Page last updated: November 2025
The information on this webpage was adapted from Understanding Secondary Bone Cancer - Information for people affected by cancer (2024 edition). This webpage was last updated in November 2025.
Expert content reviewers:
This information was developed with the help of a range of health professionals and people affected by secondary bone cancer:
- Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney, NSW
- Anne Booms, Nurse Practitioner Supportive and Palliative Care, Icon Cancer Centre Midlands, WA
- A/Prof Richard Boyle, Orthopaedic Surgeon, Royal Prince Alfred Hospital Sydney, NSW
- Belinda Fowlie, Bone Tumour Nurse Practitioner Candidate, SA Bone and Soft Tissue Tumour Unit, Flinders Medical Centre, SA
- Dr Tahlia Scheinberg, Medical Oncologist, Chris O’Brien Lifehouse, NSW
- Dr Clare Zachulski, Palliative Care Specialist, Westmead Hospital, NSW
The aim of treatment for secondary bone cancer is to control or shrink the cancer and relieve symptoms. This is called palliative treatment and may make you feel better.
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 body as a whole (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, including fatigue, changes in appetite, hair loss and skin irritation. Talk to your doctor about managing any side effects you have and if you need to avoid any particular physical activity.
Treatment types
Radiation therapy
Also known as radiotherapy, radiation therapy uses 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.
Types of radiation therapy
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 body 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.
Depending on the cancer type, you may be injected with a small amount of radioactive liquid. This is known as radionuclide therapy (theranostic therapy). The liquid spreads throughout the body particularly targeting cancer cells.
Your treatment team will let you know of any safety measures you need to follow.
Side effects of radiation therapy
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.
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 as an injection between the skin and the muscle, or sometimes as a tablet (orally).
Most people have several treatment cycles with rest periods in between. The number of sessions will vary depending on the drugs prescribed by your doctor and the type of primary cancer.
Side effects of chemotherapy
These will depend on the chemotherapy drugs you receive. Common side effects include fatigue, nausea, diarrhoea, appetite loss, hair loss and increased risk of infections
Targeted therapy
Targeted therapy uses drugs that attack certain features – genes or proteins – in the cancer cells to stop the cancer growing and spreading. The type of drugs you have will depend 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 of targeted therapy
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.
'I’ve been having palliative treatment for five years. I’m not trying to get rid of the disease, just keeping it under control. My quality of life is excellent.' Kate
Immunotherapy
Immunotherapy is a type of drug treatment that uses the body’s own immune system to fight cancer. The most common immunotherapy used to treat secondary bone cancer is checkpoint inhibitor drugs.
Some cancers block the immune system by creating “checkpoints”. Checkpoint inhibitor drugs allow the immune system to recognise and attack cancer cells, bypassing these checkpoints.
Several checkpoint inhibitor drugs are approved to treat some types of cancer that have spread to the bone, such as melanoma, lung, bladder and kidney cancers.
Clinical trials are testing checkpoint immunotherapy for other cancer types.
Side effects of immunotherapy
These will depend on the type of treatment you receive and how your body responds. Common side effects of immunotherapy are fatigue, dry eyes, rashes and diarrhoea.
Hormone therapy
Hormone therapy, also called endocrine therapy, may be used to treat breast or prostate cancer that has spread to the bone.
Synthetic hormones which have been produced in a laboratory are given as tablets or injections to slow or stop the effect of the body’s natural hormones.
The aim is to reduce the amount of hormones reaching the cancer cells. This can help to slow down the growth and spread of the cancer.
Side effects of hormone therapy
Common side effects include hot flushes, mood changes, weight changes and sweating. Some types of hormone therapy can also weaken your bones, and affect your sex drive.
Surgery
Cancer can weaken bones and cause fractures. Surgery using metal rods or prostheses can be used to stabilise a fracture, or to strengthen bones which are at risk of fracturing.
Surgery may also be used if the cancer is pressing on the spinal cord and causing weakness in the arms or legs.
Side effects of surgery
After surgery, some people develop an infection at the wound site. Your surgeon will discuss ways to prevent this happening.
Palliative treatment
Because secondary bone cancer is advanced cancer, your doctor is likely to discuss palliative treatment for symptoms caused by the cancer and to control the cancer for a period of time.
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, social and spiritual needs.
The team also provides support to families and carers. For more information, listen to Cancer Council’s podcast, The Thing About Advanced Cancer.
Find out more
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 taken as a tablet (orally)
- denosumab – given as an injection under the skin (subcutaneously).
Side effects of bone-strengthening drugs
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 a sore throat, 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 nausea, fatigue, diarrhoea, constipation and bone, joint and muscle pain.
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. Called osteonecrosis of the jaw or ONJ, this may happen after the removal of a tooth.
See a dentist before starting to take bonestrengthening drugs, and then every 6 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.
See your doctor if you experience mouth ulcers, mouth pain or jaw problems while taking bonestrengthening drugs.
Taking part in clinical trials
New treatments are constantly becoming available. Clinical trials test new treatments to see if they’re better than current methods.
If you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment.
Talk with your doctor to see if there are any suitable trials for you.
Find out more
Managing common symptoms
For many people with secondary bone cancer, managing symptoms can help them feel better.
Pain
Paracetamol and non-steroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, can be used to treat mild pain. Opioid-based medicines can help reduce moderate to severe pain.
Steroids, like dexamethasone, are strong anti-inflammatory medicines and may be used for bone pain.
Fatigue
Many people experience extreme or constant tiredness known as fatigue. This may be because the cancer is affecting your bone marrow.
You’ll have blood tests to monitor your blood cell count. If your red blood cell level is low (anaemia), you might have a blood transfusion. Getting enough rest, exercise and eating well can help with your energy levels.
Complementary therapies
Complementary therapies are used alongside conventional medical treatments. Therapies such as massage, relaxation and acupuncture can increase your sense of control, decrease stress and anxiety, manage pain and improve your mood.
Let your doctor know about any therapies you are thinking about trying, as some may not be safe or evidence-based.
Living with secondary bone cancer
People diagnosed with secondary bone cancer can feel well and have long periods of time without symptoms. However, after finding out that you have advanced cancer, it’s natural to have a lot of different emotions.
At times, you may feel overcome by fear, anxiety, sadness, depression or anger. The uncertainty of living with secondary bone cancer can have a huge emotional impact.
Your doctor, nurses, a social worker or counsellor can help you and your family find ways to cope with how you’re feeling.
Find out more information about living with advanced cancer or call Cancer Council on 13 11 20.
Question checklist
This checklist may be helpful when thinking about questions to ask your doctor.
- Which bones has the cancer spread to?
- What treatment do you recommend, and why?
- What is the aim of the treatment?
- If I don’t have treatment, what can I expect?
- What is the expected outcome of this cancer?
- How will I know if the treatment is working?
- Can I do my normal activities while having this treatment?
- Will I have a lot of bone pain? What will be done about this?
- What can I do to prevent broken bones?
- What will you do if a bone breaks?
- Are there any clinical trials or research studies I can join?
- How can I access palliative care?