NSCLC can spread to almost any part of your body, but it most commonly spreads to bone. Cancer that has spread to bone often has an unfavorable outlook and generally isn’t considered curable.

Non-small cell lung cancer (NSCLC) makes up 80% to 85% of lung cancers. It’s one of the two main categories of lung cancer, along with small cell lung cancer.

The spread of cancer to distant body parts is known as metastasis. Studies have found that lung cancer is one of the most common causes of bone metastases.

The survival rate for people with lung cancer is highest when the cancer is caught in the early stages, but it’s estimated that about 40% of NSCLC cases have spread to distant organs by the time of diagnosis.

In this article, we take a closer look at bone metastasis in NSCLC, including symptoms and how it affects treatment and outlook.

Bone metastasis is the spread of cancer to bone tissue from another organ. Metastatic NSCLC is also referred to as stage 4 NSCLC.

It’s estimated that 20% to 30% of people with NSCLC have bone metastases at the time of diagnosis and that an additional 35% to 40% of people develop bone metastases later.

Cancer can metastasize when tumor cells enter your lymph system or blood vessels. Once cancer cells enter these systems, they can spread to almost any part of your body. For people with NSCLC, bone is one of the most common areas of metastasis. Other common areas are:

  • the other lung
  • the brain
  • the liver
  • the adrenal glands

In a 2017 study, researchers found that adenocarcinoma was the most common type of NSCLC to metastasize. About 40% of lung cancers are adenocarcinomas.

The researchers also found that the ribs were the most common site of bone metastasis, followed by the thorax (the area between your neck and bottom of your rib cage) and the lumbar spine.

People with bone metastasis experience the same symptoms as other people with NSCLC but may also have other specific symptoms, depending on what part of the skeleton the cancer has spread to.

General symptoms of NSCLC include:

Most people with bone metastases develop pain. According to the American Cancer Society (ACS), pain often comes and goes at first and tends to be worse at night. Pain might become more persistent as the cancer progresses.

Other signs and symptoms of bone metastases can include:

Doctors sometimes discover bone metastases through imaging before symptoms develop. Your doctor may order imaging to look for bone metastases if you have symptoms that suggest it.

Many types of imaging can potentially identify bone metastasis. Here are some of the types of imaging you may undergo:

  • CT scan: A CT scan can potentially identify cancer before there’s enough bone destruction for metastases to appear on X-rays.
  • Fluorodeoxyglucose-positron emission tomography-CT scan (FDG-PET-CT): Your doctor may recommend an FDG-PET-CT if there’s a concern about bone metastases at the time of diagnosis. This type of scan can detect about 98% of metastases.
  • Bone scans: Bone scans are especially useful for identifying osteoblastic metastases, which are areas where cancer cells cause too many bone cells to form. Bone scans can detect about 95% of metastases.
  • MRI: MRI is the preferred imaging method when a doctor suspects that you might have spinal cord compression. It can detect about 95% of bone metastases.
  • X-rays: X-rays can help doctors identify the size and shape of your tumors. However, they detect only 40% to 50% of bone metastases and generally require a 30% to 75% decrease in bone density.

A definitive diagnosis can be made with a bone biopsy, which involves removing a small section of bone tissue for lab analysis. But a doctor may not perform a biopsy if they have a high level of suspicion that the cancer has spread or if performing a biopsy would cause substantial risk.

Your doctor may also order a blood test to look for elevated calcium levels or other markers that suggest the cancer has spread.

NSCLC with bone metastasis is not generally considered curable. Treatment aims to:

  • reduce symptoms
  • maximize daily function
  • improve quality of life

Researchers are continuing to examine different treatments for metastatic NSCLC. Current treatment options include:

  • Pain relievers: According to a 2016 research review, about 70% of people with bone metastases need opioids for pain management.
  • Chemotherapy: Cisplatin- or carboplatin-based chemotherapy is the most common regimen used for stage 4 NSCLC, although many other drug combinations may be used to try to destroy cancer cells.
  • Targeted therapy: Targeted therapy modifies genes and proteins in cancer cells to stop them from dividing. Your doctor may recommend targeted therapy if you have certain gene mutations.
  • Radiation therapy: Radiation therapy can potentially help shrink metastatic tumors. About half of people experience pain relief after 1 or 2 weeks.
  • Bisphosphonates and denosumab: The Food and Drug Administration (FDA) has approved bone-modifying agents, such as bisphosphonates and denosumab, for the management of bone metastases in all solid tumors to prevent bone loss.

Doctors rarely surgically remove primary or metastatic tumors in stage 4 NSCLC because surgery has not been shown to prolong overall survival.

NSCLC with bone metastasis is generally associated with an unfavorable outlook, but the outlook is slowly improving over time.

People with bone metastasis often have severe pain, drastically reduced quality of life, and a reduced ability to perform daily tasks. The ACS lists a 5-year relative survival rate of 9% for people with NSCLC that has spread to distant organs.

The median survival time for people with metastatic NSCLC is 14 to 17 months.

In a 2019 study, researchers found some evidence that younger people with bone metastases may have better survival than older people. They found that people under 60 years old lived an average of 11 months, while people over 60 years old lived an average of 8.8 months.

NSCLC can spread to distant organs if cancer cells reach your bloodstream or lymph system. Bone is the most common place for NSCLC to spread.

Metastatic NSCLC tends to have an unfavorable outlook, and treatment generally aims to maximize quality of life and minimize symptoms.

Receiving a cancer diagnosis can be difficult, but your doctor can help you develop the best treatment plan for your specific situation.

Survival rates are slowly improving over time as treatment improves. Your doctor may recommend taking part in a clinical trial that may give you access to treatment that’s more effective than the current standard treatments.