Bone Metastasis

  • What is bone metastasis?

    When cancer in one part of the body grows and spreads to another part, it is said the cancer has metastasized. When the cancer spreads to a bone it is called bone metastasis.

    Bone has an outer layer and a spongy inner layer. Inside that inner layer is bone marrow. All parts of the bone have blood vessels running through it, and through this network of blood vessels cancer can spread.

    Using laboratory tests doctors can tell when a cancer began in the bone (primary cancer) or has spread to the bone (secondary cancer). These tests show what types of cells are within the cancer that was found in the bone.

    For example, if the person originally had brain cancer and is now showing symptoms of bone cancer, tests can show the bone cancer has brain cells in it and is therefore a secondary cancer, not the original cancer. This information is important because it can have a significant impact on how the cancer can be treated.

  • Causes

    When cancer cells break away from a tumor, they move through the body by blood vessels or the lymphatic system (part of the circulatory system). These cells may land in a different part of the body and that is how cancer metastasizes or spreads.

  • Signs and symptoms

    Symptoms of bone metastasis depend on a variety of factors including the type of tumor, location of the tumor, and your child’s age and general health.

    Indications of bone metastasis include:

    • Bone pain, especially at night or at rest
    • Bone fractures
    • Compression of the spinal cord, which can cause pain and numbness in certain areas of the body due to pressure on the spinal cord
    • Specific complaints such as loss of bowel and bladder control
  • Testing and diagnosis

    Diagnosing bone metastasis — and the origin of the cancer cells — requires a thorough evaluation, a physical examination of your child and a detailed medical history.

    At The Children’s Hospital of Philadelphia, clinical experts use a variety of diagnostic tests to diagnose bone metastasis and malignant tumors, including:

    • Radioisotope bone scan, which can help locate areas of abnormal growth.
    • X-rays, which produce images of bones.
    • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
    • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to produce cross-sectional images ("slices") of the body.
    • Blood tests, which can help determine drug usage and effectiveness, biochemical diseases and organ function.
    • Bone marrow aspiration, a surgical procedure in which a small amount of bone marrow fluid and cells are removed by a needle inserted into a bone to check for problems with any of the blood cells made in the bone marrow.
    • EOS imaging, an imaging technology that creates 3-dimensional models from two planar images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning.
  • Treatments

    At The Children’s Hospital of Philadelphia, we practice collaborative, family-centered care. A team of expert clinicians — including leading orthopedic and oncology physicians and surgeons, advanced practice nurses, physician assistants, pediatric nurses, physical and occupational therapists, psychologists and other specialists — will partner with you in the care of your child.

    Bone metastasis is fast-growing and cancerous, so treatment must be similarly aggressive. The best way to treat bone metastasis is to treat the primary or original cancer.

    There are some treatments that can slow the spread of the cancer in the bone. One such treatment is a class of drugs called bisphosphonates, which decrease the risk of complications such as bone fractures, and lower blood-calcium levels that are too high.

    Research has also shown that over-the-counter pain relievers like aspirin and ibuprofen can be effective — at least in the short term — in stopping prostaglandin, which is responsible for a lot of bone pain. Prostaglandins are messenger molecules that control the contraction and relaxation of smooth muscle tissue.

    There are numerous options for treating bone metastasis. You and your child's doctor will discuss the best option for your child, which could include surgery, chemotherapy, radiation therapy and proton therapy. 


    Surgical treatment for bone metastasis may be used alone or in conjunction with chemotherapy, radiation therapy or proton therapy. 

    Surgeries performed are typically:

    • Wide resection with margins
    • Resection and reconstruction

    In a wide resection with margins, the tumor is surgically removed, as well as some of the healthy tissue that surrounded the tumor — the margins of the tumor. In some cases, the child will need reconstructive surgery after the tumor has been cut out.

    Reconstruction can include:

    • Endoprosthetics, which can be expanded as the child grows. These are artificial bones made of different types of metal.
    • Free vascularized fibular grafting, which includes moving one bone from the lower leg to replace a diseased thigh bone
    • Amputation of a limb 
    • Other

    Though surgery for malignant tumors is highly effective, we understand that any surgery can be a stressful experience for your child and family. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

    Additionally, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. For more details about safety protocols at The Children's Hospital of Philadelphia, see safety in surgery.


    Chemotherapy refers to medicines that help fight cancer. They are given by mouth, in the vein, in the muscle or under the skin. Intrathecal chemotherapy is chemotherapy that is injected into the spinal fluid to prevent or treat a malignant tumor in the brain and spinal cord.

    Radiation therapy

    Radiation therapy uses high-energy waves such as X-rays to kill or shrink cancer cells. It is sometimes used to treat cancer in the central nervous system or other places such as the eye or the testes.

    Proton therapy

    Proton therapy is an innovative form of radiation treatment that allows for more precise radiation doses delivered to cancerous tumors. Proton therapy’s greatest benefit is that it is less damaging to the surrounding healthy tissue because it delivers most of its energy to a very narrow field at the location of the tumor. Learn more about proton therapy.    

  • Follow-up care

    Most children are able to go home shortly after surgery. They may require pain medications until the surgical site heals or ongoing physical therapy.

    Your child will see the orthopedic surgeon about one to two weeks after surgery, then again at three and six months post-surgery. Annual monitoring by trained clinicians is strongly encouraged to monitor for possible recurrence of the growth.

    Malignant tumors can reoccur — even after being successfully treated — so it is important for your child to see a physician regularly, especially if any symptoms reoccur.

    During follow-up visits, X-rays and other diagnostic testing of the tumor site are recommended to closely monitor your child’s health and ensure there are no side effects from surgery, chemotherapy or proton therapy.

    Follow-up care and ongoing support and services are available at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with parents and referring physicians to provide the most current, comprehensive and specialized care possible for your child.

  • Outlook

    The long-term outcome of bone metastasis depends on many things: the type of primary or original cancer, how well your child responds to treatment, and if the cancer has spread to more than one location. 

Reviewed on May 20, 2014