Pain: A common complication, and often the initial symptom of bone metastases, is bone pain. The thick membrane that covers each bone, called the periosteum, has many nerves, making it a highly sensitive tissue. Damage or pressure to this tissue caused by bone metastases may result in a great deal of pain. Bone pain can be debilitating to the point that it compromises a patient’s ability to manage normal day-to-day activities. Bone pain due to metastases may be hard to differentiate from ordinary low back pain or arthritis. The most notable difference is that pain due to bone metastasis is typically more constant, even at night.

Bone loss: Bone loss occurs when there is decreased calcification or reduced density of the bones. The result is weak bones that are at increased risk of fracture. Bone loss in the leg or hip bones can be a serious condition because these are major weight-bearing bones and fractures in these areas are often debilitating.

Hypercalcemia:An increased level of calcium in the bloodstream is called hypercalcemia. This disorder results from the destruction of bone associated with metastases. Hypercalcemia can be a life-threatening condition.

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The spread of cancer from its site of origin to another location in the body is called metastasis. Cancer cells can spread, or metastasize, through the blood and lymph systems. Bone metastases usually occur by way of the bloodstream. A cancer cell may break away from the original location in the body and travel in the circulatory system until it gets lodged in a small capillary network in bone tissue. Cancer may also spread to bone by erosion from the adjacent cancer, though this occurs less frequently than spread by the bloodstream.Bone is one of the most common locations in the body to which cancer metastasizes. The major cancer types that tend to metastasize to bone include multiple myeloma, breast, prostate, lung, kidney, and thyroid cancers. Bone metastases may cause pain, may make the bones more susceptible to fractures, and may cause increased levels of calcium in the blood.Bone metastases result in lesions or injury to the bone tissue. There are two types of lesions: lytic lesions, which destroy bone material; and blastic lesions, which fill the bone with extra cells. Normal bone is constantly being remodeled, or broken down and rebuilt. Cancer cells that have spread to the bone disrupt the balance between the activity of osteoclasts (cells that break down bone) and osteoblasts (cells that build bone).Bone metastases generally occur in the central parts of the skeleton, although they may be found anywhere in the skeletal system. Common sites for bone metastases include the back, pelvis, upper leg, ribs, upper arm, and skull. More than 90% of all metastases are found in these locations.

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§                  Learn all you can. Find out everything you can about your or your child’s cancer — the type, stage and risks involved and your treatment options and their side effects. The more you know, the more you can participate in treatment decisions. In addition to talking with your doctor, look for information in your local library and from reliable Internet sources.

§                  Be proactive. Although you may feel tired and discouraged, don’t let others — including your family and your doctor — make important decisions for you. It’s vital that you take an active role in your own or your child’s treatment.

§                  Maintain a strong support system. Having a support system and a positive attitude can help you cope with the challenges cancer brings. Although friends and family can be your best allies, they sometimes may have trouble dealing with the illness of a loved one. If so, the concern and understanding of a formal support group or of others coping with their own cancer or that of their child can be especially helpful. Although support groups aren’t for everyone, they can be a good source for practical information for you and your family, too. You may also develop deep and lasting bonds with people who are going through the same things you are.

§                  Maintain hope. Although your hopes may change as you go through a cancer diagnosis and treatment, it’s important to have hope. For example, when you first hear the diagnosis, you may hope that there’s been a mistake. Once you accept the diagnosis, you’ll hope for a good result from treatment. One way to maintain hope is to set goals. Having goals helps you feel in control and can give you a sense of purpose. But don’t choose goals you can’t possibly reach. You may not be able work a 40-hour week, for example, but you may be able to work part time. In fact, many people find that continuing to work and engage in everyday activities can be helpful.

§                  Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the times when you may need to rest more or limit what you do. If your child has cancer, one of the most important things you can do is take care of yourself. As a caregiver, you need to have the strength and emotional reserves to meet your child’s needs.  

§                  Stay active. Having cancer doesn’t mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It’s important to stay involved as much as you can. If your child has cancer, try to keep his or her life as normal as possible.

Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in successfully coping with cancer.

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“Magnetic”Chemotherapy

Interventional radiologists are currently investigating a new technique in which magnets are used to pull chemotherapy drugs into tumors. Microscopic magnetic particles are attached to the cancer-killing drugs and infused through a catheter into the blood vessel that feeds the tumor. A rare earth magnet is positioned over the patient’s body directly above the site of the tumor. The magnet pulls the drug-carrying particles out of the blood vessel so that they lodge in the tumor. Although the technique is still experimental, early research is promising. Physicians are hopeful that it will bolster the effects of chemotherapy while avoiding some of the drugs’ side effects, such as hair loss and nausea.

Gene Therapy

In recent years, scientists have gained a new understanding about genes—the basic biological units of heredity—and the role they play in disease. This knowledge has set the stage for medical science to alter patients’ genetic material to fight or prevent cancer. Although the science of gene therapy is still in the early, experimental stages, researchers are hoping that in the future the therapy can be used to:

alter the cells of a patient’s natural immune system with cancer-fighting genes and returning them to the body, where they could more forcefully attack the cancer;

• remove cancer cells from the body and alter them genetically so that the patient’s own immune system will mount a strong defense against them. In this technique, the altered cancer cells would act as a cancer vaccine;

• replace a faulty gene responsible for the growth of cancer with a “good” gene;

• inject a tumor with genes that will make it more susceptible to chemotherapy or other cancer-fighting agents; and

• make bone marrow and other organs resistant to chemotherapy, so that the drugs will destroy tumors without damaging healthy tissue.

One of the challenges of gene therapy is finding safe and effective ways to deliver genes or genetically altered cells to the site of the tumor. Interventional radiologists, with their special expertise in using X-rays and other imaging techniques to guide catheters and other tools through the body are expected to play an important role in this new technology.

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Surgery for cancer of the bone is a major operation. The area must be carefully watched for infection. Rehabilitation is an important part of post-surgery treatment.

The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells and those that line the digestive tract. As a result, patients may have side effects, such as a lowered resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They may also have less energy and may lose their hair. These are short-term side effects which usually end after treatment stops.

During radiation therapy, patients can become very tired as treatment continues. Resting as much as possible is important. Skin reactions such as redness or dryness in the area being treated are common, and the skin should be protected from the sun. Good skin care is important at this time, but the patient should not use any lotion or cream on the skin without checking with the doctor.

For some patients, it may be important to have a complete dental exam before treatment begins. Because cancer treatment can make the mouth sensitive and easily infected, doctors often advise patients to see a dentist so that their mouths are as healthy as possible.

Loss of appetite can be a problem for patients during their treatment for cancer. Patients who eat well may be better able to withstand the side effects of their treatment, so good nutrition is important. Eating well means getting enough calories to prevent weight loss and having enough protein to regain strength and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.

The side effects that patients have during cancer treatment vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.

Researchers are concerned about the possibility of long-term effects in young people who are treated with chemotherapy and radiation therapy. These depend on the location of the tumor and the way it is treated. Some types of chemotherapy can affect a patient’s fertility. When this side effect is permanent, it is not possible for the person to have children. This can be true for both men and women. Radiation therapy can increase the possibility that a second tumor will later develop in the area that was treated. The doctor can tell patients and their families more about these possible effects.

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Because the pain of a compression fracture is alleviated by Vertebroplasty, patients feel significant relief almost immediately. After just a few weeks, two-thirds of patients are able to lower their doses of pain medication significantly. Many patients become symptom-free. About 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After Vertebroplasty, patients who had been immobile can get out of bed, reducing their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.

 Risks

Usually, Vertebroplasty is a safe and effective procedure. A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal. Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare. Sometimes the procedure causes another fracture in the spine or ribs.

 What are the limitations of Vertebroplasty?

Vertebroplasty is not used for herniated disks or arthritic back pain. Vertebroplasty is not generally recommended for otherwise healthy younger patients, mostly because there is limited experience with cement in a vertebral body for longer time periods. The procedure cannot serve as a preventive treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing compression fracture. Vertebroplasty will not correct an osteoporosis-induced curvature of the spine, but it may keep the curvature from worsening. It may be difficult for someone with severe emphysema or other lung disease to lie facedown for the one to two hours Vertebroplasty requires. The healthcare team will try to make special accommodations for a patient with this type of condition. Patients with a healed vertebral fracture are not candidates for Vertebroplasty.

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Treatment Methods Bone cancer is treated with surgery, radiation therapy, and/or chemotherapy. The doctor often uses a combination of treatment methods, depending on the patient’s needs. Patients may be referred to doctors who specialize in different kinds of cancer treatment. Often, the specialists work together as a team. The team may include a surgeon, a pediatric oncologist, and a radiation oncologist.Surgery is part of the treatment for most bone cancers. Because the disease may recur near the original site, the surgeon removes the tumor and some healthy bone and other tissue around the tumor.When bone cancer occurs in an arm or leg, the surgeon tries, whenever possible, to remove just the tumor and an area of healthy tissue around it. Sometimes, the surgeon can use a metal device to replace the bone that is removed. In some children, the surgeon may replace the bone with a metal device that can be lengthened as the child grows. This limb-sparing procedure will require additional operations to keep expanding the artificial bone.Sometimes, however, when the tumor is large, amputation may be necessary. If the limb is removed, a prosthesis (artificial part) can be made. The artificial part takes the place of a leg, arm, hand, or foot.Chemotherapy uses drugs to kill cancer cells. Often, a combination of three or more drugs is used. Chemotherapy can be given by mouth or by injection into a muscle or blood vessel. The drugs travel through the body in the bloodstream. Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment and recovery period, and so on.Some patients have chemotherapy as an outpatient at the hospital, clinic, or doctor’s office or at home. Depending on which drugs are given, however, the patient may need to stay in the hospital for a short while.Chemotherapy is almost always used in combination with surgery for cancers of the bone. Sometimes, chemotherapy is used to shrink a tumor before surgery. It is also used as an adjuvant therapy after surgery to kill cancer cells that may remain in the body and to prevent the disease from recurring. In some cases, a patient may have chemotherapy both before and after surgery. For some bone cancer, chemotherapy is combined with radiation therapy. Chemotherapy can also be used to control bone cancer that has spread.Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. In some cases, radiation therapy is used instead of surgery to destroy the tumor. This form of treatment can also be used to destroy cancer cells that remain in the area after surgery.The patient goes to the hospital or clinic each day for radiation treatments. Usually, treatments are given 5 days a week for 5 to 8 weeks.

Hormone therapy is either the removal of the organs which produce hormones which can promote the growth of certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy to keep the hormones from promoting cancer growth.

Biphosphonates are drugs that can be used to reduce bone pain and slow down bone damage in people who have cancer that has spread to their bones.

Vertebroplasty?

Vertebroplasty is an image-guided, minimally invasive, no surgical therapy used to strengthen a broken vertebra (spinal bone) that has been weakened by osteoporosis or, less commonly, cancer. Vertebroplasty can increase the patient’s functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain caused by a compression fracture. Often performed on an outpatient basis, Vertebroplasty is accomplished by injecting an orthopedic cement mixture through a needle into the fractured bone.

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Cancer backup online resources

Financial and legal issues

This section has been written as a guide to people who have concerns about their finances and for those who are looking into making a complaint. Although Cancerbackup cannot advise you specifically on your financial concerns, this information will give you advice about what you can do and sources of financial help to which you may be entitled. Exactly what you need to do will depend on your individual circumstances. This will include the type and stage of your cancer, as well as the treatment that you need.                                

General information on talking about cancer

If you have been told that you have cancer then you may find it very difficult to talk about what’s happening to you and how you feel. Most people with cancer find it awkward and embarrassing (or uncomfortable and even painful) to talk about their illness with their family and friends – as well as with the nurses, doctors and other professionals looking after them. If that’s what you are feeling, then this section has been written to help you.This section offers some simple advice that will make you feel more comfortable about asking what you want and need to know. It will help you to talk about what you are feeling, if you want to.It can also help you to understand why your friends, family and even your doctors and nurses may find talking awkward. It gives tips on how you can help them – even though you may feel that they should be helping you!This section aims to help you:       understand the most common reactions to being told you have cancer        understand what your friends and family may be feeling        find a sensible and practical approach that will help you to talk about your cancer more freely and easily.In this way you can get the emotional support that you need.It is very important to realise that there is no single ‘correct’ way to cope with cancer. This section can give you some general guidelines that you may find helpful. But how you talk to people about your cancer will depend very much on your own personality and how you usually talk to the people around you.Don’t be worried if the examples or illustrations used do not fit in with your own style - you can adapt them to suit yourself.

Talking to children about cancer

This section is for people who have cancer. It discusses how to talk about cancer with children aged from two to sixteen. It outlines the steps you can take to help your children understand what is happening to you and help you through this difficult time in your family life. The information is also appropriate for guardians, grandparents or carers who have cancer.

Talking to someone with cancer

Many people find it difficult to talk to a person who has cancer. This section provides information about how to talk, help and support them.

Work and cancer

This section aims to help people diagnosed with cancer cope with any work issues they may face. It may also help employers to support employees who have cancer. It aims to help people with cancer to find the information they need to understand how cancer and its treatment will affect their ability to work. It gives information on employment rights. There is advice about coping with the effects of treatment, such as tiredness, and tips on talking about cancer with your employer and colleagues.Much of the information in this section is aimed at people who are employed in a company (whether large or small), but there is a section on people who are self-employed and the information on financial issues applies to people who are working for themselves or for an employer.

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Plain x-ray

This is a simple x-ray that can show up changes in the bone and may indicate if secondary bone cancer is present. It’s painless and takes only a few minutes. 

Bone scan

This is a more sensitive test than an x-ray and shows up any abnormal areas of bone in any part of the body. For this test a small amount of a radioactive substance is injected into a vein, usually in the arm, a few hours before the scan. If there is anything wrong it will be shown up by an increased uptake of the radioactive substance in the affected area. It’s important to remember that people with other bone conditions such as osteoporosis and arthritis may have abnormal bone scans without having secondary bone cancer. The scan is not painful but you will have to lie flat and still for about an hour. 

MRI (Magnetic Resonance Imaging)

MRI uses magnetic waves instead of x-rays. The scans provide a detailed picture of the area being looked at. It can be used as well as a bone scan to help your doctors decide the best treatment for you. Like the bone scan, the MRI scan is not painful but you will have to lie flat and still for up to an hour. 

Blood tests

In some centres you may have a blood test to measure proteins known as tumour markers, which are produced by certain tumours. This may help to monitor your disease.

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