By Mayo Clinic Staff

Bone metastasis happens when cancer cells break away from where they started and spread to a bone.

Metastasis is the medical term for disease that spreads to an area away from where it started. When cancer spreads, healthcare professionals say it metastasizes or is metastatic. When cancer cells spread to one spot in a bone, it's called bone metastasis. When there is more than one area of metastasis in the bones, it's called bone metastases.

Bone metastasis is different from bone cancer, also called primary bone cancer. Bone cancer starts in the bone itself. Bone metastasis is cancer that has spread to the bone from another part of the body.

Nearly all types of cancer can spread to the bones. But some types of cancer are more likely to spread to bone. These include breast cancer, prostate cancer and lung cancer.

Bone metastasis can happen in any bone. But it more often happens in the spine, pelvis and thigh bones. Bone metastasis may be the first sign that you have cancer. Or bone metastasis may happen years after cancer treatment.

Bone metastasis can cause pain and bones that break easily. In most situations, there is no cure for bone metastasis. But treatments can help control the cancer, reduce pain and relieve other symptoms.

Bone metastasis can be osteolytic, osteoblastic or mixed.

Osteolytic metastases happen when cancer causes more bone to be broken down than rebuilt. Osteoblastic bone metastases happen when cancer causes atypical new bone to form.

Both osteolytic and osteoblastic metastases can create lesions that can weaken the bone, and some bone metastases have a mixture of both.

Sometimes bone metastasis causes no signs or symptoms.

When symptoms of cancer that has spread to the bone happen, they may include:

• Bone pain. This is the most common symptom. It may feel different depending on where the metastasis is. You may feel pain in one spot, or it may be a more general ache. If nerves are involved, you may feel burning or shooting pain.
• Broken bones. Cancer can weaken bones enough that they can break even with normal activity.
• High calcium levels in the blood, called hypercalcemia. This can cause nausea, vomiting, constipation and confusion.

If bone metastasis is in the spine, it can cause:

• Pain and stiffness in the neck or back from pressure on the spinal cord.
• Weakness in the arms and legs.
• Leaking urine, called urinary incontinence.
• Sudden urge to urinate, called urinary urgency.
• Not being able to control the passing of stool and stool leaking from the bowel, called fecal incontinence.

If you have symptoms that last a long time or make you feel worried, schedule an appointment with a doctor or other healthcare professional. If you've been treated for cancer in the past, tell your healthcare team about your medical history and your concern about your symptoms.

New symptoms or symptoms that get worse can mean that cancer has spread to your bones, made a bone weaker or caused other problems. Pain at night that doesn't have a clear cause could be a sign of something serious. Let your healthcare team know right away if your symptoms change.

Seek emergency medical care if you have new weakness or loss of strength, called paralysis, in your arms or legs. Also seek care immediately if you lose control of your bladder or bowels. These symptoms can happen when bone metastasis in the spine puts pressure on the spinal cord.

Bone metastasis is caused by cancer that starts in one area and spreads to a bone. It's not clear why some cancers travel to the bones rather than to other common sites for metastasis, such as the liver.

Cancer spreads to bones in some common areas. Those include the spine, ribs, pelvis, and upper parts of the legs and arms. Though less common, cancer also can spread to the bones further down the legs and arms, below the knee or elbow.

Anyone with cancer can develop bone metastases, but the risk depends largely on the type and extent of the original cancer. Some types of cancer have a higher risk of causing bone metastasis than others do. The cancers most likely to spread to the bones include:

• Breast cancer.
• Prostate cancer.
• Lung cancer.
• Kidney cancer.
• Thyroid cancer.
• Melanoma.

Your diagnosis likely will start with a physical exam and discussion of your medical history. To diagnose bone metastasis, your healthcare professional may suggest imaging tests. Tests may include:

• X-ray.
• Bone scan.
• Computerized tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET) scan.

Each imaging test may be used for different reasons.

• X-rays show the structure of bone in a particular area.
• Bone scans can look at the whole skeleton.
• CT scans can show bone damage and structural detail.
• MRI scans can show bone marrow, the spine and nearby nerves.
• PET scans can help find active cancer throughout the body.

To confirm the diagnosis, your healthcare professional might suggest a biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

Common treatments for bone metastasis include medicines, radiation therapy and surgery. The same treatments used for earlier-stage cancer may still be used when cancer has spread to the bones, but the goals and combination of treatments may change. Your healthcare team selects the treatments that are best for you based on your situation.

Your care team may use chemotherapy, targeted therapy, hormone therapy or other medicines to control cancer throughout the body. Radiation, bone-strengthening medicines or surgery can help treat issues in specific bones. For most people with bone metastases, treatment focuses on controlling the cancer, relieving pain, preventing fractures and other complications, and maintaining quality of life.

Bone-building medicines help strengthen the bones. They're often used to treat thinning bones, a condition called osteoporosis. Bone-building medicines also help treat bone metastasis.

Bone-building medicines can strengthen the bones and reduce the pain caused by bone metastasis. This lowers the need for strong pain medicines.

Bone-building medicines are given every few weeks through a vein in the arm or through a shot. These kinds of medicines also come in pill form, but the pill form may not work as well for bone metastasis.

Bone-building medicines can cause kidney problems and short-term bone pain. This temporary increase in pain is called a flare. These medicines also increase the risk of a rare but serious jawbone condition called osteonecrosis.

Radiopharmaceuticals are medicines that contain a low level of radioactive material. These medicines are given through a vein. Once in the body, the medicines travel to cancer in the bones and deliver the radiation. For bone metastasis, these medicines may help relieve bone pain. Radiopharmaceutical medicines that target the bones might be an option when there is more than one bone metastasis.

Side effects can include damage to the bone marrow. This can lead to low blood cell counts.

Chemotherapy treats cancer with strong medicines. If cancer has spread to more than one bone, your healthcare professional may suggest chemotherapy.

Hormone therapy for cancer blocks certain hormones in the body. Some cancers use the body's hormones to help them grow. For these cancers, hormone-blocking treatments may help control the cancer. Breast cancers and prostate cancers often are sensitive to hormone-blocking treatments.

Hormone therapy can involve taking medicines to lower hormone levels or medicines that block the action between hormones and cancer cells. Another option is surgery to remove organs that make the hormones that cancer cells use. These organs include the ovaries and the testes.

Pain medicines work to control pain caused by bone metastasis. You might take pain relievers you can get without a prescription or stronger prescription pain relievers.

Let your healthcare team know if you get constipated. This is a common side effect of some pain medicines.

It may take time to find the mix of pain medicines that works best for you. If you take pain medicines but still have pain, tell your healthcare professional. A pain specialist may be able to offer more choices for pain relief.

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted therapy can cause cancer cells to die.

Your cancer cells may be tested to see if targeted therapy is likely to work for you. Side effects of targeted therapy medicines depend on which medicine you receive.

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy can treat one or a few areas of bone metastasis. But it typically isn't used if there are many areas. Radiation can't rebuild bone weakened by cancer. But it can help ease pain and control the growth of the bone metastasis.

Radiation to the bone can be given in one treatment or several treatments over many days. Side effects of radiation depend on the site being treated and the cancer's size.

Stereotactic body radiotherapy is a highly precise, intense radiation treatment. This treatment aims beams of radiation from many angles at the cancer. Stereotactic body radiotherapy most often is done in one or a few treatments.

This treatment might be used for cancer that has spread to the spine bones. It allows healthcare professionals to target the cancer without hurting the spinal cord.

Surgical procedures can help a bone that is at risk of breaking or repair a broken bone. Operations used for bone metastasis include:

• Surgery to make the bone more stable. If a bone is in danger of breaking due to bone metastasis, surgeons can make it more stable. This may involve using metal plates, screws and rods. This procedure is called orthopedic fixation.
• Surgery to inject cement into a bone. Bone cement might help broken bones that can't be made stable with metal plates or screws. These include pelvic bones and bones in the spine.
• Surgery to repair a broken bone. If bone metastasis causes a bone to break, surgeons may work to repair the bone. This may involve using metal plates, screws and nails to make the bone stable. Joint replacement, such as a hip replacement, may be another choice. Most often, putting a cast on a bone broken by bone metastasis doesn't help.

Ablation therapy procedures apply treatment directly to the cancer cells. These procedures may use heat or cold to kill cancer cells. Ablation therapy may help control pain caused by bone metastasis. It may be a choice if you have one or two areas of bone metastasis that other treatments haven't helped.

During an ablation therapy procedure called radiofrequency ablation, a needle with an electric probe is put into the cancer. Electricity passes through the probe and heats the tissue around it. After the tissue cools, the process is done again.

Another ablation therapy procedure called cryoablation freezes the cancer and then lets it thaw. After the tissue thaws, the process is done again.

Side effects can include damage to nearby structures, such as nerves, and damage to bones that can increase the risk of a broken bone.

A physical therapist can work with you to make a plan that helps you get stronger and move better. A physical therapist may suggest assistive devices to help you cope. Examples might include crutches or a walker to take weight off a bone while walking, a cane to improve balance, or a brace to keep the spine stable.

A physical therapist also may suggest exercises to help you keep your strength up and reduce your pain.

Palliative care focuses on relieving symptoms and improving quality of life at any stage of cancer. For bone metastasis, treatments such as surgery, radiation therapy or medicines also may be used to relieve symptoms even when eliminating the cancer isn't possible. Palliative care can be provided alongside treatments intended to control the cancer.

Clinical trials are studies of new treatments and new ways of using existing treatments. Taking part in a clinical trial gives you the chance to try the latest treatments. But a cure isn't guaranteed. The side effects of new treatments may not be known. Ask your healthcare professional whether clinical trials may be an option for you.

The outlook for someone whose cancer has spread to the bone depends on many things and can be very different from person to person. Bone metastasis means the cancer has moved from where it started to the bone. Prognosis mostly depends on the kind of cancer you have, its features and how well it responds to treatment.

Other important factors include how much cancer has spread, whether it has spread to organs as well as bones, the number of bones affected, and a person's overall health.

Because so many things affect the outlook, statistics can't show exactly how long someone will live. The tools used to estimate prognosis in people with bone metastases also have limitations.

Your care team knows the details of your cancer and treatment. Care team members can give you a personalized outlook and help you make sense of what it means for you. Your care team may share a range of survival to help you and your family plan for the future. Some people want to know as much as possible about prognosis, while others choose to focus on treatment and day-to-day life. It's up to you to decide how much information is helpful.

Coping with bone metastasis involves more than coping with bone pain. It also involves coming to terms with the news that your cancer has spread.

Treatments for bone metastasis can slow the growth of the cancer and may extend your life. But cancer that spreads can be hard to cure. Your healthcare team will work to ease your pain and keep you comfortable so that you can focus on what's important to you.

People find their own ways to cope with a cancer diagnosis. Until you find what works best for you, here are some things you can try.

Find out enough about bone metastasis to help you decide about your care

Ask your healthcare team about the details of your cancer and your treatment choices. Ask about where you can get more information. Good places to start are the U.S. National Cancer Institute and the American Cancer Society.

Find someone to talk with

A close friend or family member who is a good listener might be a good person to talk with about your fears or worries. Sometimes friends and family members may have trouble coping with your diagnosis, so you might choose to talk with a professional. Talking with a counselor, medical social worker, or a pastoral or religious counselor can be helpful. These experts are trained to help guide you during this challenging time.

Connect with other cancer survivors

You may find comfort in talking with other people who have cancer. Contact your local chapter of the American Cancer Society to find cancer support groups in your area. You may find it helpful to hear how other people and their families cope with cancer.

Work toward accepting your diagnosis

It can be hard to accept that your cancer may not have a cure. For some people, having a strong faith or a sense of something greater than themselves makes this process easier.

Others want to talk with someone who knows about life-threatening illnesses. This could be a medical social worker, a psychologist or a chaplain.

Make end-of-life choices

Some people find comfort in planning ahead for difficult times. This can include organizing legal or financial details so your family is not burdened with these decisions. You also may choose to review your end-of-life care wishes with your healthcare professional. Write down your wishes and share them with your friends and family.

Think about hospice care

If cancer therapies no longer work, or if you no longer want them, you might find comfort in hospice care. Hospice care provides medical, emotional and spiritual support. Hospice care focuses on keeping you comfortable and easing your physical and emotional pain.

Hospice programs are usually for people who are expected to live about six months. Some hospices are buildings where you stay. Others have special beds within a hospital, and some offer care at home. Hospice staff work together with your cancer care team to make sure your needs are met. Choosing hospice doesn't mean giving up — it's another way to help manage difficult health issues.

Start by making an appointment with a doctor or other healthcare professional if you have symptoms that worry you. Tell your healthcare professional if you were treated for cancer in the past, even if the treatment was many years ago. If you're diagnosed with bone metastasis, your healthcare professional may refer you to a specialist. Often this is a doctor who treats cancer, called an oncologist.

Here's some information to help you get ready for your appointment.

• Ask about restrictions before your appointment. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that don't seem linked to the reason for the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you take, including doses.
• Write down questions to ask your healthcare professional.
• Ask a family member or friend to go with you. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.

For bone metastasis, some basic questions to ask include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatments are there? Which do you suggest?
• What's my prognosis?
• Are there experimental treatments or clinical trials I can try?
• I have other health conditions. How will those affect my treatment?
• Are there brochures or other printed material that I can have? What websites do you suggest?
• Will I need a follow-up visit?

Your healthcare professional is likely to ask you questions, including:

• When did your symptoms begin?
• Have your symptoms been ongoing, or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• Does anything make your symptoms worse?