Lung cancer and bone metastases

Lung cancer with bone metastases refers to secondary or metastatic tumours that are formed from cancer cells that have broken away from a primary lung cancer and spread through the lymphatic system or blood stream to the bones. Lung cancer is the third most common cause of bone metastases.

Nicky is living with advanced lung cancer and bone metastases
Nicky is living with advanced lung cancer and bone metastases

The most common bones to which lung cancer spreads include:

  • The spine (especially vertebrae in the chest and lower abdominal areas)
  • The pelvis
  • The upper bones in the arms (humerus bone) and legs (femur bone)
  • Bones in the hands and feet.

Tests for bone metastases

Once your doctor suspects that cancer has spread to your bones, they may carry out different checks and tests to assess the extent and possible impact of the tumours.

These tests can help your medical team get a clearer picture of what’s going on, and help you think about what you want to do next. These tests may include:

  • X-ray
  • Bone scan
  • Magnetic Resonance imaging (MRI) scan
  • Biopsy (tissue sample).

Symptoms of bone metastases

You may become aware of pain in a specific part of your body. There are many reasons for pain, particularly following lung cancer treatment, so it is important to know that not all pain means metastases.

It is important to be aware of what is normal for you and any changes that you experience. If you experience a new pain, or one that is affecting your day-to-day activity contact your doctor for advice. Your doctor may also be able to help you distinguish between bone metastases pain and normal aches and pains.

People with bone metastases describe the pain as gradually increasing over a period of time and becoming more severe.

It is not necessary to live with pain. Pain is something that can be removed or reduced with medication and management. If your pain is affecting your day-to-day activity, contact your doctor for advice. Your medical team will carry out further tests, including a pain assessment.

I’m now stage 4. I’ve had progression to both lungs and my bones. I know this illness is going to shorten my life by 20, 30 years. I’m not going to be in retirement with my husband. I’m not going to see my youngest child marry and have children of his own.

Because I’ve accepted that, it’s really, really important to not let it affect what remaining days, or years, I do have. It’s important to just live and not dwell.

Nicky, living with advanced lung cancer and bone metastases

On rare occasions, pain and weakness in the legs, along with loss of bowel and bladder function, may indicate tumours impacting on the lower spine. These symptoms are considered a medical emergency. Take immediate action and contact the emergency services.

Symptoms can also vary depending on where in the bones the cancer has spread to:

  • Spinal tumours: People who have metastases to the spinal cord often have pain that is worse at night, or with bed rest. They may also experience tingling in the legs and pain when walking.
  • Tumours in the arms and legs: If you have a tumour in your arms or legs, you may have pain with activity or movement, and less pain when you are resting.

Treatment for bone metastases

Treatment for bone metastases is primarily about managing symptoms, slowing the growth and improving your quality of life.

  • Pain medication: You may be given an oral anti-inflammatory and other medication including paracetamol, codeine, tramadol and morphine.
  • Radiotherapy: This treatment can be used to lessen pain, prevent fractures and relieve spinal cord compression. It can be used for people who have had multiple metastases. Physicians may consider treating the metastases aggressively with the hope of long-term survival.
  • Bone modifying / targeted therapies: These are treatments which help prevent cancer cells breaking down bone cells.

Your healthcare team will talk about your case to work out the best treatment for you. It is important to remember, just because you have treatment options doesn’t mean you have to take them.

Your medical team, including your lung cancer nurse specialist, can talk your through your treatment options and the potential impact and side effects they can have, allowing you to make an informed decision.