Secondary bone cancer

What is secondary bone cancer?

The place where a cancer starts in the body is called the primary cancer. Sometimes cells break away from the primary cancer and are carried in the bloodstream or through the lymphatic system to another part of the body. The cancer cells may settle in that part of the body and form a new tumour. This is called secondary cancer.

Secondary cancer in the bone happens when cancer cells spread to the bone from a primary tumour somewhere else in the body. Secondary cancers in the bone are sometimes called bone secondaries or bone metastases.

The diagram shows cells breaking away from a tumour and spreading into the bloodstream. The cancer cells then circulate in the blood. — Image: Cancer cells entering the bloodstream

Sometimes only 1 area of bone is affected. But in most people the cancer will spread to a few different areas.

Any type of primary cancer can spread to the bone. But the most common types that do are:

Myeloma is a primary cancer that develops from cells in the bone marrow and often affects the bones. We have more information about myeloma.

People who develop secondary bone cancer usually know they have a primary cancer. Sometimes, a secondary bone cancer is found before, or at the same time, as the primary cancer. Occasionally the primary cancer cannot be found. This is called a cancer of unknown primary.

While secondary bone cancer is not currently curable, many people will have treatments that can control the cancer, sometimes for many years.

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What is cancer?

Booklets and resources

Symptoms of secondary bone cancer

If you have secondary bone cancer you might experience 1 or more of these symptoms. Some people do not have any symptoms.

Bone pain
Pain is the most common symptom of secondary bone cancer.

Everyone feels pain differently.

The pain may also depend on which bones are affected.

Secondary bone cancer in the spine can cause backache and pain in the arms and legs.

Secondary bone cancer in the leg bones may cause pain when you are walking.

In other parts of the body such as the ribs or spine, the pain may seem to vary in where it is and when it occurs.

It is important to let your doctor or nurse know if you have pain:

in 1 or more areas that lasts for more than 2 weeks

when you are moving

that wakes you up at night

in your back that moves (or ‘shoots’) down your arm or leg.

This is especially important if you have had cancer in the past.

We have information about managing pain.
Weak bones

Cancer in the bones can weaken them. Sometimes a bone weakened by cancer will break (fracture). This may happen even if you have not had an accident or fall. This is known as a pathological fracture.
Raised blood calcium level (hypercalcaemia)
Secondary cancer in the bone may cause increased amounts of calcium to be released from the bone into your blood. A high level of calcium in the blood is called hypercalcaemia.

Hypercalcaemia may show up on a routine blood test. But it can also cause symptoms including:

tiredness

feeling sick (nausea)

constipation

increased thirst

confusion

peeing (passing urine) more often.

If you develop any of these symptoms, it is very important to let your doctor or specialist nurse know straight away.
Pressure on the spinal cord
Secondary bone cancer can put pressure on the nerves in the spinal cord. This is called malignant spinal cord compression (MSCC). It is rare but can be serious.

Symptoms of spinal cord compression include:

back or neck pain, which may be mild at first but becomes severe

weakness in your arms or legs

numbness or pins and needles in your legs, hands, around your buttocks or anywhere else in your body

problems controlling pee or peeing

constipation or problems controlling your bowels.

If you develop any of these symptoms, it is very important to let your doctor or specialist nurse know straight away.

If you cannot contact your specialist team and you develop weakness in your legs or arms or problems controlling your bowel or bladder, go to your local emergency department (A&E) straight away.
Effects on the blood
Sometimes secondary cancer in the bone can affect the way the bone marrow works.

The bone marrow produces different types of blood cells:

red blood cells, which carry oxygen around the body

white blood cells, which help to fight infection

platelets, which help the blood to clot and prevent bleeding.

If the bone marrow does not produce enough red blood cells, you may become anaemic. This means the tissues and organs in your body might not get enough oxygen. This can make you feel tired and breathless.

If you have too few white blood cells, you will be more prone to infection.

And if you have a low platelet count, you may have bruising or bleeding.

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Causes of secondary bone cancer

The cause of secondary bone cancer is always a primary cancer somewhere else in the body. We do not fully understand why some people develop secondary cancer in the bone and others do not, but this is an area of ongoing research.

Diagnosis of secondary bone cancer

You may see your GP or your cancer doctor. They will ask you about any symptoms you have and may examine you. You might have some of the following tests and scans.

Blood tests

You may have a blood test to check your general health and the level of calcium in your blood. Increased calcium levels can be a sign of secondary cancer in the bone.
Bone x-rays

Bone x-rays can show changes in the bone such as a fracture, and may show a secondary bone cancer. Not all secondary bone cancers can be seen on an x-ray.
Bone scan

A bone scans looks for changes in the bones. It is more sensitive than an x-ray, as it shows any abnormal areas of bone more clearly.
CT scan

A CT scan makes a detailed picture of the inside of the body. The picture is built up using x-rays taken by the CT scanner.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of the body.
PET-CT scan

A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body.
You may have a PET scan and a CT scan together. This is called a PET-CT scan. It can give more detailed information about cancer or abnormal areas seen on other scans.
Bone sample (bone biopsy)

A bone biopsy means the doctor takes a sample of cells from the bone to be checked for cancer under the microscope. There are different ways of doing this.

Diagnosing the primary cancer

Sometimes, a secondary bone cancer is found before the primary cancer is diagnosed.

If this happens your doctor may arrange for you to have tests to find out where the primary cancer is. Your doctor will be able to tell you more about these tests.

Waiting for test results can be a difficult time, we have more information that can help.

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Treatment for secondary bone cancer

A team of specialists will meet to talk about the best possible treatment for you. This is called a multidisciplinary team (MDT).

Treatment for secondary bone cancer is normally given with the aim of controlling the cancer rather than curing it.

However, many people live with secondary bone cancer for a long time.

If you were treated for a primary cancer, your doctor may use the same treatment for the secondary cancer to help relieve symptoms.

The treatment you have will depend on where your cancer started. This is because the secondary cancer cells in the bone have come from the primary cancer. This means they will usually respond to the same type of treatment.

You may be offered 1 or a combination of:

Radiotherapy

Radiotherapy is often used to treat secondary bone cancer. It can help relieve symptoms such as pain.

There are different ways of having radiotherapy. You may have external beam radiotherapy or radioisotope therapy.
Hormonal therapies

You may be offered hormonal therapies to treat secondary bone cancer from breast or prostate cancer.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy works by disrupting the way cancer cells grow and divide, but it also affects normal cells.

Your doctors may suggest chemotherapy if the primary cancer (where the cancer started in the body) can be treated with chemotherapy.
Targeted therapy

Targeted therapy are substances that find and attack cancer cells. They are often used to treat kidney cancer that has spread to other parts of the body, including the bones. They are also sometimes used to treat other cancers that have spread, such as prostate, breast and lung cancer.
Immunotherapy

Immunotherapy treatments use the immune system to find and attack cancer cells. It is only suitable for some types of cancer. If this is an option for you, your doctor will talk to you about it.
Surgery

Bones can sometimes be weakened by the secondary bone cancer cells. This can cause the bone to break (fracture). If this happens, it may be possible to strengthen or repair them using surgery.

If secondary cancer has caused a lot of damage to your hip or shoulder joint, you may need an operation to replace the joint.

You may also have radiotherapy before or after these operations (or both) to try to destroy any cancer cells left in the area and help repair the bone.

A procedure called percutaneous cementoplasty may help strengthen a weakened bone and relieve bone pain. A doctor injects a special cement into the bone to strengthen it. It can be used to treat bones in the arm or leg. If the procedure is used when a tumour is affecting the spine, it is called percutaneous vertebroplasty.

Some people may be offered surgery to remove secondary bone cancer, but this is very rare. Surgery is usually only considered if the cancer only affects one bone and has not spread to other parts of the body.

Your cancer doctor can tell you more and talk to you about whether surgery would be suitable for you.
Bone-strengthening drugs

Bisphosphonates and denosumab are drugs that can help to strengthen the bones. The aim of bisphosphonates is to reduce the risk of fractures or high levels of calcium in the blood (hypercalcaemia) and help with pain.

Denosumab belongs to a group of targeted therapy drugs known as monoclonal antibodies. There are 2 types of denosumab. The type you have will depend on your situation.
Other treatments
Other treatments that may occasionally be used for secondary bone cancer include:

high intensity focused ultrasound (HIFU), which uses high-frequency focused sound waves to heat and destroy cancer cells

radiofrequency ablation (RFA), which uses heat to destroy cancer cells

cryotherapy, which uses very cold temperatures to destroy cancer cells.

Your doctor will tell you whether these treatments are suitable for you.

Treatment for secondary bone cancer may be offered as part of a clinical trial.

Relieving symptoms of secondary bone cancer

Managing the symptoms of secondary bone cancer is an important part of your treatment.

We have more information about managing symptoms of secondary cancer in the bone.

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After secondary bone cancer treatment

After treatment, your specialist team or GP will organise regular check-ups for you. You may also have some tests. Your specialist team will continue to monitor your symptoms and may give you further treatments if needed.

If you have any problems between appointments, contact your doctor or specialist nurse as soon as possible.

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Finishing cancer treatment

Getting support

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our secondary bone cancer forum to talk with people who have been affected by secondary bone cancer, share your experience, and ask an expert your questions.

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About our information

References

Below is a sample of the sources used in our secondary bone cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Jimenez-Andrade, J. M. et al, 2010. Bone cancer pain. Annals of the New York Academy of Sciences. Vol. 1198, pp.173-81.

Heindel, W. et al, 2014. The diagnostic imaging of bone metastases. Deutsches Ärzteblatt International. Vol.111,(44), pp.741-7.

NHS Scotland, 2019. Scottish Palliative Care Guidelines: Malignant Spinal Cord Compression. Available from: https://www.palliativecareguidelines.scot.nhs.uk/guidelines/palliative-emergencies/malignant-spinal-cord-compression.aspx (accessed May 2022)

National Institute for Health and Care Excellence (NICE). Percutaneous cementoplasty for palliative treatment of bony malignancies. Updated 28 June 2006. Available from: https://www.nice.org.uk/Guidance/IPG179 (accessed May 2022).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.