Managing symptoms of bone metastases

When you have metastatic breast cancer in the bone, you may have symptoms you need to manage.

Remember, everyone is different and it is unlikely you will experience all of these symptoms. It depends on:

• which bones are affected
• the treatment you are having
• your general health and wellbeing.

Your treating team can recommend treatments and ways to help control any symptoms.

Pain with metastatic breast cancer

It’s important to know that pain can almost always be controlled. There are many options for pain-relieving drugs (‘analgesics’) that you can use on their own or with others.

Read about ways to Manage pain due to metastatic breast cancer.

Fractures (broken bones)

When cancer cells grow, they can cause bones to become so weak they break easily.

The most common symptom of a fracture is pain at the site of the break.

Weight-bearing bones such as the legs or spine are at the highest risk of fracture. Arm fractures can also be caused by a fall or lifting heavy weights. Sometimes fractures happen without any trauma at all.

If you have a fracture in a major bone, it’s likely you’ll need surgery to repair it. An orthopaedic surgeon can secure the bone with a screw or plate or replace a joint such as a hip that has been affected by cancer.

Bisphosphonates (drugs that strengthen bone) and radiotherapy may help to prevent new fractures. Read about Bone-strengthening medications.

Hypercalcaemia

Hypercalcaemia means the blood has high levels of calcium. Although this is uncommon with bone metastases, you need immediate medical attention if it happens.

Bone is a living tissue made up of calcium and proteins. Breast cancer cells growing in the bone change its structure and, as a result, calcium is released into the blood.

Breast cancer cells may produce a hormone that also contributes to high calcium levels by disrupting the calcium balance.

If calcium levels become too high they can cause a range of symptoms including:

• excessive thirst
• frequent urination
• constipation
• nausea and loss of appetite
• sleepiness, confusion or weakness.

Severe hypercalcaemia can cause loss of consciousness.

Treating hypercalcaemia

You may need treatment in hospital. Treatment is usually:

intravenous fluids to flush the calcium out of the body and

drugs such as bisphosphonates (e.g. zoledronic acid) or denosumab.

Low blood cell count

Cancer in the bone marrow can cause low blood cell counts, specifically:

• low red blood cells (‘anaemia’)
• low white blood cells, which increases the risk of infection
• low platelets, which causes bleeding.

Chemotherapy and radiotherapy, especially to the pelvis, can also affect the bone marrow and cause low blood counts.

Regular blood tests will monitor your blood counts, to adjust your treatment if necessary.

Controlling the cancer may improve the bone marrow function.

You may need a blood transfusion if anaemia continues.

Spinal cord compression

Spinal cord compression is a rare complication of bone metastases.  It requires urgent medical attention.

It can be caused by:

• a weakened vertebra that collapses and puts pressure on the spinal cord
• a cancer that grows near or in the spine, pressing on the spinal cord.

Symptoms may include:

• increased pain or tenderness in that area of the spine
• sudden change in feeling, such as pins and needles or numbness
• weakness in the legs
• loss of bladder or bowel control.

If you experience any of these symptoms you should contact your treating team straight away. If it is out-of-hours, phone the emergency number given to you by your treating team or go to your local hospital emergency department. Do not wait until the next day to seek treatment.

Treating spinal cord compression

Spinal cord compression is most often treated with radiotherapy. If these symptoms appear suddenly and progress rapidly, you may need urgent surgery to prevent permanent damage to the nerves or spinal cord.