Bone Metastases

At UT Southwestern Medical Center, our cancer specialists have extensive training and expertise treating all kinds of cancer, including cancer that has spread (metastasized) to bones. We focus on treatment that relieves symptoms and reduces side effects to help our patients maintain their quality of life.

As the only National Cancer Institute (NCI)-designated comprehensive cancer center in North Texas, we deliver the best cancer care available and push to discover new treatments. NCI designation means, in part, that we offer patients the ability to participate in the broadest possible range of clinical trials and have access to potential therapies not available at other facilities.

Exceptional Care for Bone Metastases

Cancer develops when cells begin to grow abnormally and uncontrollably. Cancer that is not found and treated in early stages can become late-stage, or advanced, cancer.

Metastatic cancer is advanced cancer that has spread beyond  the part of the body where it began. In bone metastasis, the cancer has moved from elsewhere in the body to involve the bones. It is much more common and very different than primary bone cancer, which is a type of cancer that has its origin in the bones.

With experience in treating all types of cancer, our specialists at the Simmons Cancer Center provide comprehensive care to treat bone metastases and manage overall care for the best possible quality of life.

Causes and Risk Factors of Bone Metastases

When cancer cells break away from the original tumor (primary cancer site), they can spread through the bloodstream to other parts of the body, including the bones, and begin to multiply.

Although medical experts are not sure why some cancers spread, certain types of cancer are more likely to spread to bones, such as:

• Breast cancer
• Kidney cancer
• Lung cancer
• Lymphoma
• Myeloma
• Prostate cancer
• Thyroid cancer

Symptoms of Bone Metastases

Bone metastasis often does not cause signs or symptoms, especially in early stages. The symptoms that can occur are similar to the symptoms of other conditions, so it is important for patients to see their doctor for evaluation of any of these signs and symptoms:

• Bone pain, often the first symptom of bone metastases
• Fractures, usually in the long bones of arms and legs or bones of the spine
• High blood levels of calcium (hypercalcemia), which can cause constipation, loss of appetite, nausea, and extreme thirst
• Spinal cord compression caused by cancer in spine bones
• Urinary or bowel incontinence caused by pressure on spinal nerves that control these functions
• Weakness in the legs or arms caused by pressure on spinal nerves that control muscles in these areas

Diagnosis of Bone Metastases

To diagnose bone metastasis, we perform a thorough evaluation, discussing a patient’s medical history and symptoms and conducting a physical exam. Often, bone metastases are found before patients experience any symptoms, when doctors run tests to see if other cancers have spread to bones. 

Tests that we often use to diagnose bone metastases include:

• Imaging studies: We might recommend one or more types of imaging to see whether cancer has spread to bones. Imaging that helps detect bone metastases includes:
• X-ray: The main imaging test to find bone metastases
• Bone scan: Nuclear imaging test that involves delivering a trace amount of radioactive material to patients before they have X-rays to highlight abnormal areas
• Computed tomography (CT) scan: Uses specialized X-rays to produce cross-sectional images of bones
• Magnetic resonance imaging (MRI) scan: Uses radio waves and a powerful magnet to produce detailed images of bones
• Positron-emission tomography (PET) scan: Uses small amounts of radioactive medicine (radiopharmaceuticals) to produce detailed images of structures in the body 
• Blood or urine tests: These tests check for certain substances released into the bloodstream or urine when cancer spreads to bones or when bones are damaged. 
• Biopsy: We don’t always need to take a biopsy (small tissue sample) to confirm bone metastasis. However, if a biopsy is recommended, the doctor might use image guidance, such as a CT scan, to guide a needle into a suspicious area in the bone to remove a sample. The sample is examined under a microscope for signs of cancer.

Treatment for Bone Metastases

Although it is very difficult to cure cancer that has metastasized, treatment helps minimize symptoms and prolong life. At UT Southwestern, our cancer specialists offer the latest advancements not only to prolong life but to maintain quality of life for patients with bone metastases.

We treat bone metastases based on the type of primary cancer that has spread to bones. For example, treatment for breast cancer that has spread to bones is similar to treatment for primary breast cancer. The goal of cancer treatment for bone metastases is to slow the cancer’s growth to help patients live longer.

Depending on each patient’s case, treatment options can include:

• Chemotherapy: Medications given by mouth or injection to destroy cancer cells or slow their growth
• Bone-building medications: Drugs that strengthen bones and reduce pain
• Hormone therapy: Medications to treat cancers that are sensitive to hormones, such as breast or prostate cancer
• Pain medications: Drugs to relieve pain caused by cancer symptoms or its treatment
• Corticosteroids: Medications that reduce swelling and inflammation at tumor sites
• Bisphosphonates: Medications that reduce high blood levels of calcium to manage symptoms such as weakness, pain, fatigue, kidney failure, and other problems
• Targeted therapy: Medications that attack specific parts of cancer cells to destroy them or slow their growth, used for certain primary cancers that respond to targeted therapies
• Immunotherapy: Medications that activate the immune system to attack cancer cells, used for certain primary cancers that respond to immune therapy
• Radiation therapy: High-energy rays, such as X-rays or gamma rays, that destroy cancer cells or slow their growth and that can be effective for metastasis to one or a few small areas of bone
• Ablation: Use of heat, cold, or chemical therapy, administered through needles or narrow probes, to damage or destroy cancer cells
• Bone stabilization: Injections of bone cement or glue to support and stabilize bones, particularly in the spine, that have been weakened by cancer
• Surgery: Procedures that stabilize bones or repair fractures, often with the use of metal plates or screws

Supportive Care

We offer a variety of support services for patients with bone metastases and their families, such as:

• Integrative therapies
• Nutrition counseling
• Palliative care and pain management
• Support groups

Clinical Trials

As a medical research institution, UT Southwestern conducts clinical trials, giving our patients access to the newest treatments for bone metastases. Patients should speak with their doctors about the availability of clinical trials for their condition.