Updated July 7th, 2021

When Cancer Spreads to Bones There are Treatment Options — Can Radiation Help?

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Cancer & Bone Pain

When cancer spreads to the bones it can cause issues with pain, function, and quality of life.
The most common cancer types that spread to the bone include prostate, breast, and lung cancer.
Many treatments exist to help with pain and improve function.
New approaches are looking to more aggressively treat cancer that has spread to bone that is showing very promising results.

When cancer becomes late-stage and spreads from one organ to another, from the lung to the bones, for example, this is called a metastasis. Unfortunately, metastases are very common and occur in many people with cancer.

The most common place that cancer spreads when it metastasizes is to the bones, although it can spread to other areas of your body including the brain and lungs.

One of the most common places that cancer spreads when it metastasizes is to the bones, although it can spread to other areas of your body including the brain and lungs. Certain cancers are more likely to spread to the bones compared with other cancers. The most common cancer types that spread to the bone are breast, prostate, and lung cancer. However, if you have been diagnosed with one of these cancers it does not mean that it will spread your bones as most people with these cancers can be cured when the cancer is caught early before it has time to spread.

Symptoms Of Bone Metastases

When cancer spreads to the bone it can cause many different symptoms. The most common symptom of cancer that spreads to the bone is pain. This pain is often very focal, meaning you can typically point to where you have the pain. The pain is sometimes described as a gnawing pain that is always present and does not go away without pain medication. Although most pain can be localized to a specific point, this is not always the case and it's possible you may have a more vague achy type pain. Although most people with bone metastases will have pain, some will not have any symptoms at all and will only know the cancer has spread when they have imaging tests such as CT scans or MRIs.

Where Is Bone Pain Most Common

The most common boney area for cancer to spread to is the spine. When cancer spreads to the spine it often will cause back pain. This pain is also usually localized and may get worse with activity. Some people may describe this pain as a gnawing or dull pain that is always present. Other patients may have more serious symptoms such as weakness in their legs, arms, and changes in their sensation. Although the spine is the most common, cancer can also spread to other bones such as the hips and shoulders.

If you have cancer and/or had cancer in the past and develop any new pain in the bones please discuss this with your doctor immediately.

In certain scenarios cancer that has spread to the spine can cause the bone to collapse and push on the spinal cord. This is a medical emergency and often causes patients severe back pain, leg weakness, sensation loss, and issues with their bowel and urinary function (urinary incontinence). When this happens, it is known as cord compression and people often require surgery to stabilize their spine and radiation after surgery to kill the cancer cells.

Be Aware Of New Pains & Talk to Your Doctor

The best treatment for cord compression is prevention. If you develop back pain please discuss this with your doctors early because if cancer is detected in the bones of your spine it can be safely and effectively treated with radiation which can help prevent cord compression. Pain is our body’s signal or alarm to tell us when something is wrong before more damage is done. If you are experiencing pain that is new, worsening, or changing please discuss this with your doctor. Be your own advocate and make sure your treating team understands what you are feeling in case the pain is caused by cancer that has spread.

Treatment for Bone Metastasis

Fortunately, there are many treatments for bone metastases. For people that are experiencing symptoms such as bone pain, your doctor may recommend radiation therapy. Radiation is extremely effective in treating pain and symptoms caused by bone metastases. Radiation is delivered non-invasively over one to ten days and targets the areas in the bone where the cancer cells are present. Most people will have significant pain relief with radiation and some may have all of their pain go away after having radiation. By using radiation many in treatment can avoid using strong pain medications that often cause fatigue and constipation.

Radiation, when used to treat bone pain or other symptoms from cancer, is called palliative radiation therapy and because it is given in gentle doses that help with symptoms, often there are very few side effects. If you have bone metastasis that's not causing you any symptoms your doctor may take several approaches including starting systemic therapy such as chemotherapy, immunotherapy, or targeted agents, or if you are already on one of these medications your doctor may recommend switching to a new form of systemic therapy.

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Another option for patients with asymptomatic bone metastasis is to observe the areas and consider treating it with radiation only if they eventually cause symptoms such as pain. And still another option doctors may use includes giving radiation and changing systemic therapy. If you do receive radiation therapy to treat cancer that has spread this does not exclude other treatments your doctor may consider.

Another form of radiation that is being used to treat cancer that has spread to the bones or other organs such as the lungs is stereotactic body radiation therapy or SBRT. SBRT is different from traditional palliative radiation therapy as it uses 3-5 very high doses of radiation to ablate or kill all of the cancer cells that the radiation targets. Because chemotherapy, immunotherapy, and targeted therapies have dramatically improved the outlook for patients with bone metastases some doctors are using this aggressive form of radiation to treat all areas where the cancer has spread. This is used to treat pain, alleviate symptoms and is being studied as it may prolong and improve quality of life. Early studies have been promising using this approach. SBRT is not for everyone and you should discuss this option with your treating teams to see if this aggressive treatment is right for you.

Whether receiving traditional radiation therapy to help with pain and symptoms, SBRT to aggressively treat all disease, or changing systemic treatment the outlook for people with cancer that has spread has greatly improved over the last decade. If you develop bone pain, please discuss this with your treating team as soon as possible. If you are diagnosed with bone metastases you have many options that can be used to treat pain, improve quality of life, and even extend life in certain instances.

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