Metastatic bone disease: diagnosis and treatment of secondary bone cancer

Written by: Mr Ian Holloway
Published: | Updated: 30/11/2018
Edited by: Top Doctors®

Metastatic bone disease, or bone metastases, is due to cancer from another part of the body that has spread to the bone. It is most commonly related to spreading from primary malignancies in the breast, lung, kidney, thyroid and prostate. It can be asymptomatic, but usually causes pain and can result in disability. Mr Ian Holloway, expert consultant orthopaedic surgeon, explains more…

Diagnosis of metastatic bone disease

Metastatic bone disease can occur anywhere in the skeleton. It tends to cause most problems when located in the long bones (femur and humerus), or in the pelvis or spine. The metastatic bone disease process tends to cause localised weakness in the bone, resulting in a risk of fracture.

Such fractures can occur with less force than would usually be required to cause the bone to break. The diagnosis is usually made on the basis of symptoms and is confirmed with X-Rays and scans. A biopsy is sometimes performed.


Treatment for bone metastases

Treatment is undertaken using a multidisciplinary team approach, with input from an oncologist, orthopaedic surgeon, specialist nurse, physiotherapist and anaesthetist. Many cases of metastatic bone disease can be treated with radiotherapy and chemotherapy alone.

Ongoing observation in the outpatient centre is required. Cases associated with a significant risk of fracture tend to need prophylactic surgery to stabilise the bone to avoid fracture, or (if fracture has already occurred), to fix the fracture. This is usually done with a device to stabilise the whole bone, called an intramedullary nail. If the metastasis is near a joint, then joint replacement is sometimes used.


Results of treatment for metastatic bone disease

Surgical treatment is not usually curative. It is designed to treat pain and improve function, and to enable subsequent radiotherapy and chemotherapy to be undertaken. Due to the multidisciplinary nature of treatment for metastatic bone disease, it is best practice for treatment to be undertaken at a specialist centre, which has the appropriate specialities represented.

Mr Ian Holloway

By Mr Ian Holloway
Orthopaedic surgery

Mr Ian Holloway is a leading consultant orthopaedic surgeon in London, who specialises in hip and knee replacement surgery. He trained in London and was a senior trainee at the Royal National Orthopaedic Hospital.

Mr Holloway completed two specialist hip and knee fellowships in Sydney and Melbourne, Australia. He undertakes revision hip replacement for cases with significant bone loss and for periprosthetic fractures. He built his experience on the Bone Tumour Unit at Stanmore and treats patients with metastatic bone disease with an emphasis on early symptom control and aggressive rehabilitation.

Mr Holloway is a national and international speaker on enhanced recovery after hip and knee replacement. He has publications in the medical literature on hip and knee surgery and is also on the teaching faculty of a number of orthopaedic training courses. 

He is Deputy Training Programme Director for higher surgical trainees in the North West Thames region and is Clinical Lead for orthopaedics at the London North West Healthcare NHS Trust. He is a reviewer for the Bone and Joint Journal.

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