Treatment of secondary bone cancer

The aim of treatment for secondary bone cancer is to control or shrink the cancer and relieve symptoms. Treatment may make you feel better. This is called palliative treatment.

Learn more about:

• What kind of treatment will you have?
• Hormone therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Radiation therapy
• Surgery
• Other bone-strengthening procedures
• Bone-strengthening drugs
• Palliative treatment
• Taking part in clinical trials

What kind of treatment will you have?

Your treatment options will depend on:

• the type of primary cancer, if it is known
• the treatment you have already had
• how many bones are affected by cancer
• whether the cancer has spread to other parts of the body
• your symptoms and general health.

You may have treatment that affects the whole body (systemic) or focuses on a particular bone (local). Systemic treatments include hormone therapy, chemotherapy, targeted therapy, immunotherapy and bone strengthening drugs. Local therapies include radiation therapy and surgery. Treatments can be given on their own or in combination.

Cancer treatments may cause a range of side effects. They can vary depending on the treatments you are given, and they may vary from person to person. Talk to your doctor about managing any side effects you have.

For more on this, see our general sections on Radiation therapy, Chemotherapy, Surgery, Immunotherapy and Targeted therapy.

To find cancer specialists, multidisciplinary teams and hospitals in NSW or ACT, you can visit the NSW Government website CanRefer.

Hormone therapy

Hormone therapy, also called endocrine therapy, may be used to treat breast or prostate cancer that has spread to the bone. This treatment uses synthetic hormones to block the effect of the body’s natural hormones.

The aim is to reduce the hormones that the cancer cells receive. This can help slow down the growth and spread of the cancer. Hormone therapy may be given as tablets or injections.

Side effects – Common side effects include hot flushes, mood changes, weight changes and sweating.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells, while causing the least possible damage to healthy cells.

Generally, chemotherapy is given through a vein (intravenously) over several hours or sometimes as a tablet (orally). Most people have several treatment cycles with rest periods in between. The number of sessions varies depending on the drugs prescribed by your oncologist and the type of primary cancer.

Side effects – These will depend on the drugs you receive. Some people have few side effects; others have more. Common side effects include fatigue, nausea, diarrhoea, appetite loss, hair loss and increased risk of infections.

Learn more about chemotherapy

Targeted therapy

Targeted therapy uses drugs that attack specific features of cancer cells to stop the cancer growing and spreading.

This treatment can only treat cancers that are growing in response to certain genes or proteins in the cells. The type of drugs you have will vary depending on the primary cancer.

Targeted therapy drugs can be given in different ways, including:

• as tablets that you swallow (orally)
• by injection under the skin (subcutaneously)
• by injection into a vein (intravenously).

Side effects – These will vary depending on the drugs used and how your body responds. Targeted therapy drugs often cause skin problems, such as dry, flaky skin and skin rashes. Other common side effects include fever, tiredness, joint aches, nausea, diarrhoea and headaches.

Listen to our podcast on targeted therapy and immunotherapy

Immunotherapy

Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. The most widely used form of immunotherapy is checkpoint inhibitor drugs. Some cancers create “checkpoints” to block the immune system. Checkpoint inhibitor drugs allow the immune system to bypass these checkpoints.

Several checkpoint inhibitor drugs are approved to treat some types of cancer that have spread to the bone, such as lung and kidney cancers. Clinical trials are testing checkpoint immunotherapy for other cancer types.

Side effects – These will vary depending on the type of immunotherapy you receive and how your body responds. Common side effects include fatigue, rashes and diarrhoea.

Learn more about immunotherapy.

Radiation therapy

Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams. Radiation therapy is often used to reduce pain in the bone. It is usually given from outside the body and is aimed at the particular bone causing pain.

The most common type of radiation therapy used for secondary bone cancer is external beam radiation therapy (EBRT). You will lie on a treatment table and a machine will deliver radiation to the affected area of the body. You may have one radiation therapy treatment, or several over a few days or weeks.

A type of EBRT called stereotactic body radiation therapy (SBRT) may also be used for secondary bone cancer. This is also known as stereotactic ablative radiation therapy (SABR). You will lie on a treatment table and a machine will precisely deliver a few high doses of radiation to the bones. SBRT is offered in some specialised centres.

If the cancer has spread to more than one bone, you may be injected with a small amount of radioactive liquid. This is known as radionuclide therapy and it aims to destroy the cancer cells.

The material spreads throughout the body but particularly targets cancer cells. Your treatment team will let you know of any safety measures you need to follow.

Side effects – These relate to the type of cancer and the part of the body treated. They include fatigue, skin problems, hair loss, low blood cell counts, appetite loss and nausea.

Listen to our podcast on Making Treatment Decisions

Surgery

Cancer can weaken a bone and cause fractures. Surgery to insert metal rods, plates, screws, wires, nails or pins can help strengthen a bone and reduce the risk of fracture. Surgery may also be used if the cancer is pressing on the spinal cord and causing damage.

Side effects – After surgery, some people develop an infection at the wound site. Your surgeon will discuss ways to prevent this happening.

Learn more about surgery.

Other bone-strengthening procedures

If the cancer is causing severe back pain and damaging the bones in the spine, you may have an injection of bone cement into the bones. This stabilises and strengthens them, and helps relieve pain. This is called vertebroplasty. It is not often done in Australia.

Bone-strengthening drugs

Your doctor may prescribe medicines to help strengthen your bones, reduce bone pain and control high calcium levels in the blood (a condition known as hypercalcaemia).

There are two options for bone-strengthening drug treatment:

• bisphosphonates – a group of drugs that can be given as an injection into a vein (intravenously) or as a tablet (orally)
• denosumab – given as an injection under the skin (subcutaneously).

Side effects

These will vary depending on how the drugs are taken. Bisphosphonates taken intravenously can cause muscle and joint pain, fatigue, nausea or flu-like symptoms such as shivering and fever. Bisphosphonates taken orally may make your throat sore, or cause indigestion or nausea. Occasionally, bisphosphonates can cause kidney damage. Your kidney function will be monitored with regular blood tests.

Side effects of denosumab are uncommon but can include bone, joint and muscle pain; nausea; fatigue; diarrhoea; and constipation.

All bone-strengthening drugs can lower calcium levels, so your doctor may advise you to take calcium and vitamin D supplements.

A rare but severe side effect of bone-strengthening drugs is the breakdown of bone tissue in the jaw. This may happen after the removal of a tooth. It is called osteonecrosis of the jaw or ONJ.

To reduce the risk of osteonecrosis of the jaw, it is recommended that you see a dentist before you start taking bone-strengthening drugs, and then every six months while taking these drugs. If you need to have dental work during treatment, let your dentist know that you are taking bone-strengthening drugs and ask your oncologist if you can have a break in treatment.

A very rare side effect that may happen when taking these drugs is a fracture of the thigh bone (femur).

See your doctor if you experience mouth ulcers, mouth pain, jaw problems or groin pain while taking bone-strengthening drugs.

Palliative treatment

Because secondary bone cancer is advanced cancer, your doctor is likely to discuss palliative treatment for symptoms caused by the cancer. Palliative treatment aims to manage symptoms without trying to cure the disease.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs. The team also provides support to families and carers.

For more on this, see Palliative care and Living with advanced cancer, and listen to our podcast The Thing About Advanced Cancer.

Medical Oncologist Dr Elizabeth Hovey explains what clinical trials are and how they can improve cancer treatment.