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Treatment for secondary bone cancer

The aim of treatment is to control the cancer and your symptoms. It can also prevent problems developing.

Deciding about treatment

Deciding about treatment can be difficult. You need to understand:

  • what treatment can do for you
  • any side effects of the treatment
  • how many visits to hospital the treatment involves

You can stop whenever you want to if you are finding it too much to cope with.

Talk through your options with your doctor or specialist nurse. You may find it helpful to talk things over with a close relative or friend, or a counsellor if one is available.

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
  • your symptoms

Types of treatment for secondary bone cancer

You may have one or more of the following treatments.

Hormone therapy

Some cancers including breast and prostate cancer depend on hormones to survive and grow. So lowering hormone levels in the body can help to control them. You might have the hormone treatment as a tablet or injection.

Radiotherapy

Radiotherapy treatment uses high energy x-rays to kill cancer cells. Radiotherapy can help to control cancer growth and symptoms.

External radiotherapy

You might have external radiotherapy. This is where the therapy radiographer uses a machine outside the body to direct radiation beams at cancer to destroy it. Each radiotherapy treatment is called a fraction and takes a few minutes. You might have one dose of radiotherapy to help with the pain. Or a number of treatments over several days. 

Internal radiotherapy

Internal radiotherapy gives radiation from inside the body. For some cancers, you might have a type of internal radiotherapy called radioactive liquid treatment. This 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. The cancer cells take this up giving a dose of radiotherapy to these areas. You might need this more than once depending on your cancer type.

For a while after you'll be radioactive. But the total amount is very small and gets lower as each day passes.

Your radiotherapist will let you know if there are any safety guidelines you need to follow. This will include how long you need to follow them. It depends on the amount of radioactive liquid you have had.

Chemotherapy

Chemotherapy uses anti cancer drugs to kill cancer cells. The type of chemotherapy you have depends on the type of primary cancer. 

The first type of chemotherapy you have is called 1st line treatment. If this doesn't control your cancer you might be able to have a different type of chemotherapy (2nd line treatment).

Targeted cancer drugs

Targeted cancer drugs are treatments that target the differences that help a cancer cell to survive and grow.

Your doctor may suggest a targeted cancer treatment if it is suitable for your primary cancer. There are different types of targeted cancer drugs including:

  • monoclonal antibodies (MABs)
  • cancer growth blockers
  • PARP inhibitors
  • drugs that block blood vessel growth (anti angiogenics) 

Denosumab is a type of targeted therapy called a monoclonal antibody. It helps strengthen the bones and reduces the risk of them breaking. You have it as an injection under the skin.

Bisphosphonates

Bisphosphonates are bone hardening or strengthening drugs that slow down or prevent bone damage and lower calcium levels. You have bisphosphonates either as a drip into your bloodstream (intravenous) or by mouth.

People with myeloma or breast cancer might have bisphosphonates to help control pain and strengthen the bones in the spine. If you have prostate cancer, you might have bisphosphonates if painkillers are not working well enough.

Treatment using heat to kill cancer cells (radiofrequency ablation)

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.

Surgery

Your doctor might suggest you see the surgeon. This is to see if they can help 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 help fix a fracture in a weakened bone. 

You may have rods put in to stabilise and strengthen your spine if you have cancer there.

Injecting bone cement into the bones

Your doctor may suggest injecting a special cement into your bones. You might have this if your cancer is causing pain or the spinal bones have collapsed.

Diagram of a cement injection into the spine

Kyphoplasty is similar, but your doctor uses a balloon through a needle to help create the normal shape of the bone.

Diagram showing kyphoplast procedure

Controlling symptoms of bone secondaries

Pain control

Many of the treatments help to control pain by shrinking the tumour and reducing pressure on nerves or surrounding tissue. You may be able to reduce the amount of painkillers you take if your treatment shrinks your bone secondaries.

High calcium levels

High levels of calcium in your blood can make you feel drowsy, weak, constipated and confused. Treatment includes medicines called bisphosphonates as well as fluids through a drip to help flush the calcium out of your body.

Tiredness

You may feel tired if the cancer is affecting your bone marrow. Your doctor may suggest blood tests to check your blood cell counts. You might have a blood transfusion if your red blood cells are low.

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.

Current research is looking for biomarkers Open a glossary item in blood, urine, tears and saliva for people with breast cancer. They hope by finding a biomarker they see in advance if it may spread to the bones.  

Other clinical trials include looking at ways to treat and manage pain with:

  • high intensity focused ultrasound (HIFU) and an MRI scan
  • a drug called tanezumab

Early research is looking at having pembrolizumab (immunotherapy drug) and radium 223 (internal radiotherapy) together. This is to treat people with non small cell lung cancer (NSCLC). The doctors want to find out about the side effects this has and how well it works at shrinking the cancer.