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Bone Metastasis: Warning signs, symptoms, and treatment options

breast cancer bone metastasis

When metastatic breast cancer cells spread, it’s very common that the cells spread to the bones instead of other parts of the body. Over 70% of patients who develop stage IV breast cancer develop bone metastasis. Because of this, it’s important to understand the symptoms of bone metastasis. That way if the cancer cells do spread to the patient’s bones, they can recognize the signs early and alert their doctor. This is especially important for patients who are no longer receiving regular scans as a part of their care plan.

Keep reading for more insight into the symptoms of bone metastasis and what some common treatment options are.

Symptoms of bone metastasis in breast cancer

The main symptom of bone metastasis to look out for—as it is the most common one—is any sudden and new noticeable pains. In some cases the pain may come and go, but it’s likely to remain constant as time progresses. Bone metastasis pain feels very similar (if not identical) to pain associated with arthritis and exercise. Because the pain can ebb and flow at first, it’s really easy to assume you experienced an injury or have arthritis.

It can never hurt to check in with your doctor about any pains you are experiencing. If the pain is actually caused by arthritis or some sort of injury, your doctor can rule out your concerns and put a treatment plan in place for those issues. If there is reason to believe that you are experiencing bone metastasis, your doctor can also address that issue and the sooner they do the better.

Complications caused by bone metastasis are called skeletal-related events (SREs). The following symptoms can be considered SREs.

  • Sudden severe pain and the inability to move
  • Numbness or weakness in an area of the body
  • Difficulty passing urine or having bowel movements

If your doctor suspects bone metastasis is causing the pain, to diagnose it they will need to order a bone scan, an X-ray, a CT scan, a MRI, a PET scan, or a combination of multiple types of scans. In some cases your doctor may also choose to order a blood test. They’ll use this blood test to check for high levels of calcium or alkaline phosphatase. If these tests indicate metastasis, your doctor may need to perform a biopsy to confirm a metastatic breast cancer diagnosis.

Treatments for bone metastasis

There are a few different treatment options used to treat bone metastasis. The type of bone metastasis a patient has will inform their treatment options. Your doctor will help determine what is the right treatment plan for you, but knowing what options are available can help you feel more informed about your next steps.

Chemotherapy to treat bone metastasis in breast cancer

Chemotherapy can destroy and weaken cancer cells all throughout the body including cells that have metastasized in the bones. Chemotherapy is a popular choice when dealing with metastatic breast cancer as it can touch every area of the body, especially if the cancer is growing despite receiving other treatments or there is a large amount of cancer in organs such as the liver or lungs and those cells are growing quickly. Your doctor may recommend combining chemotherapy with other targeted treatments such as medicine. All patients will have a chemotherapy treatment plan that is unique to them.

Hormonal therapy to treat hormone receptor-positive bone metastasis

Hormonal therapy medicines (also referred to as endocrine therapy or anti-estrogen therapy) can work to shrink or slow the growth of hormone receptor-positive metastatic breast cancer that is occurring anywhere in the body.

A few example of hormonal therapy include:

  • Tamoxifen
  • Arimidex (chemical name: anastrozole)
  • Aromasin (chemical name: exemestane)
  • Femara (chemical name: letrozole)
  • Faslodex (chemical name: fulvestrant)

Hormonal therapy doesn’t treat hormone receptor-negative breast cancer, but does treat hormone receptor-positive breast cancers by lowering the amount of the hormone estrogen in the body and by blocking the action of estrogen in the body. If the cancer stops responding to one form of hormonal therapy medicine, your doctor will switch you to a different one.

Targeted therapies to treat bone metastasis

There are targeted therapies available to treat specific characteristics of cancer cells and these therapies are usually less likely than chemotherapy to harm the healthy cells in your body. Some of these targeted therapies include antibodies designed to work in the same way the antibodies in our immune systems work. This type of therapy is known as immune-targeted therapy.

Immunotherapy to treat bone metastasis

Another treatment that tries to use the natural powers of our immune system to help fight cancer cells is cancer immunotherapy medicines. These medicines can help a patient’s immune system work harder or more efficiently to fight the cancer cells in their body. Immunotherapy treatments can use substances made by your body or by a lab to boost the immune system and as a result can stop or slow cancer cell growth.

Bone-strengthening medications for bone metastasis

Bone-strengthening medications can help treat bone metastasis by:

Relieving bone pain lowering the risk of osteoporosis
Lowering the risk of spinal cord compression
Lowering the risk of breaking a bone weakened by the tumor
Lowering high levels of calcium in the blood

When it comes to bone-strengthening medications, you’re most likely to come across medicines called osteoclast inhibitors. These osteoclast inhibitors interfere with the activity of osteoclasts and can delay SREs in the bone and can make bones stronger. Some of these medications (like Xgeva) are given as an injection under the skin on a monthly basis and others (like Zometa) are delivered directly into the bloodstream through an IV or port every three months.

Radiation therapy for bone metastasis in breast cancer

Spots of cancer in the bone that are causing pain may be treated by radiation therapy like:

  • External beam radiation therapy. Just one dose or multiple doses of external radiation therapy can provide pain relief when delivered to the affected areas of the bone. Pain flare ups that do occur after treatment typically only last 24 hours or a few days.
  • Stereotactic body radiation therapy (SBRT). This therapy targets high doses of radiation to the areas of cancer and minimizes exposure to healthy tissues nearby. SBRT is used to treat small or moderate size tumors.
  • Radiopharmaceuticals. If a patient has multiple painful areas in their bones caused by metastasis, an internal form of radiation known as radiopharmaceuticals that travels throughout the entire body may be used. This type of medicine is injected into a vein.

Ablation for bone metastasis

If bone metastasis comes back or worsens after radiation therapy some doctors may choose to pursue ablation which is a procedure in which the tumor can be destroyed with heat, cold, or electrical current. Imaging scans help map the locations of the cancer and a small needle or probe can then directly deliver treatment to the tumor.

Bone cement for bone metastasis

Bone cement can be directly injected into bones to stabilize them, reduce pain, or treat a fracture caused by metastasis.

This type of treatment can occur in a few different ways:

  • Kyphoplasty. The patient’s doctor will insert a small balloon in order to create a cavity in the bone and will then inject the cement. This specific procedure is used to treat the spinal bone.
  • Cementoplasty. This technique is similar to kyphoplasty but is used to treat any other bone in the body besides the spine.
  • Surgery for bone metastasis. Bones greatly weakened by metastasis to the point of fracture or near fracture can require surgery. Bones fractured by metastasis don’t heal in the same way that healthy bones do which is why surgical intervention may be necessary. A surgeon will place a support such as a rod, pins, screws, or plates into the bone to help relieve pain and restore function.
  • Surgery to remove a bone tumor. It’s less common, but if a patient only has a single area of metastasis in one area of a bone, there is no other evidence of breast cancer in the body, and the patient is generally in good health, then their doctor may decide to surgically remove the single tumor.

Why Tracking Symptoms Matter

As you can see there are many different ways that bone metastasis can be treated, but these treatments can only occur if your doctor is aware that bone metastasis has occurred. While your doctor will be monitoring you for signs of metastasis, it’s still a good idea to check in with and listen to your body. You can track any potential symptoms of bone metastasis or any other side effects you may be experiencing from cancer treatment and can take your notes to your doctor.

While you can track your symptoms in a simple paper notebook, we advise using the Outcomes4Me symptom tracker to make it easy to keep track of when symptoms occur, to stay organized, and to have a thorough log of symptoms to share with your doctor.

Five different studies found that patient-reported symptom surveillance led to significantly improved survival compared with usual care. This occurred mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use.

With our mobile app symptom tracker, you can:

  • Add a photo and/or note to any symptom recorded
  • Visualize symptoms on a graph to find trends in how the patient is feeling
  • Export a report on all symptoms over the last few months and share it with a doctor

Learn more about how to use the Outcomes4Me symptom tracker to stay on top of your health today!

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