When Lung Cancer Spreads to the Bones

By

Cindy Kuzma

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A lung cancer diagnosis means your disease began in your lungs. However, cancer doesn't always stay put. Tumor cells adhere poorly and can break away from primary tumors and spread, or metastasize, to other parts of your body.

About one of every three lung cancers that metastasizes will affect the bones. Bone metastasis can result in complications such as:

  • Weakened bones and fractures

  • Nerve damage in your spinal cord

  • Severe pain

  • Hypercalcemia, when cancer-ridden bones release calcium into your bloodstream. If untreated, hypercalcemia can lead not only to weak bones but also to coma or kidney damage.

Studies show a link between tobacco use and bone density. So if smoking contributed to your cancer, your bones may already be weakened, further increasing your risk of fracture.

Bone metastasis is serious, but treatment can help stop further damage to your bones and improve your symptoms. Medications, other cancer therapies such as radiation, and taking steps to prevent falls may ease your pain and protect your skeleton. 

Symptoms Point to Cancer's Spread

Some people have no symptoms of bone metastasis. For others, a fracture is the first sign. The most common broken bones are in the arms, legs, and spine. These fractures cause severe and sudden pain. They can occur after an innocent fall or seemingly trivial injury, or sometimes just in the course of daily activity. However, they're always a medical emergency.

People with bone metastasis may also feel an ache deep in their bones, especially at night. At first, the pain may be relieved with movement. But eventually, it becomes worse and tends to flare during activity.

If you also have hypercalcemia, you may feel sleepy and confused and may suffer from nausea, vomiting, or constipation. You also may urinate more frequently.

Tests Detect Tumors in Your Bones

Your doctor will often look for bone metastasis when staging your lung cancer. Tests he or she may use include:

  • Imaging tests, including X-rays, bone scans, magnetic resonance imaging (MRI), and computed tomography (CT) scans

  • Blood tests to check for high calcium levels or other chemicals that indicate your cancer has spread

  • Urine tests, which can find substances that are released when bone is damaged

  • Biopsies, when your doctor takes a sample of your tissue and looks at it under a microscope

When your doctor tells you the stage of your lung cancer, he or she will use three letters: T (for the size of the tumor), N (to indicate whether it has spread to nearby lymph nodes), and M. The "M" category describes whether your cancer has spread to distant parts of your body. If you have bone metastasis, your cancer is in stage M1b.

Treatment Often Involves Medications

One common treatment for bone metastasis is a type of medication called a bisphosphonate. This drug is given through an intravenous (IV) line.

Bisphosphonates prevent further damage to your bones, ease your pain, lower high blood calcium levels, and prevent other complications, including fractures. Your doctor will most likely tell you to take vitamin D and calcium in addition to bisphosphonates. This prevents your calcium from dropping dangerously low.

A newer drug called denosumab (Xgeva, Prolia) also prevents fractures and may strengthen your bones. Other treatment options include chemotherapy, radiation, and surgery. These may be used together with bisphosphonates, in other combinations, or separately. Your cancer care team will help you choose the best treatment plan for your cancer and metastasis.

Take Steps to Prevent Falls and Fractures

When your bones are weakened by cancer, minor accidents can be serious. Talk with your doctor about the best way to prevent falls and reduce your risk of fractures. Start by:

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 12, 2017

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Medical References

  1. Metastatic Bone Disease. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00093
  2. Hypercalcemia (PDQ®). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/hypercalcemia/Patient/page2/AllPages/Print
  3. Bone Metastasis, American