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Lytic Lesions
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Lytic Lesions

My sister who is 43 was walking through WalMart when her back suddenly began to hurt.  She went to the hospital and had an x-ray done which showed "two to three impressive lytic lesions" in her lower back.  She has had further x-rays of her arms and legs, a 24-hour urine test, chest x-ray, mammogram, kidney ultrasound, cell smear, etc.  The x-rays of her arms and legs are fine and the 24-hour urine test was fine except for elevated levels of protein.  It is taking an unbearable amount of time to get any other test results back - especially the cell smear (it has been over 2 weeks).  Is there a reason these tests take so long to get back (i.e. needing to observe the tests for a period of growth)?  Is there any particular cancer that would cause lytic lesions in the back . . . or can any/all cancer cause this.  The urine test came up negative (multiple myeloma).  Can anyone recommend a doctor in Okanogen County (Omak) in Washington State as her doctor has never dealt with anything like this before (his nurse's words).  She has been to have an MRI twice now but her doctor did not schedule it properly (she needs an open MRI).  She will be driving AGAIN to Spokane (3 hours each way) to try again.  Also, is there any treatment for the pain?  She is in SO much pain and can not sleep at night.  She is taking Oxycodone with a sleeping pill at night and the pain is still unbearable for her.  Is there anything else that will help?  I appreciate any input/information.
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Avatar_dr_m_tn
Hello!

She should consult an Orthopedician who is an expert with cancer cases. As cancer should be ruled out before she takes further course of action.

Lytic lesions occur in Multiple myeloma, Ewing’s Sarcoma, Enchondroma and Blastomycosis

The presence of unexplained anemia, kidney dysfunction, a high erythrocyte sedimentation rate (ESR) and a high serum protein (especially raised immunoglobulin) may prompt further testing for multiple myeloma.  If you do a protein electrophoresis of the blood and urine, which might show the presence of a M protein band. One type of paraprotein found in this condition is Bence Jones protein which is a urinary paraprotein composed of free light chains (see below).

MRI should be routinely used in the work-up of malignant tumors. MRI will show the full bony and soft tissue extent and relate the tumor to other nearby anatomic structures (e.g. vessels).

She should take pain killers under prescription of the Orthopedician and her case should be monitored continuously.

Take care!
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