Can Lung Cancer Spread to the Bone?

When a solid tumor such as breast cancer spreads to the bone, it is called metastatic bone cancer or bone mets. The two most prevalent sources for bone mets are breast and prostate cancer. Lung cancer is the third most common type of cancer to spread to the bones. Both small cell lung cancer and nonsmall cell lung cancer are capable of metastasizing into the bone.
For about 80% of lung cancer patients with bone mets, pain is likely to be the first symptom. A doctor will order a special type of imaging called a bone scan or a PET/CT scan to determine if a metastatic tumor is causing the pain, and if there are any other locations that are not yet creating symptoms. One study showed the skeletal areas most often affected by nonsmall cell lung cancer bone mets:

• Spine (50%)
• Ribs (27.1%)
• Ilium or largest part of the hip bone (10%)
• Sacrum or backbone at the base of the spine where it meets the hip bones (7.1%)
• Femur or thigh bone (5.7%)
• A very small number (2.9%) form in the long bone of the upper arm, shoulder blade, or breastbone.ⁱ

Diagnosing bone mets

Imaging by bone scan and/or MRI is used to detect and diagnose bone mets. To perform a bone scan, a very small amount of a radioactive substance called a tracer is injected into a vein. As the tracer travels through the body, it will be absorbed by bone tumors, usually in about 2-4 hours so patients are advised to bring a book to occupy them while they sit comfortably to wait for maximum absorption. Once this happens, the patient undergoes an imaging scan. An experienced radiologist is able to interpret any areas suspicious for bone mets, and these results are used to plan treatment.

In addition, an MRI (magnetic resonance imaging) scan may also be ordered. MRI provides information that supplements the bone scan, and does not involve exposure to radiation.

Treating lung cancer bone mets

Once a diagnosis of bone mets has been established, prescribing chemotherapy or immunotherapy is considered the standard of care. There are different drug strategies, for example, strengthening bones or inhibiting tumor “hijacking activity” against bone may slow the cancer’s destructive action. In some cases, a doctor may recommend surgery or radiation.

A new treatment for bone mets pain

Whether bone mets develop from lung cancer or other organ cancer, there is a new noninvasive treatment for painful bone mets that uses focused ultrasound, or targeted sound waves. It is called MRI-guided Focused Ultrasound (MRgFUS) and is used to control bone pain. In a similar manner that a magnifying glass focuses sunlight to create a small spot of bright, hot light, a special technology can focus sound energy precisely into a bone tumor where it creates enough heat to destroy the tumor. MRgFUS is performed inside an MRI scanner, because the real-time imaging identifies the target and guides the soundwaves accurately so there is no damage to nearby healthy tissue. MRgFUS can be used in any of the locations listed above, as long as the tumor can be seen on MRI.

How effective is MRgFUS?

In a study at Stanford University, most patients found pain relief within 3-7 days of the treatment, and at three months’ follow-up, 65% reported substantial pain reduction.ⁱⁱ Since there is no surgery, recovery is rapid and patients experience improved quality of life.

The Sperling Medical Group offers MRgFUS for painful bone mets from lung cancer or other cancers. If you or a loved one has bone mets pain that does not respond to pain control medication, contact the Sperling Medical Group to learn if MRgFUS can help.

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ⁱD’Antonio C, Passaro A, Gori B, Del Signore E et al. Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies. Ther Adv Med Oncol. 2014 May; 6(3): 101-114.
ⁱⁱhttps://stanfordhealthcare.org/medical-treatments/m/mr-guided-focused-ultrasound/procedures/bone-metastasis-pain.html