Bone Pain from Cancer and percutaneous treatment methods

There are many ways to treat bone pain due to cancer. Your doctor will likely prescribe you painkillers first. You may not need further treatment if you respond to them. 

However if the pain does not improve with medications then there may be a role in minimally invasive percutaneous treatment methods which are provided by our department, namely nerve blocks and/or ablations, cementoplasty (i.e. injection of bone cement), and/or tumour ablation (using extreme heat or cold to kill the cancer cells). There are other methods of treatment bone pain from cancer, namely radiation and surgery. When you see the interventional radiologist, available options will be discussed and if needed consultations with other specialists will be carried out to find the best option for you. 

A nerve block can be performed by injecting medications directly to the nerves affected by the cancer. These can be performed as day procedures (can be discharged the same day). The nerves are located using a combination of X ray, CT or ultrasound guidance with a small needle. However the effects of the nerve blocks can be temporary. Some nerves can be ablated, that is to apply high or low temperature to either modulate or to destroy the nerve, using similar guidance but with more specialised needles.

If there is a fracture from tumour invading the spine or the pelvic bone, cement can be injected into these affected areas to lend strength to the bone and at the same time provide pain relieve. These are also performed with X ray or CT guidance but require larger size specialised needles. These procedures will generally require one or 2 nights’ stay in hospital and use of at least conscious sedation during the procedure. Other common terms vertebroplasty (cementoplasty specific to the spine) and kyphoplasty (vertebroplasty with inflation of balloon to try and restore lost bone height).

Sometimes the offending tumour cell will need to be destroyed directly with extreme heat or cold. The interventional radiologist will review your scans and discuss the best option for you. 

Press 'Play' to learn about how cryoablation, the use of extreme cold, works to kill tumours and tissue: 

The ablations are also minimally invasively procedures and often these will be combined with cementoplasy. 

Patient in his 60s who had kidney cancer spread to his lower spine causing pain.

A: pre-treatment CT scan showing a tumour invading the spine (*). 

B: CT scan taken during cryoablation, showing the extent of the ice ball which will destroy the tumour cell. 

C: post-treatment CT scan, showing the tumour being much smaller (#). Symptoms also improved.