Treating the Complications of Bone Metastases
At times, cancer that starts in one part of your body—such as the breast, prostate, lung, thyroid, or kidney—may spread to your bones. This condition, known as bone metastasis or secondary bone cancer, can bring up a whole new set of challenges.
Potential complications include bone pain and weakness, bone fragility and fractures, high calcium in the blood, and harmful pressure on the spinal cord. But just as there are treatments for the original cancer site, there are treatments to help you feel better with secondary bone cancer.
Treatments for Bone Pain and Weakness
When cancer starts growing in a bone, it can cause pain there. For some, it's a dull ache, and for others, it's a sharp or shooting pain. The bone can also become fragile and easy to break. Several treatments are available to help with these problems. The right one for you depends on the type of cancer you have, which bones are affected, and which approaches you've already tried. Treatment options include:
Chemotherapy. This treatment uses drugs to destroy cancer cells. The drugs, given through a vein or by mouth, can shrink tumors and reduce bone pain. But they can also damage normal cells, causing side effects such as hair loss, nausea, vomiting, mouth sores, loss of appetite, diarrhea or constipation, tiredness, problems with bruising or bleeding, and increased chance of infection.
Bisphosphonates. These medications—including pamidronate (Aredia) and zoledronic acid (Zometa)—interfere with the cells involved in bone breakdown. They can slow bone damage, reduce pain, and decrease the risk for broken bones. When treating secondary bone cancer, they're typically given through a vein every three to four weeks. Possible side effects include tiredness, fever, nausea, vomiting, bone or joint pain, and rare problems with the jaw bone.
Denosumab (Xgeva). This medication, taken by injection every four weeks, blocks a protein that turns on the cells involved in bone breakdown. It can help prevent bone pain and broken bones. Possible side effects include tiredness, nausea, diarrhea, and problems with the jaw bone.
Pain relievers. Other medications that help ease pain include acetaminophen (e.g., Tylenol), aspirin, ibuprofen (e.g., Advil, Motrin), naproxen (e.g., Aleve, Naprosyn), and opioids (e.g., Dilaudid, Percocet, Percodan, Tylenol with Codeine, Vicodin).
Radiation therapy. This treatment uses high-energy X-rays to destroy cancer cells or slow their growth. For treating secondary bone cancer, it may be given in a single large dose or in smaller doses spread out over five to 10 treatments. Radiation therapy can lessen pain and, if given before a bone becomes too weak, reduce the risk for a break there.
Radiopharmaceuticals. These medications—including strontium-89 (Metastron) and samarium-153 (Quadramet)—contain radioactive substances. Injected into a vein, they're another way to get radiation to affected bones, which can reduce pain. The main side effect is an increased risk for infection or bleeding. Radiopharmaceuticals may also cause flare reactions—pain that briefly gets worse before getting better.
Ablation. This treatment involves inserting a needle into a tumor to destroy it, which can reduce pain. In radiofrequency ablation, the cancer is destroyed with an electric current transmitted by the needle. Other ablation methods use heat, cold, or chemicals.
Bone cement. Sometimes, special cement is injected into weak bones to make them stronger. If a bone of the spine is affected, bone cement may be injected in a minimally invasive procedure, fixing the bone in place and reducing pain.
Surgery. If a bone is severely weakened or already broken, surgery may be necessary to relieve pain, restore strength, and regain the ability to carry out daily activities. During surgery, the tumor is removed, and bone cement is often injected into the resulting hole to strengthen the bone. Then the bone can be fixed in place and supported with rods, wires, plates, pins, or screws.
Physical therapy. When combined with medical or surgical treatments, physical therapy can help ease pain, improve mobility, and decrease the risk for bone-shattering falls. The therapy typically includes mild exercise and stretching. In some cases, it also involves other pain management methods, such as hot or cold packs and massage.
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