Treating individual metastatic tumors

If there are metastases in bones, the cancer cells interfere with the process of building up and breaking down bone tissue. This affects the stability of the bones, causing them to break more easily.

Pain in the bones can be treated with painkillers. The metastases can be treated using radiotherapy or surgery. The aim here is to strengthen the bones in order to prevent bone fractures and relieve the pain.

Medications such as bisphosphonates can slow down bone loss. Although these drugs can't completely prevent bones from being damaged by metastases, they at least slow down bone loss enough to reduce the likelihood of bone fractures or prevent fractures altogether. Severe side effects such as the death of jaw bone tissue (osteonecrosis of the jaw) are rare.

Another medication that inhibits bone loss is called denosumab. It can cause diarrhea, sweating and shortness of breath, as well as pain in the muscles and bones. It may also affect the body's metabolism of calcium. Denosumab is often associated with the death of jaw bone tissue. It can also increase the risk of another cancerous tumor developing.

Metastases in the skin or internal organs – for instance, in the lungs or the liver – can be treated with surgery if

• the metastases are only found in one lung or in one lobe of the liver (not in both),
• the tumor has not grown back in the same place (recurrence),
• there is no second tumor, and
• there was more than one year between the first treatment and the occurrence of the metastases.

Alternatives to the surgical treatment of metastases in only one lobe of the liver include radiofrequency ablation (RFA), chemoembolization and stereotactic radiotherapy. The aim of these treatments is to damage the metastatic tumor tissue so badly that it can no longer grow. They do this using heat, medications, the closure of blood vessels or precisely targeted radiation. These approaches are usually followed by treatment with medication.

Metastatic tumors sometimes grow in a part of the lungs known as the pulmonary pleura too. This can lead to the build-up of fluid in the pleural cavity (the narrow space between the lungs and the ribs). The medical term for this is pleural effusion. Built-up fluid can cause breathing difficulties and pain. Surgery can be done to seal up this space and prevent fluid from building up there again.

Clearly outlined metastases on the skin or metastases in muscles can be surgically removed or treated with radiotherapy. If the metastases are still relatively small and located on the surface of the skin, ointments containing a chemotherapy drug might help too.

Metastases in the brain can lead to severe pain. The pain may be caused by swelling or fluid building up in the brain. Depending on where brain metastases are, they can affect your sense of balance or result in paralysis.

Individual brain metastases can be operated on and then the affected part of the brain can be treated with radiotherapy. If there are several metastases in the brain, the whole brain is treated with radiotherapy. Another option is radiosurgery, where a very specific area of the brain is treated with high-dose radiation. That way, the surrounding tissue is exposed to less radiation than when radiotherapy is used on the whole brain.

Medication can be used here too, for instance to reduce pain and other effects of swelling in the brain.