Sometimes cancer cells break away from the original tumour and travel to the bones in different parts of the body. This may happen through the lymph or blood system.
The cells that have spread to the bone are breast cancer cells. It is not the same as having cancer that starts in the bone.
The bone is the most common site of secondary breast cancer. The bones most commonly affected are the spine, ribs, skull, pelvis, or upper bones of the arms and legs.
When breast cancer spreads to the bone, it can usually be treated often for many years but it cannot be cured.
What symptoms might I have and how can they be managed?
If you have secondary breast cancer in the bone, you may have a number of different symptoms or none at all. Many people with secondary breast cancer in the bone feel quite well and their symptoms can be controlled.
Any symptoms you may experience can also be a sign of conditions other than secondary breast cancer in the bone so you should talk to your specialist team about any new symptoms you have.
Secondary breast cancer in the bone can cause pain that may range from mild to severe. Each person’s experience of pain is different. For example the pain may feel like a dull ache or a burning or stabbing pain. You may find that the pain is there all the time, or it may be worse at night. If the pain is not well controlled, it can affect your mobility and quality of life.
Pain can almost always be improved or relieved. Try to be very clear when you are telling your doctor or nurse where the pain is and what it feels like. You may find it helpful to record this in a ‘pain diary’ that you can get from your doctor or nurse.
Bone weakening and/or fracture
Secondary breast cancer in the bone may mean that the affected bones are weakened, which can sometimes increase the risk of fracture (breaking a bone). This is called a pathological fracture which means that the break in the bone is due to disease and not as a result of an accident.
If a bone has become weakened, radiotherapy or surgery can be used to try to prevent it from fracturing. An orthopaedic surgeon may be able to secure the bone with a metal screw or plate, or replace a joint, for example a total hip replacement. The implants that are used in these procedures are designed to last indefinitely. If a bone has already fractured then an orthopaedic surgeon will try to repair the fracture, again by using a metal screw or pin or joint replacement. In rare cases, a whole section of bone can be replaced (endoprosthesis).
Spinal cord compression
If an area of the vertebrae (bones in the spine) fractures or collapses it can cause pressure on the spinal cord (spinal cord compression). The symptoms of spinal cord compression are an increase in pain around the spine, tenderness over the spine that sometimes goes down one or both legs, changed sensation such as pins and needles or weakness in the legs and incontinence (loss of ability to control the bladder and/or bowels).
Spinal cord compression requires immediate medical attention and should be treated as an emergency. If you experience any of these symptoms it is important to contact your specialist team or GP without delay.
Hypercalcaemia (excessive calcium in the blood)
Bone is living tissue and consists of calcium and various proteins that make it strong. Secondary breast cancer in the bone can alter the bone structure so that calcium is released into the bloodstream. If the calcium level gets too high you may get symptoms such as nausea, vomiting, constipation or drowsiness. In more severe cases you may experience excessive thirst, weakness or confusion.
To relieve your symptoms you might be told to drink plenty of water but you will usually need to go into hospital or a hospice to have intravenous fluid (fluid given directly into a vein). This fluid helps to flush the calcium out of the body through your urine. You may also be given one of a group of drugs known as bisphosphonates.
Anaemia/bone marrow infiltration
In rare cases the secondary breast cancer may invade the bone marrow. This is the hollow part of the bone where blood cells are made. This may cause anaemia (lack of red blood cells). You may get symptoms such as tiredness or breathlessness and need blood tests and a bone marrow biopsy to make a diagnosis. Anaemia can be treated with regular blood transfusions in hospital.
Content last reviewed November 2012; next planned review 2014