Treating Cancer in the Bones
- Cancer that spreads to the bones can cause symptoms such as pain and fractures.
- Prostate, lung, and breast cancers are some of the most common types that spread to the bone.
- Surgery can help to stabilize a bone that cancer has weakened and prevent it from breaking.
- Ablation is a treatment that uses heat, cold, or an electrical current to control pain or shore up a weakened bone.
Nearly 10% of people with solid tumors will eventually have a bone metastasis. The most common area of bone for cancer to spread is to the spine.
Read MoreSymptoms of Bone Metastases
Cancer that has spread to the bone can cause many symptoms, including weakness in the legs or arms, and fractures. “Pain is the most common symptom,” says Dr. Carla Falkson, breast oncologist and director of the Breast Oncology Clinical Research Program at the University of Rochester Wilmot Cancer Institute.
Related: Why Do Some People With Cancer Experience Back or Bone Pain?
The pain can be mechanical — caused by the cancer spreading into the bone. Or, it can be caused by the cancer releasing substances that promote inflammation.
You’ll feel mechanical pain when you move or put weight on that bone. A sign of inflammatory pain is that it gets worse at night or when you’re at rest, Dr. Szerlip says. Knowing what type of pain you have will help your doctor prescribe the right treatment for it, he adds.
When is Surgery Used?
Treatment for metastatic bone disease is to “minimize pain and maximize function,” says Dr. Julia Visgauss, orthopedic surgical oncologist at Duke Cancer Center. “It is important to understand that surgery in the setting of metastatic bone disease is not curative. Therefore, we make every attempt to treat the disease with the least invasive measures possible to achieve these goals.”
There are a couple of reasons why doctors might use surgery to treat cancer that has spread to the bones. One is to stabilize a bone that the cancer has severely weakened and prevent it from breaking. “A surgical ‘pin’ may be placed inside the bone to strengthen it and attempt to prevent fracture,” Dr. Falkson says. Surgeons also use screws, rods, or plates for this purpose.
Cancer can sometimes cause the bones of the spine to collapse and compress, or to push on the spinal cord. When that happens, you can have severe pain, leg weakness, and a loss of sensation. Spinal compression is a medical emergency. It often requires surgery to reinforce the damaged bone(s) in the spine with cement. If you develop any of these symptoms, please discuss them with your doctor immediately.
The second reason to do surgery is to treat the metastasis more effectively, Dr. Szerlip tells SurvivorNet. The surgeon moves the tumor away from the spinal cord in order to deliver higher doses of radiation to it.
Ablation for Bone Metastasis
To “ablate” means to remove or destroy. Ablation is a treatment that uses heat, extreme cold, or an electric current to destroy the cancer. Ablation may be used in place of surgery, radiation, or other treatments to help with pain from a bone metastasis.
The main reasons to perform ablation are to relieve pain, and to control the tumor in that area. “Ablation reduces pain by destroying cancer cells,” explains Dr. Alan Alper Sag, interventional radiologist at Duke University Medical Center.
There are three types of ablation, each of which treats cancer in a different way:
- Thermal ablation uses very high heat.
- Cryoablation uses freezing cold.
- Radiofrequency ablation uses an electrical current
These treatments are delivered directly to the tumor through a needle or probe. “A probe is guided into the tumor using X-ray or CT [computed tomography] guidance,” says Dr. Sag. “The thermal energy is delivered in the appropriate dose to destroy the tumor.”
Your doctor might consider ablation if you have a very small area of cancer, you have a medical condition that would prevent you from undergoing surgery, the cancer is in an area of bone that is hard to access surgically, or you don’t want to have surgery, says Dr. Nadine Williams, an orthopedic oncology surgeon at Loma Linda University Health.
If you’re in a lot of discomfort from the cancer, this treatment could help you feel better. “Thermal ablation of bone metastasis is very useful in reducing pain in patients with advanced stages of cancer,” Dr. Williams says.
Doctors also use ablation to prevent a bone from breaking. Although radiation is more effective than ablation, “there are times when you can’t give any more radiation, and then ablation may be a good alternative,” Dr. Szerlip says.
Ablation is not for everyone and is often used when a patient has had radiation to a bone metastasis but the pain returns. There is a limit on how much radiation a person can have. When they reach this limit, doctors turn to other options, such as ablation, to treat pain.
Related: When Cancer Spreads to Bones There are Treatment Options Can Radiation Help?
If you’re diagnosed with a bone metastasis, or you have symptoms like bone pain, discuss them with your oncologist. There are many treatments, in addition to these, that can help control your symptoms and possibly lengthen your lifespan.
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