Bone Pain FAQs
- Q: What causes bone pain from
cancer?
- A: When cancer invades the bone it can cause
the bone to deteriorate or build up too quickly. Although the mechanism
is not fully understood, it is theorized that bone pain occurs due
to stretching of the tissue around the bone, which can have an inflammatory
effect. It also may result from pressure on nerve roots or muscle
spasms. This may lead to a number of problems, including bone pain,
swelling and the weakening of bones.
- Q: What does bone pain mean?
- A: One of the most common complaints of cancer
patients is pain in the bones. It can come and go at first and perhaps
worsen at night, depending on the type of cancer. The pain may occur
when the bone is used, such as a leg bone when walking or hand bones
when grasping or squeezing. Swelling in the painful area also may
occur. Prompt diagnosis at the first signs of pain can help. The right
treatment often may delay further cancer spread, relieve pain and
help to avoid complications. Patients experiencing symptoms such as
pain, swelling, tenderness, fractures, joint pain and stiffness, or
other unexplained aches and pains in the bones and joints should seek
prompt medical attention.
- Q: What is the difference
between primary bone cancer and metastatic bone cancer?
- A: Bone cancer is a malignant or abnormal,
out-of-control growth found in any part of the bone, and in any bone
of the body. Primary bone cancer occurs when the cancer originates
in the bone itself. More commonly, metastatic bone cancer results
when cancer spreads from somewhere else in the body to the bones.
We refer to cancer that has spread as metastasized, and bone tumors
from metastasized cancer as bone metastases. Primary bone cancers
occur more frequently in children and young adults, particularly in
those who have had radiation or chemotherapy treatments for other
conditions.
- Q: What are the symptoms
of bone cancer?
- A: Pain is the most common symptom of bone
cancer. However, the cancer size and location can vary the symptoms.
Tumors that occur in or near joints may cause swelling or tenderness
in the affected area. Bone cancer may also impede ordinary movements
and can weaken the bones, sometimes leading to a fracture. Other symptoms
may include fatigue, fever, weight loss and anemia. None of these
symptoms is a sure sign of cancer. They may also be caused by other,
less serious conditions. It is important to check with your doctor
as soon as you notice any symptoms.
- Q: Does bone pain always
mean that the cancer has metastasized?
- A: Other conditions can cause some people
to have long-term, persistent discomfort in the bone, the muscles
surrounding the bone and in joints. Breast implants also may put pressure
on the sensitive surface around the bones of the rib cage. Chemotherapy
can produce pain in hips, legs and arms. These discomforts may happen
during the time you're receiving chemotherapy and can worsen with
each session. Stiffness and aches similar to arthritis may be caused
by Tamoxifen treatment. Non-metastatic bone and joint pains often
respond to heat, massage and other therapies. Yoga helps stretch and
strengthen muscles, which may reduce pain in the supporting muscles
and soft tissues.
- Q: How is bone cancer diagnosed?
- A: To diagnose bone cancer, the doctor asks
about the patient's personal and family medical history and does a
complete medical exam. Often a doctor will order a blood test to determine
the level of an enzyme called alkaline phosphatase. A large amount
of alkaline phosphatase can be found in the blood when the cells that
form bone tissue are very active. Many conditions can raise alkaline
phosphatase levels, so this test is not a reliable indicator of bone
cancer. Typically, the doctor will first order a nuclear medicine
whole-body bone scan because of its ability to detect metastatic bone
lesions. An X-ray may also be ordered to confirm the results of the
bone scan. Special imaging tests, such as a computed tomography scan
(CT) or a magnetic resonance image (MRI), are often used to locate
the bone tumor and show its size, shape or if the bone has been worn
away. Once the tests suggest a tumor or eroding of the bone, the removal
of a sample of tissue from the bone tumor is often needed to determine
whether cancer is present. This procedure is called a biopsy and the
surgeon, often an orthopedic oncologist, may perform a needle biopsy
or an incisional biopsy. During a needle biopsy, the doctor makes
a small hole in the bone and removes a sample of tissue from the tumor
with a needle. In an incisional biopsy, the surgeon cuts into the
tumor and removes a sample of tissue. A pathologist, a doctor who
identifies disease by studying cells and tissues under a microscope,
examines the tissue to determine whether it is cancerous.
- Q: What cancers are most
commonly associated with bone metastases?
- A: Any type of cancer can spread to the bone.
But the most common bone metastasizing cancers are prostate, breast,
lung, kidney and multiple myeloma.
- Q: What are the treatment
options for bone pain due to cancer?
- A: Treatment objectives for pain caused by
bone metastases include pain relief, increase in bone strength to
reduce the risk of fractures and the prevention of additional bone
complications such as hypercalcemia, hypocalcemia and spinal cord
compression. Treatment options for cancer related bone pain include
pain medications, bisphosphonates, radiation, chemotherapy, radiopharmaceuticals
and/or surgery.
Pain Medication: Pain medication is prescribed based
on the level of pain. Patients should keep a journal and use a pain
scale to help describe the location and levels of pain. Non-opioids
such as aspirin, acetaminophen or ibuprofen may be helpful to patients
experiencing mild to moderate pain. If the bone pain is moderate to
severe, the doctor may prescribe opioids such as morphine, oxycodone,
methadone or fentanyl in addition to the non-opioids.
Bisphosphonates: Drugs used to treat osteoporosis
and the bone pains caused by many types of cancer are called bisphosphonates.
By acting on osteoclasts, the cells responsible for breaking down
bone, bisphosphonates have been shown to decrease the events associated
with weakening of bone. Therefore, bone density is maintained, reducing
pain and the risk for fractures.
Radiation Therapy: Radiation can be effective in
the reduction of bone pain due to metastases. When lesions are limited
to a single area, local treatments such as external beam radiation
therapy (EBRT) are commonly used.
Radiopharmaceuticals: Radiopharmaceuticals require
the injection of a radioactive substance. This radioactive material
is targeted to destroy the cancer cells in the bone. This form of
radiation therapy is most commonly used when the cancer has spread
to multiple sites in the bone.
Quadramet® is a targeted radiopharmaceutical that contains radioactive
samarium153 combined with a bone-seeking agent that is used to target
the drug to certain types of bone lesions. Quadramet is used to treat
pain associated with prostate, breast, multiple myeloma and other
cancers that have metastasized (spread) to the bone.
Quadramet can be prescribed by your physician
to relieve pain caused by the spread of cancer to the bone. In clinical
studies, Quadramet has provided pain relief for up to 72% of patients
with bone pain from cancer (28% did not respond).1,2 Quadramet
causes a decrease in bone marrow production of certain types of blood
cells, which tends to return to pre-treatment levels within 8 weeks.3
If you are receiving other treatments that affect your ability to make
these cells, your physician should determine if the clinical benefits
of receiving Quadramet outweigh the risks.3
- Serafini AN, Houston SJ, Resche I, et al. Palliation of pain associated
with metastatic bone cancer using samarium-153 lexidronam: A double-blind
placebo-controlled clinical trial. J Clin Oncol. 1998; 16:1574-1581.
- Sartor O, Reid RH, Hoskin PJ et al. Samarium-153-Lexidronam complex
for treatment of painful bone metastases in hormone-refractory prostate
cancer. Urology. 2004; 63:940-945.
- Prescribing information for Quadramet (Samarium Sm 153 Lexidronam
Injection)
Surgery: Weakened bones can be stabilized by the
surgical insertion of rods, screws, nails or pins. Surgery may be
necessary when metastases pose an immediate and significant risk of
bone fracture.
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