for a primary cancer and it can feel very unfair to have to cope with cancer a second time. Some people already have a secondary cancer when they are first diagnosed.

Finding out about your cancer and treatment options can help you to feel more in control and better able to cope. Try to give yourself time. It is usually easier to deal with one issue at a time rather than trying to sort everything out at once.

You will need to get information from your own specialist to understand what the diagnosis means for you. It depends on where the cancer first started and whether it has spread anywhere else. Your specialist can also tell you about treatment and how it may help.

 

Which cancers spread to the bones

Any cancer can spread to the bone. The most common cancers to do so are

  • Prostate cancer 
  • Breast cancer
  • Lung cancer
  • Kidney cancer
  • Thyroid cancer
 

How secondary bone cancer affects the bones

Bones are made of living tissue which constantly changes in healthy bones. Specialised cells called osteoclasts break down old bone. Other cells called osteoblasts build new bone. This well controlled process keeps the rates of breakdown and growth in balance, so the bones stay healthy and strong.

Secondary bone cancers produce chemicals that interfere with the balance between these two types of cells. This damages the bones making them weaker and more likely to break. When these changes happen the bone may release calcium into the blood.

Secondary bone cancer can develop in any of the bones of the body

skeleton

 

Symptoms of secondary bone cancer

Sometimes secondary cancers in the bone are picked up before they cause symptoms, during tests to diagnose your primary cancer. But sometimes the first symptoms people have are from the secondary cancer.

Symptoms can include

  • Pain from breakdown of the bone – the pain is continuous and people often describe it as gnawing
  • Backache, which gets worse despite resting
  • Weaker bones – they can break more easily
  • Raised blood calcium (hypercalcaemia), which can cause dehydration, confusion, vomiting, abdominal pain and constipation
  • Low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding

Cancer in the spinal bones can cause pressure on the spinal cord. If it isn't treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control (incontinence). This is called spinal cord compression. It is an emergency so if you have these symptoms, you need to contact your cancer specialist straight away or go to the accident and emergency department.

If you have cancer, it can be difficult not to worry that every new ache or pain means your cancer has spread.

Remember that aches and pains are common and may be a muscle strain or an everyday ache. If you have a new pain you should tell your doctor. They will investigate if it doesn’t seem to be getting better. Telling your doctor and getting treatment as soon as possible helps to avoid further problems with bone fractures or severe pain.

 

Tests to diagnose secondary bone cancer

The main test to check for secondary bone cancer is a bone scan. You can read about bone scans.

Other tests you may have include 

Some people need a bone marrow test to check whether the cancer is changing the number of blood cells the bone marrow makes, but this is not common.

 

Treatment for secondary bone cancer

The aim of treatment is usually to control the cancer and symptoms. It can also prevent problems developing, such as raised calcium levels, pain and fracture.

Secondary bone cancer can’t usually be cured. But treatment can control it for some time and help to control symptoms. This is called palliative treatment. 

Deciding about treatment

Deciding about treatment can be difficult when you have advanced cancer. You need to understand what treatment can do for you. You may also want to think about your quality of life while you are having treatment. All treatment will have some side effects. You also need to think about other factors that treatment involves, such as travelling to and from hospital. If you start treatment, you can stop whenever you want to if you are finding it too much to cope with.

Your doctor will be able to talk this through with you and you can ask questions. You may find it helpful to talk things over with a close relative or friend. Or there may be a specialist nurse or counsellor at the hospital you can talk to.

Your treatment will depend on a number of factors including

  • Your type of primary cancer
  • The treatment you have already had
  • How many bones are affected by cancer
  • Whether your cancer has spread to other parts of the body
  • Your general health

Treatment will also depend on the symptoms you have.

  • Pain can be reduced with radiotherapy, painkillers and other treatments
  • Weak bones can be strengthened with surgery, bisphosphonates, a biological therapy called denosumab or radiotherapy
  • Raised calcium in the blood can be treated with bisphosphonates and fluids
  • Pressure on the spinal cord from cancer cells in the spine needs to be treated urgently with steroids, radiotherapy and sometimes surgery
  • Low levels of blood cells can be treated with blood transfusions or platelet transfusions.
 

Types of treatment for secondary bone cancer

You may have one or more of the following treatments for cancer that has spread to the bone.

Hormone therapy

Some cancers depend on hormones to survive and grow. So lowering hormone levels in the body can help to control them. This includes breast and prostate cancers. You may have hormone treatment for other types of cancer.

Hormone treatment may be tablets or injections. We have general information about hormone therapy. And we have specific information about hormone therapy for different types of cancer in our cancer type sections.

Radiotherapy

Radiotherapy treatment uses high energy waves similar to X-rays to kill cancer cells. Radiotherapy can help to control cancer growth and control pain. You usually have this as external radiotherapy. The photo shows an external radiotherapy machine.

A photo of a linear accelerator, which gives radiotherapy

For some cancers, internal radiotherapy using radioactive liquids called isotopes can work well. Doctors may suggest this if your cancer has spread to more than one bone. It works best for cancers that started in the prostate gland or the thyroid gland. You have an injection of a small amount of radioactive liquid, which the cancer cells in the bone take up. This gives a dose of radiotherapy to these areas. You can have radioisotope treatment more than once.

You will have some radioactivity in your body for a while after internal radiotherapy. But the total amount is extremely small and gets lower each day. Your radiotherapist or specialist nurse will let you know if there are any safety guidelines you need to follow after your treatment and how long you need to follow them for. This will depend on the dose of radioisotope you have had.

You can find out about radiotherapy for bone pain and internal radiotherapy using isotopes.

Chemotherapy

Chemotherapy uses cell killing drugs to kill cancer cells. Your doctor may suggest chemotherapy if hormone treatment is not an option or has stopped working. The type of chemotherapy you'll have depends on your type of primary cancer. You can find out more in the chemotherapy section for your type of cancer

You can also read our general information about chemotherapy.

Biological therapy

Biological therapies are treatments that act on processes in cells. Or these drugs may stop cancer cells telling each other to divide and grow.

Your doctor may suggest biological therapy if it is suitable for your particular type of primary cancer. There are many different types of biological therapy, including monoclonal antibodies and cancer growth blockers.

Denosumab is a type of monoclonal antibody that can help to strengthen bones and reduce the risk of fractures. It does this by helping to stop the bones being broken down by osteoclasts. You have denosumab as an injection just under your skin (subcutaneously).

The national bodies in the UK that decide on NHS treatments (NICE and the SMC) have approved denosumab as a treatment for people with breast cancer and other solid tumours who would otherwise have bisphosphonates (see below). But they have not approved it as a treatment for bone secondaries from prostate cancer because there is not enough evidence that it is better than other treatments.

You can read about biological therapies. You can also find out whether biological therapies are suitable for your type of cancer by looking at the section for your cancer type.   

Bisphosphonates

Bisphosphonates are drugs that doctors use to slow down or prevent bone damage and lower calcium levels. You may hear them called bone hardening or bone strengthening treatment. You have bisphosphonates either through a drip or as tablets. There are a number of different types. Possible side effects include constipation and stomach ache.

Find out more about bisphosphonates.

Surgery

You may have surgery to strengthen weakened bones. This is not a very common treatment. It includes having metal pins put in, or a joint replaced (such as a hip joint). Surgery can also be used to fix a fracture that has occurred in a weakened bone.

If you have cancer in your spine you may have rods put in to stabilise and strengthen it. You can find out about this treatment in the spinal cord compression section.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) kills cancer cells by heating them up. RFA is quite a specialised treatment and you may have to travel to a specialist centre to have it.

You can find out about radiofrequency ablation.

Injecting bone cement into the spine

Your doctor may suggest injecting a special cement into the spine if

  • Your cancer is in the bones of the spine and causing pain
  • The spinal bones have collapsed

There are 2 ways of injecting bone cement into the spine. They are called vertebroplasty and kyphoplasty.

Pain control and supportive treatments

Many of the treatments above help to control pain by shrinking the tumour and reducing pressure on nerves or surrounding tissue. Most people start by taking painkillers. If you then have treatment that shrinks your bone secondaries, you may be able to reduce the amount of painkillers you take.

There are many different types of painkiller. If your pain is mild, paracetamol may help. If you have moderate or severe pain you will need stronger painkillers, including opioid painkillers such as morphine. You may need to take a combination of drugs. Anti inflammatory medicines such as ibuprofen can help to control bone pain. An experienced doctor or nurse will be able to assess your pain and decide which type of painkiller and dose is best.

Find out about treating cancer pain.

You may find it difficult to sleep because of pain or because of the cancer itself.  This may make you feel tired and can make everyday tasks difficult. It can help if you allow yourself extra time to do things and let other people help when necessary.

Read our information about tiredness.

You may also feel tired if your bone marrow is affected by the cancer. Your doctor may suggest blood tests to check your blood cell counts. You may have blood transfusions if your red blood cells are low.

If you have high calcium levels in your blood, you will have medicines called bisphosphonates as well as fluids through a drip to help flush the calcium out of your body.

 

Coping with secondary bone cancer

There is no set way of dealing with cancer that has spread. Support is available at the hospital and from cancer support groups. Getting the support you need can help you to cope. 

Your hospital or cancer organisations can offer emotional support or practical help, such as dealing with money matters.

It is important that you feel as well as you possibly can. Ask your specialist, GP or hospital nurse about referral to a symptom control nurse (sometimes called palliative care nurses or home care nurses). These specialist nurses can work with you and your doctor to help control your cancer symptoms and improve your physical well being.

Most people are worried about their outlook (prognosis) when they have a secondary cancer. It is very difficult to say what will happen. Only your own doctors can guide you as they have all the information about your cancer. Even then, they can only give you a general idea. Your individual outlook depends on many factors including whether the cancer has spread to more than one part of your body, how quickly it is growing, and how it responds to treatment.

Your doctor may have told you that treatment is no longer working or is not possible. This can be a shock. It is likely that you will have all sorts of questions that are difficult to ask and also difficult to answer.

Common questions include

  • How long do I have to live?
  • How will I die?
  • Will I have pain?
  • What will happen to me?

It may help to write your questions down before you talk to your doctor or nurse. Or you can contact the Cancer Research UK information nurses to talk your questions and worries through with them. Their number is freephone 0808 800 4040 and the lines are open from 9am to 5pm, Monday to Friday.

It is common in any family for some people to want to ask difficult questions and some not to want to. It is helpful to respect each person's way of dealing with things and give each other space to talk if you want to. This may mean that you need to give your doctor permission to talk to your next of kin or other family members alone. Or if you are a relative you may need to give the person with cancer the space to talk to the doctor on their own.  

Our section about dying with cancer has information about coping with the news when cancer has come back or spread. It also discusses the help and support that is available to you and your family.

 

Research into secondary bone tumours

Research is going on all the time into improving treatments for secondary bone cancer and helping people to cope with symptoms. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

See our clinical trials database.

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Updated: 13 May 2015