Doctor talking with senior male patient in doctor’s office.

Treatment advancements are optimizing outcomes and helping patients maintain mobility.

Innovative treatments are helping many patients with advanced stages of cancer live longer and maintain their quality of life for years after diagnosis. As survival rates improve, however, bone metastasis is becoming increasingly common.

Bone metastasis means that cancer cells have spread from the primary tumor to the bones. Research shows the risk of developing bone metastasis rises over time.

“Bone metastasis can be controlled,” says Lee Zuckerman, MD, an orthopedic oncologist with USC Orthopaedic Surgery and lead physician of the metastatic bone disease program for Keck Medicine of USC who specializes in treating musculoskeletal tumors and metastatic disease.

“I have patients with metastatic cancer to the bones who I have been treating for 10 years,” he says. “That is why in addition to treating the cancer, we focus on treatments that give patients the best functional outcomes.”

Which cancers are most likely to spread to the bones?

Any cancer can spread to the bone. However, the five types of cancer that spread to bone most often are prostate, breast, lung, thyroid and kidney cancer.

Survival rates vary from months to years depending on where the cancer has spread from and whether it has metastasized beyond the bone.

“About half of patients with cancer will end up getting bone metastasis sometime in their life,” explains J. Dominic Femino, MD, an orthopedic oncologist with USC Orthopaedic Surgery and chief of the USC Musculoskeletal Oncology Center for Keck Medicine. “And that is due to advances in drug therapies. Patients are living longer than they used to, which is why we see more metastatic disease than in past years.”

“Our surgical techniques are much better than they were 20 years ago,” Dr. Zuckerman adds. “For renal cell carcinoma, for example, or when there are localized sites of disease, we are able to treat those cancers more aggressively. That has helped outcomes as well.”

“For some of these kinds of cancers, where there is only one or a few sites of disease, we aim for a more curative-approach surgery,” says H. Paco Kang, MD, an orthopedic oncologist with USC Orthopaedic Surgery. “Typically, this involves larger surgery where more tissue is removed, but studies have shown that this can help patients’ long-term life expectancy.”

What does bone metastasis feel like?

Chronic pain is the most common symptom of metastatic bone cancer. Patients may experience dull or sharp pain that wakes them up at night, does not go away and gets worse when weight is put on the bone.

The areas of the body affected most frequently by metastatic bone cancer include the spine, pelvis and ribs. The upper arm and leg bones are also susceptible.

Once spread, the cancer damages the cells that are responsible for breaking down old bone and growing new bone. This process elevates the risk for breaks and fractures.

“It is like having a tooth cavity,” Dr. Zuckerman explains. “The cancer thins out the bone to the point where it weakens it enough to cause a crack.”

Imaging tests, including X-rays, MRIs and CT scans, are used to diagnose bone metastasis. Dr. Zuckerman emphasizes that a biopsy is also an important verification step.

“If someone has a cancer and they have a spot in the bone, they should see an orthopedic oncologist to get checked out,” he says. “Not every cancer spreads to bone. It could be a secondary cancer or even a benign finding that is not cancerous.”

How is bone metastasis treated?

Keck Medicine medical, radiation and orthopedic oncologists work collaboratively to treat metastatic bone cancer. “The primary treatment is systemic drug therapy,” Dr. Femino says. “That may be chemotherapy, immunotherapy or hormone therapy. Metastatic carcinoma to the bone is generally very sensitive to radiation therapy as well.” He adds that it is exceedingly rare to undergo an amputation for bone metastasis.

The orthopedic oncology team performs surgical interventions to target disease. “There have been significant advances in our ability to treat tumors around the hip socket and the pelvis. We are using a minimally invasive approach more and more,” Dr. Femino says. “We make a small incision and do a percutaneous ablation of the tumor, which means we use a radiofrequency probe to burn the tumor and kill it.”

Dr. Kang adds, “We then can use the same small incision to stabilize the bone to reduce or eliminate the pain and improve patient function.”

A major benefit to this approach, Dr. Femino says, is that patients do not need to pause their drug therapies to have the procedure. He says the surgery relieves pain and that blood loss in minimal. Patients can often go home the same day.

Orthopedic surgery for bone metastasis may also involve removing portions of the bone and then reconstructing it. Dr. Zuckerman pioneered a technique using magnetic nails and bones from an organ donor. “I take out a segment of bone, put the donated bone in that space and then the magnetic rods compress the bones together. We are getting great healing rates with this method,” he says.

In addition, Dr. Zuckerman says the magnetic nails are used to help the body grow new bone. “The magnetic device tricks the body into thinking the bone is broken and will heal it. This approach means less risk of infection or failure, because now it is the patient’s own bone, and there is less metal in there.”

Thanks to advancements in orthopedic oncology procedures, patients are able to recover quickly and go home. Dr. Femino says most patients can expect to be walking the day after surgery. “These are patients with limited lifespans usually, and so we do not want them to have prolonged rehabilitation time. The advances that we have now have really made a big difference in the patient’s ability to recover.”

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Understanding Metastatic Bone Cancer