Symptom Management For Bone Metastases

When cancer spreads from the first site where it developed on the body to other areas of the body we say that the cancer has metastasized. Certain cancers tend to metastasize in certain ways. For instance, lung cancer, which is one of the most common cancers in America (making up 13% of all cancers diagnosed), has cells that tend to break away from the site of the original tumor and enter the bloodstream and lymph nodes, spreading to other parts of the lung, nearby organs such as the heart, or to the liver, kidneys, brain, and bones.

When secondary tumors form in the bones we call these tumors bone metastases. Since many lung cancers are not diagnosed until they have grown and spread to other parts of the lungs and/or body, metastases are common in lung cancer patients.

Doctors can attack the problem by targeting the primary cancer to shrink the tumor and prevent its spread. At the same time, doctors can use treatment options to attempt to shrink or remove metastasized tumors and thus ease symptoms such as bone pain. When lung cancer spreads to the bone it can cause severe pain and weak bones among other symptoms.

Relieving Symptoms

In order to relive symptoms of bone meatsases, doctors can use systemic (which target cancer all over the body) therapies such as chemotherapy or administer drugs known as bisphosphonates. Doctors may also try local therapies (which target specific areas of cancer, particularly those causing pain or other side effects) such as radiation and surgery. At the same time, doctors usually prescribe some type of pain-killing medication to control pain for patients experiencing discomfort.

Systemic Therapies

These types of therapies enter the bloodstream through an injection or a pill. Once in the bloodstream, they work on destroying cancerous cells wherever they exist in the body. Systemic therapies are therefore generally more effective than local therapies in killing cancerous cells in widespread areas of the body. When they succeed, bone metastases symptoms recede and may disappear entirely for a time, or forever.

• Chemotherapy - Patients with bone metastases may receive chemotherapy drugs by injection or by mouth. These drugs can be injected or taken orally, usually in "on-off" cycles over a period of weeks and months. Chemotherapy kills cancer cells, but also kills normal cells at the same time which can cause significant side effects. Chemotherapy can be very effective on some cancers and can help reduce the need for pain medications by reducing the size or spread of metastases.
  
• Bisphosphonates - Once used to combat osteoporosis, these drugs are now gaining a reputation for being beneficial in treating bone metastases. Biophosphonates work to slow the activity of osteoclasts, thereby preventing excessive bone loss (reabsorption) and the associated elevation of blood calcium levels. In this process, they ease symptoms, including fracture due to weak, thinning bones, as well as the range of symptoms associated with hypercalcemia. Bisphosphonates may be taken by mouth or given intravenously. Intravenous use is most common, as these drugs are difficult for the digestive system to absorb. Bisphosphonates are proving to be very useful since patients experience few side effects (generally only minimal flu-like symptoms) and only for a short period of time. Lung cancer patients who take bisphosphonates most commonly take Zometa (zoledronic acid).