Non-small cell lung cancer (NSCLC) makes up about
The survival rate for people with lung cancer is highest when it’s caught in the early stages, but it’s estimated that
NSCLC can spread to almost any part of your body, but it
In this article, we take a closer look at bone metastasis in NSCLC, including symptoms and how it affects treatment and outlook.
Bone metastasis is the spread of cancer to bone tissue from another organ. Metastatic NSCLC is also referred to as stage 4 NSCLC.
It’s estimated that about
Cancer can metastasize when tumor cells enter your lymph system or blood vessels. Once cancer cells enter these systems, they can spread to almost any part of your body. For people with NSCLC, bone is one of the
- the other lung
- adrenal glands
The researchers also found that the ribs were the most common site of bone metastasis followed by the thorax (area between your neck and bottom of your rib cage) and lumbar spine.
People with bone metastasis share the same symptoms as other people with NSCLC along with specific symptoms depending on where in the skeleton cancer spreads.
General symptoms of NSCLC include:
- shortness of breath
- chest pain
- loss of appetite
- unintentional weight loss
- coughing up blood
- coughing up phlegm
Most people with bone metastases develop pain. According to the
- high blood calcium levels
- increased risk of fractures
- spinal compression, which can cause:
- severe pain and weakness in your legs
- loss of bowel and bladder control
- reduced coordination
- numbness in your legs
Doctors sometimes discover bone metastases with imaging before symptoms develop. Your doctor may order imaging to look for bone metastases if you have suggestive symptoms.
Many different types of imaging can potentially identify bone metastasis. Here are some of the types of imaging you may receive:
- X-rays: X-rays can help doctors identify the size and shape of your tumors. However, they only detect about 40% to 50% of bone metastases and generally require a 30% to 75% decrease in bone density.
- Magnetic resonance imaging (MRI): MRI is the imaging of choice when it’s suspected you might have spinal cord compression. It can detect about 95% of bone metastases.
- Computed tomography (CT) scan: A CT scan can potentially identify cancer before there’s enough bone destruction for metastases to appear on X-rays.
- Bone scans: Bone scans are especially useful for identifying osteoblastic metastases, which are areas where cancer cells cause too many bone cells to form. Bone scans can detect about
- Fluorodeoxyglucose-positron emission tomography-CT scan (FDG-PET-CT): An FDG-PET-CT may be recommended if there’s a concern of bone metastases at the time of diagnosis. They can detect about 98% of metastases.
A definitive diagnosis can be made with a bone biopsy where a small section of bone tissue is extracted for lab analysis. A biopsy may not be performed if doctors have a high level of suspicion that the cancer has spread or if performing a biopsy would cause substantial risk.
Your doctor may also order a blood test to look for elevated calcium levels or other markers that suggest the cancer has spread.
NSCLC with bone metastasis isn’t generally considered curable. Treatment aims to:
- reduce symptoms
- maximize daily function
- improve quality of life
Researchers are continuing to examine different treatments for metastatic NSCLC. Current treatment options include:
- Painkillers: About 70% of people with bone metastases need opioids for pain management.
- Chemotherapy: The most common
chemotherapydrug combination for stage 4 NSCLC is cisplatin or carboplatin with gemcitabine. Although any other drug combinations may be used to try to destroy cancer cells.
- Targeted therapy:
Targeted therapymodifies genes and proteins in cancer cells to stop them from dividing. Your doctor may recommend targeted therapy if you have certain gene mutations.
- Surgery: Surgical removal of the primary lung tumor may help some people obtain
longer survival. Surgery may also be used to treat metastases that have severely weakened a bone or are causing spinal cord compression.
- Radiation therapy: Radiation therapy can potentially help shrink metastatic tumors. About half of people experience pain relief after 1 or 2 weeks.
- Bisphosphonates and denosumab: The Food and Drug Administration (FDA) has approved bone-modifying agents, such as bisphosphonates and denosumab, for the management of bone metastases in all solid tumors to prevent bone loss.
NSCLC with bone metastasis is generally associated with a poor outlook, but the outlook is slowly improving over time.
People with bone metastasis frequently have
Only about half of people with metastatic NSCLC live more than 14 to 17 months.
NSCLC can spread to distant organs if cancer cells reach your bloodstream or lymph system. Bone is the most common place for NSCLC to spread.
Metastatic NSCLC tends to have a poor prognosis, and treatment generally aims to maximize quality of life and minimize symptoms.
Receiving a cancer diagnosis can be difficult, but your doctor can help you develop the best treatment plan for your specific situation.
Survival rates are slowly improving over time as treatment improves. Your doctor may recommend taking part in a clinical trial that may give you access to treatment that’s more effective than current standard treatments.