Cancer that begins in other parts of the body can sometimes spread to the bone(s).
Our 'Living well with advanced cancer' booklet is available now.
What is advanced cancer?
Advanced cancer (also called secondary cancer or metastatic cancer) is cancer that has spread from the part of the body where it started (the primary cancer), to another part of the body.
Although the cancer is growing in a different part of the body, it is still named after the primary cancer. For example, if breast cancer has spread to the bone, it is called advanced breast cancer.
Advanced cancer that has spread to the bone(s)
Cancer that begins in another part of the body can sometimes spread to the bone(s).
This is called advanced cancer that has spread to the bone.
Your treatment team may use different words to describe cancer that has spread to the bone.
You may hear it called:
- metastatic bone cancer (bone mets)
- secondary cancer in the bone
- stage 4 (IV) cancer.
Symptoms of cancer that has spread to the bone
Having any of the following symptoms does not always mean that cancer has spread to the bone, but it is important to get any changes checked by your GP or whānau doctor.
Signs that cancer may have spread to the bone include:
Bone pain is the most common symptom of cancer that has spread to the bone.
Everyone has aches and pains from time to time. Let your GP or whānau doctor know if you have:
- new pain that is not going away after a week or two
- pain that is waking you at night.
Cancer that has spread to the bone makes the bone weak. A bone weakened by cancer can sometimes break. This can happen even if you have not had an accident or a fall (pathological fracture).
Cancer that has spread to the bone may cause high levels of calcium in your blood. This is called hypercalcaemia.
Hypercalcaemia can cause symptoms which may include:
- feeling sick (nausea)
- increased thirst
If you get any of these symptoms, contact your treatment team, GP or whānau doctor straight away.
Cancer that has spread to the bone(s) of the spine can put pressure on the spinal cord. This is called spinal cord compression. Symptoms of spinal cord compression include:
- pain in your back
- weakness in your arms or legs
- tingling or numbness in your arms or legs (can cause difficulty walking)
- problems with control of your bladder or bowel (incontinence).
If you have any of these symptoms, it is very important to let your treatment team know straight away.
If you can’t contact your treatment team, go to your local emergency department (A&E) straight away.
Spinal cord compression needs urgent treatment. The earlier it is diagnosed, the better the chances are of treatment helping.
The bone marrow makes different types of blood cells – red blood cells, white blood cells and platelets. Cancer that has spread to the bone can affect how well the bone marrow works.
Red blood cells:
Red blood cells carry oxygen around your body. If you do not have enough red blood cells (anaemia), you may feel tired and breathless.
White blood cells:
White blood cells help your body to fight infection. If you don’t have enough white blood cells (leukopenia), you are more likely to become unwell with infections.
Platelets help your blood to clot and stop any bleeding. If you don’t have enough platelets (thrombocytopenia), you may notice you bruise easily, or that you take longer to stop bleeding.
Finding out if cancer has spread to the bone(s)
If your GP or whānau doctor is concerned that any symptoms you may be experiencing could be caused by cancer that has spread to the bone, they will recommend further tests (investigations).
These tests may include:
Your doctor will feel around the affected bones or joints.
A radioactive dye is injected into your arm and a scan will show if that dye has been attracted to abnormal cells in your bones.
An x-ray will show cancers 1cm or larger.
A CT scan creates a 3D picture of the inside of your body. It can show smaller cancers than an x-ray can.
An MRI uses magnets and radio waves to make a detailed picture of the inside of your body.
A PET-CT scan uses a radioactive dye injected into your arm that will show up in areas affected by cancer. You may have to travel to a different hospital to have this scan.
A biopsy takes a small sample of the abnormal cells to check if they contain cancer.
Managing cancer that has spread to the bone
Cancer that has spread to the bone is often managed with more than one type of treatment.
Your treatment may include:
- Bisphosphonates – medications to strengthen your bones
- Hormone treatment – most commonly used in cancer that has spread from the breast or prostate
- Radiation treatment
- Specialist palliative care
- Supportive care
- Targeted treatments
- Traditional healing or complementary therapy
The goals of any treatments are to control the cancer for as long as possible, improve any symptoms you may be experiencing, and to maintain your quality of life.
Sometimes treatments for cancer, such as radiation or chemotherapy, may no longer work, but you will always benefit from supportive care.
Supportive care includes the management of physical symptoms, emotional and spiritual support, and guidance to help you plan for the future.
Supportive care will mostly be provided by your primary health care team, Cancer Society support workers, and specialist palliative care services.
If the symptoms you are experiencing are difficult to manage, you and your whānau may be referred to a specialist palliative care service.
Specialist palliative care helps with the physical and emotional needs of people with advanced cancer and can link you with practical support in your local area. Care can be provided at home or in a hospital, rest home, or hospice by doctors, nurses, social workers, spiritual care workers, and cultural health services.
Living well with advanced cancer
Looking for ways to stay as well possible can help reduce stress and improve your wellbeing.
The following suggestions may be helpful:
- Eating well, keeping active and relaxing can help your overall health and improve sleep.
- Keeping in touch with whānau and friends can be an important support. You may choose to keep working if you can - talk to your employer about reduced hours or lighter duties if you need.
- Some people find that prayer or talking to a spiritual advisor/tohunga is a way to find strength and meaning in times of stress.
- Setting goals for things you have wanted to do but have not yet had the chance can give a sense of structure and purpose.
Learning to manage uncertainty is another important part of staying healthy.
These tips may help:
- It is important to ask for support. Talk with your treatment team about support and resources available to help you if you are struggling.
- Accept that there are things you can control and things you cannot.
- Talk to the Cancer Society or your GP/whānau doctor about counselling services.
- Try a local support group or talk with a social worker at the hospital.
- Talk with family/whānau and friends. Tell them how you are feeling and how they can help.
- Learn as much as you can about the cancer and its treatment. Having the right information can help you know what to expect.
- Maintain your usual interests, friendships, and activities that give you time out from cancer.