top of page
Writer's pictureEmma Najman

Bone Metastases Oncology Physio

Updated: Dec 21, 2022


A diverse population of people live with bone metastases with complicated health histories including:

  • Those with mets to the bones, as well as other organs.

  • Those with bone mets throughout their spine, pelvis and ribs.

  • Those with a single metastatic spot.



Cancer Rehab Physio is to help people:

  • Optimise their physical capacity.

  • Maintain their independence.

  • Avoid falls.

  • Understand went to seek emergency care.

  • Learn to live with bone mets. An ongoing process as emotional and physical health changes and needs change also.

  • Cope with ongoing daily risk assessment.

  • Cope with grief and loss.


Cancer Rehab Client performing her exercise program with her Physiotherapist

The spine is often the first bone metastatic site.


Clinical changes include:

  • Pain

  • Several metabolic disturbances

  • Increased fracture risk

  • Impaired mobility

  • Spinal cord compression

  • Hypercalcaemia

  • Suppression of bone marrow function


Other challenges include:

  • Skeletal muscle loss

  • Muscle weakness

  • Functional deficits

  • Osteoporosis and osteopenia


Pathological fractures:


Cause an increase in symptom burden and is linked to reduced survival.



Medical options to reduce fracture risk include:

  • Osteo protective medication

  • Prophylactic fixation surgery

  • Palliative radiotherapy


When older than 40 years of age the likelihood that a pathological fracture occurs from a metastatic lesion is 500 times more common than the likelihood of it being a primary bone sarcoma.


Cancer Rehab Patient working with his Physiotherapist on his exercise program

Greatest pathological fracture risk occurs in bone affected by metastases:

  • In the trochanter, near the hip, followed by lower limb, then upper limb.

  • With stronger pain levels.

  • With lytic, more than mixed and more than plastic appearance on X-ray.

  • With size of lesion greater than 2/3rds of the bone cortex, rather than less than 2/3rds to 1/3rd.

Pain with functional activity is associated with greater risk of pathological fracture.


Metastatic spinal cord compression is a medical emergency.


Symptoms include:


Pain, usually severe, at the level of the lesion, which progressively increases in intensity.


With worsening pain or neurological symptoms, recording, reporting and seeking medical advice is recommended.


If pain or neurological symptoms worsen during exercise, stop the activity and return to a spinal protective position which reverses the symptoms.


Pain with weight bearing activities can be a warning of pathological fractures, particularly of the legs.


Pain should be monitored throughout the exercise session and modified accordingly.



The highest prevalence of bone mets occurs in those with:

  • Advanced prostate cancer = 85%

  • Advanced breast cancer = 70%

  • Advanced lung cancer = 49%

  • Advanced kidney cancer = 40%


The most common sites for skeletal metastasis include:

  • Spine 87%

  • Ribs 77%

  • Pelvis 63%

  • Femur 53%

  • Skull 35%

What is the difference between Lytic and Plastic bone lesions in cancer?


Osteoblasts are generally bone building cells, but can also send messages to osteoclasts to mature. Blastic lesions build bone up.

Osteoclasts are generally bone breaking down cells. Lytic lesions break bone down


Those with osteolytic mets have the highest incidence of skeletal morbidities.


50% of breast cancer patients with bone mets experience fractures.


Bone fracture presents in 75% of patients with multiple myeloma.


How are bone metastases diagnosed?


By bone scan, plain X-ray and CT scan.


How are bone metastases managed?

  • The focus is on presenting progression and treating musculoskeletal morbidities.

  • Radiotherapy can successfully release sentence.

  • Large randomised trials have demonstrated 80% of patients receiving radiotherapy for osseous metastasis will experience complete to partial pain relief typically with a 10 to 14 days after the initiation therapy.

  • Pain reduction is associated with positive changes in physical function.

  • Studies prescribing exercise for patients receiving palliative radiation treatment report no adverse events.

  • Bone targeted agents, such as bisphosphonates and denosumab have been shown to:

Decrease the incidence of skeletal morbidity;

Improve progression free survival;

Reduce the need for palliative radiotherapy and surgery.


Acute phase reactions to bisphosphonates occur in 15-20% of patients, characterised by flu-like symptoms, such as low grade fever, fatigue, arthralgia, (joint pain) or myalgia, (muscle pain), increased bone pain and nausea.



What is Hypercalcaemia?


Hypercalcaemia is a medical emergency when an abnormally large amount of calcium is in the blood, affecting 10% of patients with advanced cancer.


How does Hypercalcaemia present?


Neurological changes, cognitive changes, gastrointestinal, renal and cardiovascular symptoms.

Hypercalcaemia with malignancy usually presents with marked elevated calcium levels, above 3.5 mol/L, is usually severely symptomatic and considered and oncology emergency.


When is surgery required?


To prevent impending fractures or to stabilise a pathological fracture.



What treatment is required after bone stabilising surgery?


Weight bearing postoperatively depends on bone quality, types of fractures pattern, surgical procedure.


A collaborative approach to post operative mobilisation is paramount between the surgical and rehabilitation team.




Demonstration of an exercise progression in Rehab Program



Physical inactivity is associated with a loss in:


Physical function,

Mobility,

Balance,

Protective muscle mass,

Strength,

Bone mineral density.


The loss of these hampers quality of life and increases fracture risk.


What are the Current Research Recommendations?


The ‘No-load’ approach, avoiding load on regions with bone lesions to enable safe exercise for all other parts of the body.


Exercise has been shown to preserve physical function in prostate cancer patients with bone metastases.


Outcome measures used:


1/ Patient rated physical functioning - The Medical Outcomes Study Short Form 36 Questionnaire.


2/ Objective tests to measure physical function -


  • Timed up and go test, (timed and performed 3x with recovery between tests).

  • 6 metre walk test, testing usual and fast pace, (timed and performed 3x with recovery between tests).

  • 400 metre walk.

  • For Muscle Strength: 1 rep maximum, *(1RM) knee extension and chest press exercises.

*Strength Testing -1 RM

The one-repetition maximum (1RM) test is often considered as the ‘gold standard’ for assessing the strength capacity of individuals in non-laboratory environments It is simply defined as the maximal weight an individual can lift for only one repetition with correct technique. Purpose of test:

To determine the maximum weight that can be lifted for one complete repetition of the movement

Equipment required:

Weights dependent on muscle group testing.

Test procedure:

‘The following represents the basic steps in 1-RM (or any multiple RM) testing following familiarisation/practice sessions:

1) The subject should warm up, completing a number of sub maximal repetitions.

2) Determine the 1-RM (or any multiple RM) within four trials with rest periods of 3 to 5 minutes between trials.

3) Select an initial weight that is within the subject’s perceived capacity (~50%–70% of capacity).

4) Resistance is progressively increased by 2.5 kg to 20 kg until the subject cannot complete the selected repetition(s). All repetitions should be performed at the same speed of movement and range of motion to instil consistency between trials.

5) The final weight lifted successfully is recorded as the absolute 1-R or multiple RM.

  • Balance and risk of falling: Static and dynamic balance tests. Activities specific balance confidence scale.


3/ Bone pain nature, severity and impact - Bone Pain Questionnaire.


4/ Patient-reported physical functioning - Function Index.


5/ Cancer specific distress - Impact Events Scale.


6/ Fatigue - Questionnaire.


7/ Sleep Quality - Pittsburgh Sleep Quality Index.


8/ Tolerance of the exercise program -Participants ratings of perceived exertion on a Borg scale after every exercise session.



Demonstration of an exercise progression in Rehab Program



9/ The Safety of the exercise program - Recording the incidence and severity of any adverse events and skeletal complications.


10/ Bone pain according to the Common Terminology Criteria of the National Cancer Institute:

  • Grade 1 mild pain, not interfering with function.

  • Grade 2 moderate pain, interfering with function, but not interfering with their activities of daily living.

  • Grade 3 severe pain, severely interfering with their activities of daily living.


Exercise Prescription Guide for Bone Metastases:


Pelvic Metastases - Resistance training upper and lower limbs, (excluding hip flexion and extension, including knee flexion and extension), and trunk, non weight bearing aerobic exercise, eg cycling, and static flexibility.


Lumbar (lower back) Metastases - Resistance training upper and lower limbs, non weight bearing aerobic exercise, eg cycling, and static flexibility.


Thoracic (mid back) and Rib Metastases - Resistance training upper limbs, (excluding shoulder flexion, extension, abduction and adduction, including elbow flexion and extension), and lower limbs, weight bearing, eg walking and non weight bearing aerobic exercise, eg cycling, and static flexibility.


Proximal Femur, (upper thigh bone) Metastases - Resistance training upper and lower limbs, (excluding hip flexion and extension, including knee flexion and extension), and trunk, non weight bearing aerobic exercise eg, cycling, and static flexibility.


All regions - Resistance training upper limbs, (excluding shoulder flexion, extension, abduction and adduction, including elbow flexion and extension), and lower limbs, (excluding hip flexion and extension, including knee flexion and extension), and trunk, non weight bearing aerobic exercise, eg cycling, and static flexibility.




Example of an Exercise in the Rehab Program




Current Research


1/ Exercise Prescription in the recent M3EP trial included:



Resistance Component: Increased by 5-15% increments if 3 sets of 12 reps achieved.


Aerobic Component: 20-30 mins of cardiovascular exercise with target intensity 60-85% of estimated maximum heart rate.


Flexibility Component: Static stretching using 2-4 reps for 30-60 seconds per stretch.


2/ The second approach being investigated: “Isometric Load Approach":


Specifically training muscles in the regions with bone lesions, therefore having the potential to elicit local adaptations.


Designed for patients with spinal metastases undergoing palliative pain relieving radiotherapy.


Free isometric spinal stabilisation exercises reveal positive effects on bone mineral density after radiotherapy, pain and pain medication use.


3/ A Cross sectional study of 50 patients living with a high burden of metastatic disease reported that 92% were interested in completing exercise programs and felt able to do so.


However exercise levels in this population are sub optimal, with only 29% of patients with bone metastases meeting the current aerobic exercise guidelines for cancer survivors.



What are the Predictors of Probability of Thoracic or Lumbar Vertebra Collapse?


Probability of Thoracic Vertebra Collapse is higher the higher percentage occupancy of the tumour in the vertebral body and the destruction of costovertebral joint, then pedicle, then posterior elements.


Probability of Lumbar Vertebra Collapse is higher the higher percentage occupancy of the tumour in the vertebral body and the destruction of the pedicle, then posterior elements.


What are the key considerations for exercise prescription for someone with bone mets in their lower spine?


  • Don’t challenge this part of the spine with exercises. Exercises to challenge other parts of the body eg/ exercise bike rather than rower, as less force on lumbar spine.

  • As increased fracture risk avoid falls, prioritise balance retraining in a safe, supported environment.

  • Focus on static muscle contraction and avoid compression of lumbar spine.

  • Avoid flexion and extension exercises involving the lumbar spine.

  • Avoid twisting when exercising.

  • Exercises to strengthen quads to assist with getting up and down, eg lunges and squats with ball behind back on wall with safe, non slip, foot positioning, maintaining neutral spine.

  • Strengthen upper body with supine, unloaded chest press if no thoracic spine involvement.

  • Static strengthening of core muscles in 4 point kneeling with leg slides, progressed to leg lifts, arm lifts, then opposite arm to leg lifts, maintaining neutral spine. (75% of patients tested were able to achieve these in all sessions and were found to be beneficial so continually encouraged).

  • Static strengthening of core in elbow plank, swimmer lying on front with arms overhead or with elbows bent and upper arms lower, as tolerated, with opposite arm to leg lifts. (42-54% of patients tested were unable to achieve these in all sessions but were found to be beneficial so continually encouraged).

  • Static strengthening of upper back muscles in standing with theraband. (75% of patients tested were able to achieve these in all sessions and were found to be beneficial so continually encouraged).

  • Accept will have pain and still important to exercise safely.

  • Need to learn to live with bone mets, as an ongoing process and as emotional and physical health changes, needs will change also.

  • Ongoing risk assessment daily, understanding when to seek emergency care.

  • Monitor pain and manage risk assessment throughout exercise sessions and modify treatments accordingly.



Demonstration of an exercise progression in Rehab Program



Summary of Exercise Interventions:

Resistance exercise is prescribed systematically based on location of bone metastases, ensuring affected regions are not targeted and mechanical force at areas of metastases is minimised. This is important for those with more than one metastasis, limiting loads to multiple areas of the body.

Circuit exercise classes tailored to individuals and exercise programs, determined by baseline functional ability, have been prescribed with no exercise related adverse events reported.

Tuition and monitoring of correct, effective exercise techniques is important, and guidance on exercise intensity, monitoring heart rate and perceived exertion.


Safety precautions include:


Medical history

Comorbidities

Treatment related side effects

Peripheral neuropathy

Pathological fracture risk

Immunosuppression

Lymphodema risk

Cardiopulmonary issues


Impact of Bone Metastases on Quality of Life:

  • Mortality considerations aside, bone metastases can also significantly impact quality of life as a consequence of their associated effects.

  • Whereas fatigue is the most stressful symptom cited by men with metastatic prostate cancer, patients with bone metastases may also experience pain as well as activity limiting lifestyle, discomfort, extremity weakness, neurological impairment, dyspnea, impaired mobility, loss of bladder and bowel function, mild sensory loss or numbness, loss of appetite, sleep disturbance.

  • A 2015 US survey commissioned by BayerHealth Care suggests that (68%) of men with advanced prostate cancer ignore or under-report their symptoms to their healthcare providers.


The most commonly reported symptoms by survey participants included:


Fatigue: 85%

All over body pain or aches: 55%

Numbness or weakness: 55%

Difficulty sleeping as a result of pain: 42%

Difficulty performing normal activities: 40%

Anxiety or distress as a result of pain: 40%

Vomiting: 25%

Loss of appetite

What are the subjective red flags with bone mets?

  • Pain with weight bearing activities indicating pathological fractures, particularly in the lower limbs

  • Change in pain intensity levels

  • New onset of pain

  • A band of pain

  • Unremitting night pain

  • Change in pain medications

  • Pain during their prescribed exercises

  • Pain on movements

  • Movements becoming more difficult, eg walking, getting in and out of bed, or chair

  • New continence issues, bladder or bowel dysfunction

  • Pain on sleep breaths or straining

  • Limb weakness

  • Pins and needles or numbness


Is Manual therapy indicated for advanced cancer appropriate and are there precautions or contraindications?


  • Soft tissue work to unaffected extremities.

  • Adhesive scar massage, post surgery, avoiding areas of disease and previous radiated areas due to skin thinning.

  • Manual lymphatic drainage techniques for self and family to assist.

  • Joint stiffness causing pain and/or loss of function not at level of bone mets - gentle mobilisations if nil osteoporosis/ fracture risk.

  • Muscular tension causing pain - gentle massage avoiding areas of bone mets.


Precautions-

If unsure check with your oncologist.

X-ray/bone scan to exclude bony mets and fractures in area of treatment.


Contraindication -

Joint mobilisations or manipulation over or adjacent to bone met sites.




Related Terms:

bone metastases, metastases, spinal metastases, osseous metastatic disease, metastatic bone cancer, osteolytic osseous metastases, metastatic bone disease, breast cancer metastasis to bone, bone metastasis symptoms, breast cancer spread to bones symptoms, osteoblastic metastases, breast cancer spread to bones, osteoblastic lesion, cancer spread to bones, metastatic spinal cancer, skeletal metastases, symptoms of bone mets in ribs, metastatic bone, cancer symptoms, lung cancer metastasis to bone, lung cancer spread to bones, prostate cancer spread to spine, secondary malignant neoplasm of bone

bone metastases treatment, prostate cancer spread to bones, bone mets symptoms

bony metastatic disease, osteolytic metastases, symptoms of bone mets in hip

sclerotic bone metastases, metastatic spinal cancer symptoms, bony metastases, osteoblastic metastatic disease, bone metastases pain, lung cancer spread to spine, breast cancer that has metastasised to the bone, vertebral metastases, prostate cancer bone metastasis treatment, lymphoma metastasis to bone, spinal mets, lower back pain breast cancer metastasis, metastatic bone cancer treatment, bone marrow metastasis, prostate cancer metastasis to lung, treatment for metastatic breast cancer to bone, thyroid cancer metastasis to bone, prostate cancer bone metastasis, rib metastasis symptoms, osteoblastic bone metastases, skeletal metastasis, breast cancer metastasis to sternum symptoms, breast cancer metastasis to spine, breast metastasis to bone, skeletal metastatic disease, bone cancer spread to lungs, metastatic bone lesion, breast cancer mets to bone, bone mets pain, osteolytic bone metastases, rib metastasis, bone met, multiple bone metastases, metastatic bone tumor, bladder cancer metastasis to bone, colon cancer metastasis to bone, targeted therapy for bone metastases, spinal metastases treatment, melanoma bone metastases, spinal cord metastasis, bone scan metastasis, prostate cancer osteoblastic, prostate cancer bone metastasis osteoblastic, metastatic bone disease symptoms, breast cancer metastasis to bone marrow, lung cancer that has spread to the bones, skeletal metastases life expectancy, treatment for bone metastasis, ovarian cancer metastasis to bone, bone marrow metastasis symptoms, breast cancer bone metastasis symptoms, bone only metastatic breast cancer, lung cancer metastasis to spine, kidney cancer metastasis to bone, skeletal metastases treatment, cervical cancer metastasis to bone symptoms, metastatic spine disease, bladder cancer metastasis to bone symptoms, renal cell carcinoma metastasis to bone, osteoblastic bone lesions, intramedullary metastasis, osteoblastic skeletal metastases, colon cancer spread to bones, myeloma metastasis, pancreatic, cancer bone metastasis, lung cancer with bone mets, cancer spread to bones symptoms, spinal mets symptoms, metastatic lesion on spine, osteosarcoma metastasis sites, metastasis lumbar, multiple skeletal metastases, cancer that metastasis to bone, prostate cancer spread to bone marrow, blastic metastatic disease, lung cancer spread to ribs, bone scan breast cancer metastasis, bladder cancer spread to bones, kidney cancer spread to bones, metastatic lesions in thoracic and lumbar vertebrae, osseous metastatic disease treatment, prostate cancer metastasis to bone symptoms, thyroid cancer spread to spine symptoms, prostate cancer bone mets, femur metastasis symptoms, metastatic spine cancer treatment, multiple bone metastasis, iliac bone metastasis, basal cell carcinoma metastasis to bone, osteoblastic lesion spine, osteoblastic mets, osseous metastatic lesions, breast cancer spread to spine prognosis, sclerotic bone mets, treatment for prostate cancer that has spread to the bones, metastasis pelvis, metastatic pain, thyroid cancer spread to bones symptoms, pelvic bone metastases, bone and lung cancer, cervical cancer bone metastasis, sclerotic metastatic disease, melanoma spread to bones, breast cancer metastasis to spine symptoms, types of bone metastases, most common bone metastases, vertebral metastases causes, osteo metastasis, breast cancer metastasis to knee, multiple myeloma metastasis to bone, prostate cancer spread to hip bones, esophageal cancer widespread osseous metastatic disease, multifocal metastatic disease, esophageal cancer metastasis to bone symptoms, metastatic bone cancer pain, metastatic osteosarcoma symptoms, skin cancer spread to bones, osteoblastic metastases, prostate cancer, if cancer spreads to bones, hip metastasis, osteoblastic lesions of bone, prostate cancer metastasis to vertebral column, vertebral mets, lung cancer spread to liver and bones, metastatic bone disease treatment, melanoma metastasis to spine prognosis, skeletal metastases symptoms, osseous metastatic disease spine, liver cancer metastasis to bone, diagnosing bone metastases, liver cancer spread to bones, sbrt bone metastases, extensive skeletal metastases, femur metastasis, prostate cancer that has spread to the bones, cancer mets to bone, malignant, neoplasm metastatic to bone, prostate bone metastasis, osteolytic and osteoblastic bone metastases, prostate cancer with bone metastasis, extensive bone metastasis, osteoblastic lesions prostate cancer, prostate metastasis to bone osteoblastic, metastasis of osteosarcoma, neuroblastoma bone metastasis, gastric cancer bone metastasis, cholangiocarcinoma bone metastasis, prostate cancer metastasis to spine, cancer spread to pelvis, symptoms of bone metastases from thyroid cancer, symptoms of breast cancer spread to bones, testicular cancer bone mets, lung cancer spread to bones symptoms, squamous cell carcinoma metastasis to bone, multiple myeloma spine metastasis, common metastatic sites for prostate cancer, breast cancer that has spread to the bones, esophageal cancer spread to bones, breast cancer spread to bones and liver, most common site of bone metastases, osteoblastic bone metastasis, pancreatic cancer spread to bones, thoracic spine metastasis, ovarian cancer spread to bones, cancer that has metastasized to the bone, bone cancer from prostate, esophageal cancer bone metastasis, physical therapy for bone metastases, symptoms of cancer spreading to bones, lung cancer metastasis to bone symptoms, sternum metastasis, vertebral metastases symptoms, most common cancer metastasis to bone, breast cancer metastasis to elbow, lung cancer spread to hip, endometrial cancer metastasis to bone, hip replacement metastatic cancer, metastatic breast, cancer spread to bones, metastatic carcinoma of bone, mets bone cancer, most common cause of bone metastases, colorectal cancer bone metastasis, colon cancer metastasis to spine symptoms, metastasis femur, prostate cancer that has metastasised to the bones, bone marrow, metastasis treatment, vertebral body metastasis, cancer that has spread to the bones, breast cancer mets to spine, bony mets symptoms, breast cancer metastasis to foot, lung cancer spread to spine symptoms, multiple myeloma bone metastasis, adenocarcinoma metastasis to bone, triple negative breast cancer bone metastasis, vertebral metastases treatment, lung cancer metastasis to spine symptoms, breast cancer and bone metastasis, prostate bone mets, cervical cancer spread to bones, prostate cancer spread to bones and liver, papillary thyroid cancer metastasis to bone symptoms, osteosarcoma most common site of metastasis, prostate cancer bone lesions, rectal cancer bone metastasis, secondary bone metastasis, hepatocellular carcinoma metastasis to bone, lung cancer and bone metastasis, lumbar spine metastases, lymphoma spine metastasis, renal cell carcinoma metastasis to bone symptoms, bone metastasis causes, lymphoma bone metastasis, uterine cancer metastasis to bone, prostate cancer vertebral metastases, common bone metastases, common cancers that metastasise to bone, treatment of bone pain in metastatic breast cancer, bone and liver metastases, esophageal cancer spread to spine, kidney cancer spread to bones symptoms, squamous cell carcinoma spread to bone, thyroid cancer spread to spine, metastatic bone cancer in spine, renal cell, carcinoma bone metastasis treatment, rib mets symptoms, symptoms breast cancer has spread to bones, non small cell lung cancer metastasis to bone, metastatic cancer of the sacrum, colon cancer spine metastasis, prostate cancer spread to bones and lungs, melanoma metastasis to spine symptoms, breast cancer metastasis to vertebral column, common sites of bone metastases, bone metastases prostate cancer osteoblastic, cancer spine metastasis, metastatic spine cancer prognosis, endometrial cancer bone metastasis, most common site of prostate cancer metastasis, causes of bone metastasis, liver cancer bone metastasis, metastatic prostate bone cancer symptoms, once cancer spreads to bones, bone metastasis primary tumour, thyroid bone metastasis, breast cancer metastasis to sacrum, if breast cancer spreads to bones, metastatic cancer in vertebrae, cancer spread to hip bone, leukaemia metastasis to bone, metastatic prostate cancer bone lesions, breast cancer metastasis to bone treatment, small cell lung cancer with bone metastasis prognosis, testicular cancer spread to bones, breast cancer spread to ribs, cancer in lungs and spine, common sites of metastasis for prostate cancer, lung cancer bone metastasis symptoms, widespread bone metastases, cancer spreading to spine, shoulder bone metastases symptoms, cancer vertebral metastasis, prostate cancer spread to ribs, prostate cancer metastasis to lumbar spine, sclerotic bony metastases, symptoms of, advanced prostate cancer bone metastasis, breast cancer spread to vertebrae, rib metastases, triple negative breast cancer spread to bones, spinal bone metastases, bone metastasis in prostate cancer, breast cancer bone metastasis osteolytic osteoblastic, metastatic breast cancer bone pain treatment, metastatic bone marrow cancer, common sites of prostate cancer metastasis, colon cancer bone metastasis treatment, breast cancer metastasis to ribs, treatment of metastatic prostate cancer to bone, prostate cancer sites of metastasis, most common metastasis to bone, bony metastatic lesions, breast bone metastases, osteosclerotic metastases, bone scan mets, lytic skeletal metastases, rectal cancer spread to bones, urothelial carcinoma bone metastasis, symptoms cancer has spread to bones, melanoma bone mets, lung cancer spread to pelvis, throat cancer metastasis to bones, breast cancer sternum metastasis, breast cancer metastasis to hip bone, common sites for prostate cancer metastasis, adenoid cystic carcinoma bone metastasis, metastatic breast cancer bone pain, prostate cancer skull metastasis, thyroid cancer with bone metastasis, bladder cancer metastasis to spine, bone scan bone metastasis, extensive bony metastatic disease, hip metastasis symptoms, oral cancer metastasis to bone, osteo metastatic disease, prostate cancer with bone mets symptoms, proximal femur metastasis, metastatic pelvic bone cancer, papillary thyroid cancer bone metastasis, stomach cancer spread to bones, bone mets prostate cancer treatment, breast cancer vertebral metastases, skin cancer metastasis to bone, cancers most likely to metastasise to bone, most common site for prostate cancer metastasis, breast cancer metastasis to vertebrae, hepatocellular carcinoma bone metastases, 5 cancers that metastasise to bone, lung bone metastasis, tnbc bone metastases, disseminated skeletal metastases, prostate cancer metastasis bone pain, colon cancer mets to bone, lytic osseous metastatic disease, mesothelioma metastasis to bone, prostate cancer spread to rib cage, cancer spread to bones and lungs, mesothelioma bone metastases, bone metastasis bone scan, osteoblastic metastatic lesions, prostate cancer lung metastasis symptoms, prostate cancer that metastasised to bones, breast cancer metastasis to thoracic spine, breast cancer moved to bones, back pain metastatic cancer, thyroid cancer spread to bones, vertebrae metastasis, metastatic hip cancer, cervical, cancer metastasis to bone, prostate metastasis to bone, bone metastasis in thyroid cancer, follicular thyroid carcinoma bone metastasis, most common cancer to metastasise to bone, melanoma bone metastases symptoms, mets on spine, osteoblastic metastasis prostate cancer, cancer moved to bones, thyroid metastasis to bone, treatment for bone mets from breast cancer, melanoma spine metastasis, seminoma bone metastases, metastasis en femur, renal cell, carcinoma metastasis to spine, cancer femur metastasis, cancer metastasis to scapula, humerus metastasis, blastic metastatic bone disease, uterine cancer bone metastasis, multiple osteoblastic lesions, most common site for bone metastases, cancer spread to liver and bones, metastatic breast cancer in bones and liver, colon cancer metastasis to spine, knee metastasis, treatment for breast cancer that has metastasised to the bone, cancers which metastasise to bone, small cell lung cancer spread to bones, widespread skeletal metastases, back pain metastatic breast cancer, metastasis on spine, non small cell lung cancer bone metastasis, symptoms of metastasis to bone, advanced prostate cancer with bone metastasis, renal cancer bone metastases, breast cancer bone mets symptoms, leiomyosarcoma metastasis to bone, lung cancer spread to bones and brain, cancer spread to pelvic bone, liposarcoma bone metastasis, liver cancer metastasis to spine, prostate cancer and metastasis to bone, prostate cancer moved to bones, if breast cancer metastasis to bone, osteoblastic metastatic bone disease, bone and brain metastases, melanoma bone metastases prognosis, most common bone metastases from breast cancer, colorectal cancer metastasis to bone, multifocal bone metastases, primary bone cancer metastasis, osteoblastic skeletal metastasis, metastatic lesions in bones, widespread osseous metastases, bladder cancer mets to bone, metastatic breast cancer that has spread to the bones, small cell lung cancer metastasis to bone, first site of metastasis breast cancer, uterine cancer metastasis to spine, breast cancer skull metastasis, cancer pelvis metastasis, breast cancer metastasis to scapula, breast cancer that metastasised to bone, cancer that spreads to spine, lung cancer spine metastasis, renal cancer metastasis to bone, breast cancer metastasis to pelvis, colon cancer metastasis to pelvic bone, lung metastasis to bone, esophageal cancer metastasis to spine, papillary thyroid carcinoma bone metastasis, symptoms of prostate cancer that has spread to the bones, lung cancer mets to spine, lymphoma metastasis to spine, widespread bony metastatic disease, breast cancer spread to bones and lungs, melanoma cancer in bones, osteosarcoma bone metastasis, thyroid cancer metastasis to spine, cancer spread to lungs and bones, lung cancer that has metastasised to the bone, prostate cancer metastasis bone scan, sarcoma metastasis to bone, metastatic rib cancer, bone cancer that has metastasised, renal cell carcinoma with bone metastases, cholangiocarcinoma metastasis to bone, lung and bone metastases, ovarian cancer mets to bone, prostate cancer and bone metastasis, metastasis to ribs, rectal cancer metastasis to bone, bone cancer metastasis sites, sites of metastasis for prostate cancer, bone cancer spread to spine, metastatic bone prostate cancer treatment, prostate cancer spread to bones symptoms, blood cancer spread to bones, prostate cancer that has metastasised to bone, bladder cancer and bone metastases, lung cancer spread to bone marrow, most common tumour metastasis to bone, thyroid cancer metastasis to bone symptoms, treatment for bone metastasis in breast cancer, colon cancer in bones, prostate cancer with bone mets prognosis, bone and lung metastasis, melanoma spread to bones symptoms, metastatic breast cancer in liver and bones, colon cancer pelvic metastasis, metastasis in vertebrae, metastatic hip cancer symptoms, metastasis in spine symptoms, breast cancer in bones and liver, lung cancer spread to vertebrae, lung cancer that metastasised to the bone, metastatic renal cell carcinoma to bone, spinal mets treatment

hip pain prostate cancer metastasis, pelvic metastatic disease, renal cancer spread to bones

multiple spinal metastases, kidney cancer metastasis to spine, pancreatic cancer bone mets, sarcoma bone metastases, symptoms of bone mets in shoulder, symptomatic bone metastases, metastatic lesion in spine, bone cancer with prostate cancer, widespread metastases, brain and bone metastases, breast cancer metastasis to spine treatment, uterine cancer spread to bones, vertebral metastatic disease, breast cancer spreads to spine, lung cancer bone metastasis treatment, ovarian cancer and bone metastases, neuroblastoma metastasis to bone, pancreatic cancer spine metastasis, symptoms that breast cancer has spread to bones, bone mets spine, breast metastasis to spine, endometrial cancer spread to bones, metastasis to spine symptoms, metastatic bone cancer from breast cancer, hip mets symptoms, lung cancer metastasis to ribs, secondary malignant neoplasm of the bone, prostate carcinoma bone metastasis, symptoms of bone mets in spine, cancer mets to spine, characteristics of metastatic bone pain, osteoblastic, skeletal metastatic disease, kidney cancer spreads to spine, symptoms of metastatic bone cancer from breast cancer, bone metastases exercise, metastatic lumbar cancer, prostate cancer common sites of metastasis, prostate cancer mets to spine, symptoms of secondary bone cancer after breast cancer, breast cancer spread to pelvis, breast cancer and bone mets, breast cancer spread to bones treatment, liver and bone mets, single bone metastasis, bone metastases symptoms after breast cancer, bone pain in metastatic breast cancer, colon cancer spread to bones and liver, hip pain metastatic breast cancer, malignant melanoma bone metastases, neuroblastoma bone mets, ovarian cancer bone mets, thyroid cancer and bone metastases,bladder cancer bone mets, prostate cancer and bone metastases, small cell lung cancer spread to spine, secondary metastatic bone cancer, symptoms of bone mets in leg, thyroid cancer bone metastasis symptoms, thyroid cancer mets to bone, cancer that has metastasised to the spine, lung cancer metastasis to hip bone, metastatic disease thoracic spine, follicular thyroid cancer with bone metastases, breast cancer mets to spine prognosis, cancer that metastasis to spine, brain cancer metastasis to spine, breast cancer metastasis to back, follicular lymphoma bone metastases, symptoms of cancer that has spread to the bones, breast cancer metastasis to femur, lung cancer spread to hip prognosis, lung cancer spread to rib cage, treatment of spinal metastases, breast cancer and metastasis to bone, medullary thyroid cancer bone metastases, once cancer has spread to the bones, osteoblastic metastases symptoms, prostate mets to bone, soft tissue sarcoma metastasis to bone, tibial metastasis, brain cancer spread to bones, symptoms of prostate cancer that has spread to bones, blastic osseous metastatic disease, lung cancer metastasis to bone treatment, symptoms that cancer has spread to bones, lung cancer with secondary bone cancer, metastases in bone, metastatic breast cancer in hip, bone cancer secondary to lung cancer, ovarian cancer metastasis to spine, cervical cancer metastasis to spine, metastatic bone pain symptoms, breast cancer and secondary bone cancer, prostate cancer metastasis to cervical spine, metastatic breast cancer in bones treatment, lung cancer spread to liver and spine, triple negative breast cancer metastasis to bone, blastic skeletal metastases, breast cancer metastasis to lower back, lung cancer spread to leg, prostate cancer spread to bones treatment, lung cancer in the bones prognosis, lung cancer spread to hip bone, positive bone scan breast cancer metastasis, secondary breast cancer spine, bone mets after breast cancer, multiple myeloma and bone metastases, prostate cancer spine metastasis, testicular cancer metastasis to bone, breast cancer metastasis to pelvic bone, osseous metastatic disease symptoms, lung cancer metastasis to hip, secondary bone metastases, head and neck cancer metastasis to bone, lung cancer in spine prognosis, non small cell lung cancer spread to bones, prostate cancer spread to bones and lymph nodes, bone cancer as secondary cancer, bone mets in ribs, melanoma and bone metastases, thyroid cancer bone mets, treatment for prostate cancer spread to bones, breast cancer that has metastasised to the spine, treatment of bone pain in patients with metastatic breast cancer,, bone mets pain treatment, cancer that mets to bone, kidney cancer mets to bone, prostate metastasis to spine, bone cancer mets symptoms,

breast cancer and spinal metastases, pancreatic cancer metastasis to spine, bone mets hip pain, breast mets to bone, skeletal cancer metastasis, renal cell carcinoma bone mets

bladder cancer that has spread to bones, skeletal metastatic lesions, advanced prostate cancer spread to bones, esophageal cancer spread to bones prognosis, symptoms of breast cancer metastasis to spine, lung cancer that has metastasised to the spine, metastatic carcinoma spine, metastatic melanoma to bone, multiple myeloma metastasis to spine,

rib pain breast cancer metastasis, triple negative breast cancer metastasis to spine, kidney cancer that has spread to the bones, metastatic disease to the spine, adenocarcinoma metastasis to spine, liver cancer that has spread to the bones, breast cancer metastasis to liver and spine, osseous metastases breast cancer, small cell lung cancer metastasis to spine, metastasis to sacrum, bone cancer after lung cancer, melanoma metastasis to bone symptoms, breast cancer mets to spine symptoms, metastatic breast cancer bone scan, single bone metastasis, bone metastases symptoms after breast cancer, bone pain in metastatic breast cancer, colon cancer spread to bones and liver, hip pain metastatic breast cancer, malignant melanoma bone metastases, neuroblastoma bone mets, ovarian cancer bone mets, thyroid cancer and bone metastases, bladder cancer bone mets, prostate cancer and bone metastases, small cell lung cancer spread to spine, secondary metastatic bone cancer, symptoms of bone mets in leg, thyroid cancer bone metastasis symptoms, thyroid cancer mets to bone, cancer that has metastasised to the spine, lung cancer metastasis to hip bone, metastatic disease thoracic spine, follicular thyroid cancer with bone metastases, cancer that metastasis to spine, brain cancer metastasis to spine, breast cancer metastasis to back, follicular lymphoma bone metastases, symptoms of cancer that has spread to the bones, breast cancer metastasis to femur, lung cancer spread to rib cage, treatment of spinal metastases, breast cancer and metastasis to bone, medullary thyroid cancer bone metastases, once cancer has spread to the bones, osteoblastic metastases symptoms, prostate mets to bone, soft tissue sarcoma metastasis to bone, tibial metastasis, brain cancer spread to bones, symptoms of prostate cancer that has spread to bones, blastic osseous metastatic disease, hypermetabolic osseous metastatic disease, lung cancer metastasis to bone treatment, symptoms that cancer has spread to bones, lung cancer with secondary bone cancer, metastases in bone, metastatic breast cancer in hip, bone cancer secondary to lung cancer, ovarian cancer metastasis to spine, cervical cancer metastasis to spine, metastatic bone pain symptoms, breast cancer and secondary bone cancer, prostate cancer metastasis to cervical spine, metastatic breast cancer in bones treatment, lung cancer spread to liver and spine, triple negative breast cancer metastasis to bone, blastic skeletal metastases, breast cancer metastasis to lower back, lung cancer spread to leg, prostate cancer spread to bones treatment, lung cancer spread to hip bone, positive bone scan breast cancer metastasis, secondary breast cancer spine, bone mets after breast cancer, multiple myeloma and bone metastases, prostate cancer spine metastasis, testicular cancer metastasis to bone, breast cancer metastasis to pelvic bone, osseous metastatic disease symptoms, lung cancer metastasis to hip, secondary bone metastases, head and neck cancer metastasis to bone, lung cancer in spine prognosis, non small cell lung cancer spread to bones, prostate cancer spread to bones and lymph nodes, bone cancer as secondary cancer, bone mets in ribs, melanoma and bone metastases, thyroid cancer bone mets, treatment for prostate cancer spread to bones, breast cancer that has metastasised to the spine, metastatic bone cancer stages, treatment of bone pain in patients with metastatic breast cancer, bone mets pain treatment, cancer that mets to bone, kidney cancer mets to bone, prostate metastasis to spine, bone cancer mets symptoms, breast cancer and spinal metastases, pancreatic cancer metastasis to spine, bone mets hip pain, breast mets to bone, skeletal cancer metastasis, renal cell carcinoma bone mets, bladder cancer that has spread to bones, skeletal metastatic lesions, advanced prostate cancer spread to bones, symptoms of breast cancer metastasis to spine, lung cancer that has metastasised to the spine,

metastatic carcinoma spine, metastatic melanoma to bone, multiple myeloma metastasis to spine, rib pain breast cancer metastasis, triple negative breast cancer metastasis to spine, kidney cancer that has spread to the bones, metastatic disease to the spine, adenocarcinoma metastasis to spine, liver cancer that has spread to the bones, breast cancer metastasis to liver and spine, osseous metastases breast cancer, small cell lung cancer metastasis to spine, metastasis to sacrum, prognosis kidney cancer spread to bone, bone cancer after lung cancer, melanoma metastasis to bone symptoms, breast cancer mets to spine symptoms, metastatic breast cancer bone scan.





Recent Posts

See All

Comments


bottom of page