Coping With Bone Metastases From Breast Cancer

Coping With Bone Metastases From Breast Cancer

When breast cancer spreads to the bones, it can cause severe complications like fractures, pain, and hypercalcemia. Unfortunately bone metastases are relatively common, occurring in up to 70% of patients with advanced breast cancer. While bone mets can significantly impact quality of life, there are treatments available to help manage symptoms and prolong survival.

What are Bone Metastases?

Bone metastases refer to breast cancer cells that have spread from the original tumor site and multiplied in the bone. This causes lesions or tumors to form within the bones. The ribs, spine, pelvis, and long bones of the arms and legs are most commonly affected.

Bone mets develop when breast cancer cells break off from the primary tumor and enter the bloodstream. They then circulate until lodging in and adhering to bone marrow. The bones rich blood supply nurtures the metastasized cancer cells, allowing them to grow and destroy healthy bone tissue.

Signs and Symptoms of Bone Metastases

Some key signs of possible bone mets include:

• New onset or worsening bone pain - typically feels dull, achy, or throbbing
• Swelling around affected bones
• Limited mobility in joints near metastases
• Spinal cord compression (back pain, numbness, weakness)
• Fractures, often in weight-bearing bones of hips, legs, arms
• High blood calcium levels (confusion, fatigue, nausea)

Since many of these symptoms mimic regular aches and pains, bone metastases often go undetected initially. Speak to your oncologist promptly about any new bone pain, fractures, or limitation in movement as it could signal mets.

Diagnosing Bone Metastases

If bone metastases are suspected, doctors can deploy several tests to confirm their presence and location, including:

• Bone Scan - Radioactive material is injected into the bloodstream and highlights areas of high bone activity. Hot spots indicate metastases.
• PET Scan - Radioactive glucose highlights tumors throughout the body, including the bones.
• CT Scan - Detailed cross-sectional x-rays detect bone changes from metastases.
• MRI - Magnetic fields and radio waves produce 3D images of bone marrow to pinpoint mets.
• Biopsy - Removing a small bone or marrow sample for lab analysis can definitively diagnose metastases.

Identifying metastases early maximizes treatment options and life expectancy. If you had a high-risk subtype like triple negative or HER2+ breast cancer, remain vigilant about screening for recurrence.

Bone Metastases Staging

Staging describes the severity and progression of cancer. Bone mets are categorized as either:

• Oligometastatic - Cancer has spread to a limited number of bone sites, typically 1-3 locations.
• Polymetastatic - Cancer has spread to multiple bones throughout the body.

Patients with fewer bone metastases generally have better outcomes. Their cancer may still be isolated enough to be controlled with localized radiation therapy.

Treating Oligometastatic Bone Lesions

For oligometastatic bone disease confined to a few isolated bone lesions, treatments like:

• Surgical resection - Removing the metastatic bone tumor if possible.
• Ablative radiotherapy - Delivering focused, high-dose radiation to target lesions.
• Stereotactic body radiotherapy (SBRT) - Providing concentrated radiation over just a few treatments.

These localized therapies help eliminate cancer cells without exposing the whole body to radiation. They can provide lasting control of limited bone mets.

Treating Widespread Bone Metastases

When multiple bone sites are affected, systemic treatments like chemotherapy, hormone therapy, targeted drugs, and bone modifying agents become necessary. Goals include limiting bone damage, reducing complications, and managing pain.

Intravenous bisphosphonates like zoledronic acid are commonly used to:

• Slow bone destruction by inhibiting osteoclasts (cells involved in bone breakdown)
• Reduce risk of pathologic fractures and need for radiation or surgery
• Help control bone pain from metastases

The RANK ligand inhibitor denosumab has been shown to reduce skeletal-related events like fractures even better than bisphosphonates.

For cancers fueled by estrogen or progesterone, anti-hormonal drugs can slow tumor progression and offer palliative effects. Targeted therapy matches specific drugs to the biomarkers expressed by cancer cells. Chemotherapy may help those with aggressive or rapidly advancing bone metastases.

Managing Pain From Bone Metastases

Metastases in weight-bearing bones often cause severe discomfort. Effective pain management is critical for maintaining quality of life. Options include:

• Over-the-counter analgesics like acetaminophen and NSAIDs
• Prescription narcotic pain medications
• Joint support braces or orthopedic devices
• Physical therapy and exercise
• Complementary techniques like massage, acupuncture, meditation

If you have severe or breakthrough pain, speak to your oncologist about prescribing a long-acting opioid or trying a spinal epidural. Relieving pain can help you stay active and slow bone density loss.

Managing Hypercalcemia From Bone Metastases

Bone metastases can cause dangerously high blood calcium levels (hypercalcemia) by releasing calcium from deteriorating bones. Symptoms require prompt treatment and include:

• Fatigue, confusion, cognitive issues
• Nausea, vomiting, poor appetite
• Extreme thirst and frequent urination
• Abdominal pain, constipation
• Muscle weakness, bone pain

Severe hypercalcemia requires hospitalization for IV hydration and calcium-lowering drugs like bisphosphonates, denosumab, and calcitonin. Milder cases can be managed with increased fluids and diuretics to flush out excess calcium.

Preventing Fractures and Spinal Cord Compression

Bone mets weaken structural integrity and heighten fracture risk, especially in the hips and legs. Vertabral metastases can also trigger spinal fractures leading to nerve damage.

To help prevent fractures:

• Get prompt treatment for bone pain
• Adhere to bone modifying medications
• Use walking aids and orthotics
• Do weight-bearing and resistance exercises
• Maintain a calcium and Vitamin D rich diet

Good posture, back braces, and steroids like dexamethasone can help alleviate pressure on compressed nerves causing numbness, weakness, or paralysis.

Palliative Radiation Therapy

Targeted radiation is frequently used to manage painful bone metastases. It destroys cancer cells triggering discomfort. Radiation can rapidly improve quality of life by:

• Relieving bone pain in 50-80% of patients
• Stabilizing bone to prevent pathologic fractures
• Slowing hypercalcemia by protecting bones
• Shrinking spinal or brain tumors causing neurologic symptoms

You can undergo palliative radiation therapy over just 1-5 days. Repeat if pain recurs. Radiosurgery like CyberKnife delivers ultra-precise beams requiring only 1-3 high dose treatments.

Alternative Therapies to Relieve Bone Pain

Talk to your oncology team about adding complementary techniques to ease bone metastasis discomfort:

• Physical therapy - Stretches and exercises improve mobility and strengthen bones.
• Massage - Relieves muscle tension exacerbating skeletal pain.
• Acupuncture - Stimulates natural pain relief hormones like endorphins.
• Mindfulness meditation - Reduces perception of pain signals.
• Yoga - Gentle poses boost flexibility, balance, and breathing techniques for pain management.

A multidisciplinary approach combining treatments can optimize bone mets pain relief. Don't hesitate to speak up if your pain isn't adequately controlled.

Living With Bone Metastases

Bone metastases can negatively impact mobility, energy levels, emotional health, and independence. But maintaining quality of life is absolutely still possible. These tips can help:

Get Good Nutrition

Eat a balanced diet focused on lean proteins, fruits and vegetables to help your body heal. Calcium and Vitamin D support bone health. Stay hydrated since dehydration worsens pain and hypercalcemia.

Conserve Energy

Listen to your body and rest when needed to avoid exhaustion. Take breaks between activities or ask for help with strenuous tasks. Take a nap or meditate when fatigued.

Join a Support Group

Connecting with others experiencing metastatic breast cancer can reduce isolation. Share coping strategies and encouragement in-person or online.

Express Your Feelings

Confide worries, fears, and grief over your diagnosis with loved ones. Consider counseling or journaling to process difficult emotions. Focus on enjoying each day.

Make Your Home Safer

Reduce fall risks by installing grab bars in bathrooms, removing trip hazards, and improving lighting. Use chairs with firm arms for support when standing.

Try Occupational or Physical Therapy

An OT or PT can recommend assistive devices and exercises to maintain strength, functionality and prevent falls. They also teach techniques for daily activities.

While bone metastases present challenges, numerous treatments exist to limit their impact and progression. Being proactive with your medical team gives you the best chance of living fully and comfortably.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.