Easing the Pain Caused by Bone Cancer

By Denis R. Clohisy, M.D.

There more than 200 bones in the human body, and any of them can be affected by cancer. The two main types of bone cancer are primary bone cancer (cancer that originates in bone), and cancer that has spread from another part of the body.

The spread of cancer to the bone, called bone metastasis, is very common. Bone metastasis is a result of cancer cells that break away from a primary tumor, such as a breast tumor, and travel to other areas of the body through the blood stream. Bones are one of the most common sites where these cancer cells settle and grow. The most common types of cancers that spread to bones include those of the breast, prostate, lung, kidney, and thyroid.  Bone metastasis can occur in bones anywhere in the body, but they are mostly found in the spine, ribs, pelvis, and bones near the hips and shoulders.

Cancers that originate in bone, called bone sarcomas, are rare. These tumors tend to be more common in children and adolescents than in adults. The most common types of bone sarcomas are osteosarcoma, Ewing's sarcoma, chondrosarcoma, and fibrosarcoma. Some sarcomas are more common in specific bones. For example, osteosarcoma and Ewing's sarcoma are most commonly found in the bones around the knee, while the pelvis is the most frequent location for chondrosarcoma. However, it is possible for these cancers to affect any bone in the body.

The exact cause of most bone sarcomas is unknown and most people with bone cancers do not have any apparent risk factors. Researchers, however, have found that some conditions can increase a person's risk for developing bone cancer, such as inherited mutated genes or previous radiation treatment.

Common symptoms of bone sarcomas include swelling and pain in the affected bone. If you experience these symptoms and they do not appear to be caused by an injury, talk with your health-care provider immediately so he or she can perform appropriate medical tests.

All types of bone cancer sarcomas and cancers that spread to bone can be extremely painful. In the early phase of bone cancer, the pain is constant but can be managed with medication and other therapies. As the cancer progresses, however, bone cancer pain generally will also increase. This form of advanced cancer pain can greatly diminish a person's quality of life, affecting everything from the ability to work, sleep, move, or exercise.

Current treatments for this advanced pain are often inadequate. In an effort to better understand how bone pain develops and how to treat it, my colleague Patrick Mantyh, Ph.D., and I have recently identified how certain cell changes in bone, bone cancers, and the nervous system trigger pain. We are currently using this knowledge to study the possibility of developing new, more effective bone pain treatments.