Cancer growing in bone can cause tremendous pain and disability.  As the tumor cells grow, they make the bone porous and weak. Bones can break with the slightest action—such as stepping off a curb or rolling over in bed.

"Bone cancer" as it is often called, can be caused either by tumors which form directly from bone cells, or tumors from other body sites can spread to the bones.  The first type of "bone cancer" is very rare and is called a sarcoma.  Sarcomas usually occur on the arms or legs.  In the past, amputation was the only treatment.  However, that is no longer the case.  Successful treatment can often be achieved using  a combination of chemotherapy and radiation therapy to shrink the tumor.  If this is successful, an operation to remove the tumor can often be done without sacrificing the limb.  It requires a team approach, and we are fortunate to have such a team of doctors with experience treating these tumors.

The second type of "bone cancer" is called metastasis.  This is a much different kind of problem as several bones are usually affected at the same time.  Tumor cells which have traveled to the bone through the bloodstream cannot be cured by surgery or spot radiation.  Depending upon the type of tumor, chemotherapy, hormone therapy, bone hardening chemicals (bisphosphonates), or intravenous radioactive particles (Quadramet®) are often used.  For specific painful spots, or for weight bearing bones which might break, radiation therapy is very effective.  Spot radiation usually relieves pain within two weeks.  And, by killing the cancer in that spot, the bone can heal and become solid again.   This is an important part of maintaining a good quality of life for many patients with cancer.

Management of Metastases

When cancer enters the bloodstream, malignant cells are carried throughout the body.  Frequently, they lodge in  tissues such as the lungs, liver, bone and brain, and begin to grow there.  This process is called "Metastasis."  The formation of metastases the one of the major obstacles to cure of cancer patients.  In order for cancer cells to grow into masses, they must have oxygen and nutrition.  Cancer cells produce chemicals which cause new blood vessels to form, feeding the growing tumor.  This process is called "angiogenesis."  Treatment of metastases is varied.  It depends upon the type of cancer, the site of the metastasis, the number of metastases, and general health of the patient.

Usually, treatment of metastases requires the use of medicines which can circulate through the bloodstream and fight cancer cells wherever they may be.  This could be in the form of chemotherapy, hormones, anti-tumor antibodies, or chemicals which interfere with angiogenesis (such  as thalidomide).   The type of medicine used depends upon the type of cancer under treatment.  Unfortunately, these chemicals  also expose normal cells and can cause systemic side effects.

When cancers spread, they tend to behave as they did when they originally formed.  That is, breast cancer which has spread to the bone does become "bone cancer". It remains breast cancer but in the bones. Thus, treatments which are usually effective against cancer in the breast are often effective against breast cancer in the bones.

• What treatment choices do I have?
• Is this treatment intended to cure the disease and help me live longer, or to relieve or prevent symptoms of the cancer?
• Which treatment do you recommend, and why?
• What side effects are likely to result from the treatment(s) that you recommend, what can be done to reduce these side effects?

• Systemic chemotherapy
• Hormonal therapy for cancers of the breast, prostate, and uterus
• External beam radiation therapy
• Radioactive drugs—often hooked to anti-tumor antibodies
• Bisphosphonates—chemicals that stabilize the calcium crystals in bone
• Surgery to prevent or repair fractures
• Injection of cement to prevent collapse of weight bearing bones of the back (vertebroplasty)
  

• Systemic chemotherapy are rarely used to treat tumors of the brain and spine
• External beam radiation therapy with or without Stereotactic Radiosurgery boost
• Surgery – especially in the case of single brain metastases or when tumors are pressing on cord causing paralysis
  

• Chemotherapy given intravenously, or through a tube placed directly into the blood supply to the liver(intra-arterial chemotherapy)
• Hormonal therapy for cancers likely to be sensitive to these treatments such as breast, prostate, and uterine cancers
• Surgery—This is especially useful in patients with colorectal cancer which can spread to the liver  but not to other sites in the body.  The liver has enormous restorative ability and up to 70% of the liver can be removed
• Ablative methods to destroy the cancer without surgery  such as freezing, heating with microwaves, injecting  alcohol, plugging  blood vessels feeding the tumor (embolization)
  

• Systemic chemotherapy
• Hormonal therapy for hormonally sensitive tumors such as breast, prostate and uterine cancers
• External beam radiation therapy—especially for tumors which are bleeding or causing blockages of the airway
• Surgery for certain types of tumors such as  certain sarcomas, and for patients who have a limited number of metastases
  

Investigational agents such as new chemotherapy drugs, angiogenesis inhibitors, gene therapy, tumor vaccines are often considered when patients develop metastases after other treatments have been tried.  Often, this requires patients to be treated as part of scientific studies that pool  their data with other patients to determine how successful the new treatment is.  Because these are largely untested treatments, the benefits  may be unknown.  However, all modern effective treatments have come about through this process.  In addition, investigational treatments are frequently provided for free to patients who agree to be on such studies.  As with all treatments, discuss risk and benefits with your physician.