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When Cancer Spreads to the Bone: Surgery for Metastatic Bone Disease

Last updated Thursday, August 13, 2009

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Symptoms

What parts of the body does metastatic bone disease affect?

Metastatic bone disease is more likely to affect the parts of the skeleton that have a lot of red bone marrow. Examples are the bones in the hip, spine, and other bones near the midsection of the body. However, tumors can spread to any bone in the body.

What are some initial warning signs of metastatic bone disease?

Metastatic bone disease is signaled by the appearance of a new musculoskeletal pain that doesn’t go away, especially in a person who has had cancer. The pain may be mistaken for any number of things: a muscle injury or strain, or the patient may think he or she has unknowingly bumped the arm or leg, or slept in the wrong position. The pain may feel as if it is coming directly from the bones or joints, or the pain may feel as if it is coming from another location, like the muscles. It can also appear as a new pain in someone who has cancer elsewhere in the body, but who is unaware that he or she has cancer.

Any new musculoskeletal pain in a person who has had cancer should be taken very seriously and imaged appropriately by a radiologist. An image as simple as an X-ray may tell whether that patient has metastatic bone disease.

What are symptoms of metastatic bone disease?

The major symptom of metastatic bone disease is musculoskeletal pain.

On an X-ray, a spot may be seen on a bone. Some forms of metastatic bone disease will cause bone deformity, others may cause parts of the bone to disappear. Either way, the quality of the affected bone is poor. Women who have breast cancer or who already have osteoporosis (bone loss from another cause) may be more badly affected.

How do the symptoms of metastatic bone disease change over time?

Typically if metastatic bone disease is not treated, the symptoms will worsen.

The patient may begin to have mobility problems, such as difficulty walking. If the backbone is affected, the patient may feel as if a nerve in the back is pinched, or feel pain shooting down the leg, or have other signs that the spinal cord is being compressed. Paralysis can occur if this is left untreated. The patient may suffer one or more broken bones after a slight fall or seemingly minor injury, because bones with metastasis are fragile.

However, if metastatic bone disease is treated, the patient may see a remarkable diminution of pain, a lowered risk of fractures, and a restoration of function. The treatment will not prolong life, but it may make the quality of life better.

The speed of progression of metastatic bone disease depends on the type of cancer that has spread to the bones, and on the individual patient. It is difficult to predict how quickly or slowly the disease will progress.

What are the indirect effects of metastatic bone disease?

Some of the secondary effects of metastatic bone disease are hypercalcemia (a problematic increase of calcium in the blood stream); anemia (a reduction in red blood cells); sedation, mental cloudiness, and other effects of narcotics; and an increased risk of falls and bone fractures.

What conditions have similar sympoms or might be confused with metastatic bone disease?

Metastatic bone disease may initially be confused with pain from a muscle ache or sprain, when the real problem is skeletal from cancer, not muscular from an injury. Delays made from writing off the symptoms as being do to a muscle injury can profoundly impact the patient’s quality of life.

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