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Treatment | Other ways to manage symptoms | Living with secondary bone cancer

Treatment

Secondary bone cancer can’t be cured, but treatment can reduce symptoms and improve quality of life. In some cases, treatment can keep secondary bone cancer under control for many years.

The aim of treatment is therefore to control or shrink the cancer and relieve symptoms of secondary bone cancer. You may have treatment that affects the whole body (systemic) or focuses on a particular bone (local). 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.
  
  

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. It aims to reduce the hormones that the cancer cells receive, which can help slow down the growth and spread of the cancer.

Hormone therapy may be given as tablets or injections. 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.

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

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.

Targeted therapy drugs can be given in different ways, including as tablets that you swallow (orally), by injection under the skin (subcutaneously) or by injection into a vein (intravenously). These 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.  

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. Common side effects include fatigue, rashes and diarrhoea.

Radiation therapy

Also known as radiotherapy, radiation therapy is the use of targeted radiation to kill or damage cancer cells and reduce pain in the bone. The radiation is usually in the form of x-ray beams and is commonly 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), which requires you to lie on a treatment table while a machine delivers radiation to the affected area of the body. You may have one radiation therapy treatment, or several over a few days or weeks.

Side effects of radiation therapy can include fatigue, skin problems, hair loss, low blood cell counts, appetite loss and nausea.

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. After surgery, some people develop an infection at the wound site. 

Other bone-strengthening procedures

Vertebroplasty

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 procedure is called vertebroplasty and 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 (called 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).

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.

Side effects of denosumab are uncommon but can include bone, joint and muscle pain, nausea, fatigue, diarrhoea and constipation. A rare but severe side effect of bone-strengthening drugs is the breakdown of bone tissue in the jaw. It is called osteonecrosis of the jaw or ONJ. A very rare side effect that may happen when taking these drugs is a fracture of the thigh bone (femur).

Other ways to manage symptoms

For many people with secondary bone cancer, managing symptoms can help them feel better.

Pain

Your doctor may prescribe pain-relieving medicines to reduce the pain. Medicines to control mild pain include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Opioid-based medicines, like oxycodone or morphine, are used to reduce moderate to severe pain.

Steroids, like dexamethasone, are strong anti-inflammatory medicines and may be used in some cases for bone pain. For example, they may be used instead of NSAIDs in people with kidney (renal) failure and bone pain. If your treatment shrinks the bone tumours or reduces the pressure on nerves and surrounding tissues, your doctor may be able to reduce the dose of the pain-relieving medicines. Read more about overcoming cancer 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.

Living with secondary bone cancer

People diagnosed with secondary bone cancer can feel well and have long periods of time without symptoms. But, after finding out that you have advanced cancer, you may feel a range of emotions. At times, you may feel overcome by fear, anxiety, sadness, depression or anger.

The uncertainty of living with secondary bone cancer can leave you feeling emotionally up and down. 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.