Breast Cancer Expert Forum
possible mets?
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possible mets?

Upon 6 mon checkup, lump was found opposite surg. site (same breast as cancer), mammogram and sonogram ordered were abnormal.  

It was also time for bone and liver scan and blood work.  Tech asked if rib on left was tender...said 'sorta' and she pointed out a black spot - have had no falls or injuries in that area.   I thought the tenderness was from muscle pain (laying on scan bed) but as day wore on, pain became more pronounced.  Spot tenderness.   I've been very tired, and according to a lot of my friends, losing a lot of weight.  I have appt. with doc next Tuesday (4/29).   Is this suspicious for mets?
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Avatar_n_tn
Dear grannymac17:  With respect to the breast lump in the same breast, the concern is that this could be a "local recurrence."  Was this breast radiated?  In general, anytime a person has had breast cancer (or any other cancer), the concern with the development of any symptom is that it could be metastasis. So, doctors will often want to do additional testing to "rule it out."  With respect to the pain on your rib, it is premature to rule this as mets.  It is premature to assume that it is mets but you are doing the right thing by having it evaluated.
8 Comments
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Avatar_n_tn
It could be. Plain xrays of the area may help to clarify.
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Avatar_n_tn
What would be the next steps to see if it's mets - provided the bloodwork doesn't show anything abormal (i.e., the markers are within normal limits, etc.).  Will they do a biopsy of the rib?  Will they do an MRI or CAT scan?

I do know if it IS mets what the next steps will be - chemo and radiation.  I am probably going to get a 2nd opinion if that's the case, from Karmanos here, after I see what my oncologist wants.  I would love to come to Cleveland Clinic, given what I hear, but the distance to travel is the barrier...granted, I'm in Detroit area, so...    Depending on the 2nd opinion and if they and onco are 'on same page' - still might go to Karmanos, due to the fact that the hospital my onco is with is not a dedicated cancer hospital, but Karmanos is...

Sorry about ramling on ...I'm just running scared.  I know, don't borrow trouble, but it's easier said than done (pardon the lower case...too many years using unix :))

Gina
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Avatar_n_tn
Thanks so much for the replies.  Visit to doc confirmed bad news on the breast...biopsy (needle first, then excisional if no fluid appreciated) in a couple weeks.

Doc's gonna peruse my multitude of chest xrays done over the last year (for various and sundry reasons - I'm gonna really glow in the dark soon) and correlate 'em with the hot spot on the left ribcage.  Should she find no degeneration, etc., we'll schedule a bone biopsy - OUCH!  I know that chances are low for mets with stage I breast cancer but I've talked to too many survivors not to count it out...I've seen stage III go years without problems and stage I return in a couple years with mets.  Wife of a friend of mine had tumor akin to mine - no nodes, etc. refused treatment and was dead within 18 months...THAT's terrifying!

Now we begin the waiting.  I don't want to borrow trouble, but I'm scared...but if it should be the worst, I'm geared up to fight...I won once...I'll win again.
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Avatar_n_tn
sorry abotu the multiple posts...this old chemo brain of mine is fragmented :)

Studying the bone scan results (gee, these transcribers really have a time hearing the doc...grammar is horrendous), it appears, I think that they noticed quite a few hotspots on back, lower ribs in back on the right, and front ribs on the left.  Granted, the back was injured (a couple thoracic vertebrae were 'shattered' in 1970 in a fall), but these talk about lumbar vertebrae.  However, i have a rather severe case of scoliosis (can this cause hotspots on bonescan?).  Two ribs were ostensibly cracked when I fell last January.  So at this point, the major concern is the rib(s) on the left that show black spots - where no hx of injury.  Now, my question is this...how long can they attribute hotspots on bone scans to past injuries and at what point can they be suspicious?  I'd hate to be told that 'these are old injuries' and two years from now, end up having a routine scan and have mets all over because they missed the early signs.  Needless to say, I would definitely get a 2nd opinion from a local cancer center here if she deems the bone scan 'normal' and I might try to find out EXACTLY what vertebrae where 'shattered' in 1970.

Thanks again!

Grannymac
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Avatar_n_tn
OK, things are progressing...my surgeon referred me to a thoracic surgeon who is going to order a CT scan (next week) and PET scan (after ct is done - presumably if CT shows definite mets, PET won't need to be done), then a bone biopsy (rib).

Here's the thing...a lady I know who has mets made a recommendation that I talk to my onco, should the ct and PET show probable mets, about not doing the bone biopsy, but rather treating on the basis of the CT and PET alone, because the bone biopsy will be risky, painful and cause delay in treatment due to healing time.  I'm going to see my onco Thurs (12th) and will broach this subject with him.  If he flatly refuses, I can then choose to make an appt. with cancer center and ask them what their thoughts are, or to go ahead with the biopsy, so 'too much grass isn't growing under feet'

What are your thoughts on the matter?  Is the biopsy done usually just to absolutely confirm, or is it also done to find out the type/pathology of the cancer?  If it's the latter, obviously, it has to be done.  If it's simply the former, and if the other tests are conclusive, I don't see why I should take the risk - and time - of having the biopsy.  This lady I talked to had been misdiagnosed (they told her it was old injuries) and by the time she was properly diagnosed, a lot of time had gone by, and her chances had shrunk considerably.  

I would appreciate any comments on this.  Thanks!

Grannymac

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Avatar_n_tn
ok, I'd like to post one more time...things have happened since last post!

Given several 'misdiagnoses' by my local hospital (in other areas than beast cancer); I am preparing my reports, scans, etc. for 2nd opinion at local cancer center here (Karmanos) though would be open to coming down to the Cleveland Clinic (not TOO far from Detroit).  

Back in November of 2002, I had a PET scan to determine, among many things, why I was still weak, and had had mysterious fevers after my kidney stone.  The written report simply said "increased uptake in breast"  This percipitated a mammogram, and the right breast (the same one as was cancerous) showed suspicious areas.  I figured they had correlated with PET, and biopsy was done (it was scar tissue - negative).  Now...I picked up the actual PET scan 'films' (they now hand you the 'films' on regular typing paper - looks like they xeroxed them from the films); and unless I can't tell my left from right, the uptake is on the LEFT!  (why on god's green earth, given we have two breasts, they didn't denote which breast that increased uptake was on to begin with!).  I'm going to take these 'films' over to the surgeon who is working me up for the bone mets.  IF this spot correlates with the spot on the bone scan (done 5 months later) there are going to be some very pointed questions, and rolling heads (not the least of which would be mine for not asking more questions).  At the very least, this might prevent me from having to undergo the expense of another PET scan, possibly prevent the pain of a bone biopsy (although I think these have to be done to check the histology and make 100% sure they ARE 'breast cancer cells'?).  I need some advice...would a 'hotspot' on a bone scan that turns out to be in the same place as the 'increased uptake' on a PET scan, given my history of breast cancer in 2001, all other things considered equal, be a pretty much definitive proof of bone mets?  Would a biopsy HAVE to be done?  (advice from people have told me to avoid that if at all possible - it's painful, can be risky, and will delay treatment needed for healing time - and I am not a happy camper thinking of yet another surgery (my 13th since 2001), nevermind the fact that the surgeon said "you'll be in overnight, and may wake up with a chest tube if your lung collapses...OUCH!).  Any advice would be appreciated!

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Avatar_n_tn
Much has happened since my last posting.  I did have the ct scan and PET scan...CT was equivicol, and the PET scan lit up; in a few places, including kidneys (more so than usual); lung bases, thyroid...and right breast...some of which can be explained by inflammatory changes (they said they kidneys MIGHT be hydronephrosis...something I need to check out later, given my history of kidney problems.

The surgeon stated that, inspite of the other stuff, he's most concerned about the hotspot in the left rib, so is going to do a rib biopsy next week - as he put it, "if there's cancer there, wherever else it is, you'll need chemo, so let's go for the hottest spot"

I'm scared, it's going to be an open biopsy, and I'll probably have a cheset tube in for 24-48 hours...

I just keep thinking they're missing something with the PET scan lighting up like that.  I can understand perhaps the lung bases -  from cracked ribs (although I believe it said bilateral - perhaps the left base relates to the lower rib so affected?, but the kidneys?  Hmmm...

Gina
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