If pain is being caused by a tumour, cancer treatments such as surgery, radiotherapy, chemotherapy or hormonal therapy may be helpful in shrinking the tumour and reducing the pain.

    * Surgery
    * Radiotherapy
    * Chemotherapy
    * Hormonal therapy

Surgery

Surgery can be used to remove part, or all, of a tumour to relieve pressure on organs or a nerve. Sometimes, laser treatment can be used to reduce the size of the tumour.

Operations on the spinal cord, though rare, can be helpful for pain that is not relieved by other methods.

Radiotherapy

Radiotherapy is sometimes used to shrink a tumour, which can reduce pain and other symptoms. Radiotherapy is a very effective way of controlling pain in the bones, especially the spine, thighbones, pelvis and ribs. It can help to relieve pain and helps the bone to build its strength again. Often, only one or two sessions of radiotherapy are needed. The treatment does not work immediately; usually it is 7–10 days before it starts to have an effect. You will need to keep taking your other painkilling drugs during this time. The dose of radiotherapy used to treat pain is usually quite low and so the treatment has very few side effects other than tiredness (fatigue).

Sometimes radioisotopes may be used to help control pain in the bones. Radioisotopes are mildly radioactive substances that are taken up (absorbed) by the bones. The isotope is given as a liquid that is injected into a vein in the arm. When the isotope reaches the bone affected by cancer it gives a dose of radiotherapy which can help to relieve any pain. Strontium 89 is a commonly used radioisotope. It can often take several weeks, or even months for this type of treatment to work, so you will need to carry on with your ordinary painkillers in the meantime.

Chemotherapy

Chemotherapy can also sometimes shrink tumours to help control pain. It may improve pain and help people feel better, however it does not work for everyone and may cause side effects that are difficult to deal with. Some chemotherapy drugs cause hair loss and some cause a lower resistance to infection, tiredness, a sore mouth, or diarrhoea. Your doctor can discuss with you whether chemotherapy may be helpful in controlling your pain. It is helpful to ask how likely it is to work and what the likely side effects may be, so that you can decide whether chemotherapy would be helpful in your particular situation.

In some people chemotherapy will shrink the tumour and improve pain giving an improved quality of life, however for others the treatment will not work and they will just have the side effects of the treatment without the benefits. Generally, the fitter a person is the more likely the treatment is to be helpful and the less likely they are to have distressing side effects.

Making decisions about treatment in these circumstances is always difficult. You may like to discuss the benefits and side effects of treatment with your doctor on more than one occasion before making a decision about whether or not to have chemotherapy. You can also discuss these issues with the nurses at Cancerbackup or some of the support organisations listed.

Hormonal therapy

Hormonal therapy can be used to reduce pain for some types of cancer. Hormonal therapies can reduce the size of some cancers by altering the levels of particular hormones in the body, or preventing the hormones from attaching to cancer cells.

There are many different types of hormonal therapy and the side effects of each vary, but hormonal therapies tend not to cause severe side effects. Your doctor can discuss with you whether hormonal therapies may be helpful in controlling your pain. It may be helpful for you to ask how likely the treatment is to work for you and what are the likely side effects.

Cancerbackup has further information on all the commonly used hormonal therapy drugs.

For more information on Cancer Pain, please visit http://www.cancerbackup.org.uk/