hx of breast cancer with an abnormal cat scan

[sami4965]

i have had breast cancer 1x 1998 with a reaccurence in 2000. i just had a cat scan of my chest,pelvis,abdomen
it revealed 3 4 mm lesions..the report reads like this...small 3-4mm lesions in the mid and lower dorsal spine veterbral bodies..early hematogenous metastaic disease must be given first consideration also it states it projects along the right superior acetabulum and proximal left femur what does this mean and what should be my next step?

[Fernando Roque, MD]

Hi.  The bone scan and CAT scan are designed to detect different things, so it's quite possible that lesions which appear on one test may not be detected by the other.  The bone scan is better than CAT scan in detecting metastatic bone cancer, while the CAT scan is better at detecting soft tissue lesions.  So if the bone scan is clear, it may be that the 3-4 mm lesions detected on CAT scan are soft tissue metastases adjacent to the bone, but not yet invading the bone itself.  If those lesions are accessible, it might be wise to have a biopsy done to confirm that these are indeed cancer metastases, before proceeding with any kind of treatment.

[sami4965]

although the bone scan said its clear..but the cat scan showed otherwise
i have alot of prior cancer history  and alot of bone pain and bruising...so it seems to me they missed something..is it likely? also when i was diagnosed a second tine in 2000 i was not treated with chemo therapy because of no health insurance..so, i would think i would be a greater risk.and the second time was er&pr positive at stage 3 too
i am very confused

[Fernando Roque, MD]

Hi.  Since you've had a prior history of cancer recurrence, the probability that this is another relapse is high.  You may need to have a bone scan or maybe a PET scan to verify the CAT scan findings.  If these subsequent tests confirm the diagnosis of cancer recurrence, then you probably need to undergo another round of chemotherapy.  If the tumor has spread to your bones, you may also need to be given intravenous bisphosphonates (e.g. Ibandronate, Pamidronate).  These drugs will repair your bones and protect them from further damage by the cancer.