What to Know if Metastatic Non-Small Cell Lung Cancer Spreads to Your Bones

“Sometimes we see involvement of one or two bones at initial diagnosis of non-small cell lung cancer,” says Amy Cummings, MD, PhD, a thoracic oncologist at the UCLA David Geffen School of Medicine in Los Angeles. “[But] bone metastasis can also occur later on.”

• Bone Pain The most common symptom of bone metastases is an achy pain, Cummings says. It often comes from the chest, back, or hips, and tends to be worse in the morning after you first wake up. Over time, the pain may become severe. While not all pain means metastasis, it’s important to tell your cancer care team about any new, unexplained pain that doesn’t get better with rest.
• Broken Bones Bones weakened by metastatic cancer can break or fracture. This might happen from a fall, an injury, or what doctors refer to as a pathological fracture, which happens during ordinary activities, such as coughing, stepping out of a car, or bending over. A fracture often causes sudden, severe pain that doesn’t let up and can sometimes make it hard to move.
• Numbness and Weakness Cancer growth in the spine can squeeze or press on the spinal cord — a potentially serious complication. The spinal cord has nerves that allow you to move and feel what happens to your body. If the nerves get compressed, it can cause numbness and weakness in the areas of the body below the tumor. Spinal cord compression can also cause difficulty urinating and controlling your bowel movements. If you have any of these symptoms, let your team know right away. Left untreated, spinal cord compression can result in paralysis.
• Extreme Thirst, Loss of Appetite, or Sluggishness As cancer cells damage the bones, calcium is released into the blood. This can lead to high blood calcium levels, or hypercalcemia, and cause you to make more urine, leading to dehydration. It can also cause extreme fatigue or sleepiness, loss of appetite, or nausea. If you experience any of these symptoms, alert your medical team right away. Left untreated, hypercalcemia can lead to complications like kidney failure, difficulty thinking or concentrating, and even coma.

• X-rays create an image that allows providers to see the bones inside the body and identify any abnormal areas or tumors.
• Computerized tomography (CT) combines a series of X-rays to create a more detailed image, and can also be used to guide a needle for biopsy.
• Bone scans (scintigraphy) take images of the entire skeleton at once.
• Positron emission tomography (PET) is similar to bone scans, but involves an injected substance that highlights cancer cells.
• Magnetic resonance imaging (MRI) provides an extremely detailed picture of both bone and soft tissues, and are often used to follow up on an abnormal X-ray result.
• Biopsy involves removal of bone tissue to test in a lab for cancer cell identification.

• Systemic Cancer Treatment Some of the same methods your doctor uses to treat the cancer in your lungs can also shrink bone tumors and relieve the pain of bone metastases. Depending on the particular characteristics of your cancer, this may include chemotherapy, immunotherapy drugs, or targeted medications. You should also consider clinical trials if you have advanced lung cancer with metastases, particularly if your current therapies aren’t adequately controlling the disease, says Cummings.
• Bone-Modifying Medications Drugs called osteoclast inhibitors can treat cancer that has spread to the bones. They do so by slowing down the action of osteoclasts, thereby slowing or preventing tumor growth in the bones. This can reduce bone damage and pain, as well as hypercalcemia.

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• Radiation This technique uses powerful beams of energy to shrink tumors and relieve pain. Depending on the size and location of bone metastasis, stereotactic radiation therapy may be used. This is a precise, intense radiation treatment that aims beams of radiation at the tumor from many different angles.

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• Surgery If a bone has fractured or is very weak and at risk of fracturing, you may be referred to an orthopedic surgeon, who can insert a rod or pin to stabilize the bone, says Cummings. Spinal fractures or compression are sometimes treated with an outpatient procedure called vertebroplasty, in which a quick-setting bone cement is injected into a collapsed vertebra to build it back up and help relieve symptoms.
• Palliative Care This type of specialized medical care focuses on relieving symptoms, mitigating any side effects of treatment, and improving overall quality of life. Talk to your NSCLC treatment team about all the palliative care options available at your center.

Information and support for people with lung cancer and their families is also available at the American Cancer Society (ACS), the Go2 for Lung Cancer foundation, and the Global Resource for Advancing Cancer Education (GRACE).

• Non-small cell lung cancer can spread to the bones, including the long bones, ribs, spine, and pelvis.
• Bone metastases cause symptoms like bone pain, broken bones, numbness, weakness, and high blood calcium levels, which can cause extreme thirst and sluggishness.
• Your cancer treatment team may recommend treatments including systemic cancer medications, bone-modifying medications, and surgery to address bone metastases with non-small cell lung cancer.