Contradictory Diagnosis

[baringa]

I had a mastectomy 8 yrs ago after a DCIS diagnosis, 3 years later a recurrence in the same breast (on the outer edge of the surgery) which resulted in radiation therapy and 3 years later I was diagnosed with cancer in the sternum and liver. I had Chemo for a few months with herceptin (which I am still receiving) and was ok for several months but have had a pain in my sternum in the past 2 or 3 months. I am also tired and have a slight cough which are  all new symptoms. I have just had a CT and bone scan which have had completely contradictory results. The bone scan indicates a spread of the disease and the CT shows no change and both show no problem anywhere else.. I have always been lead to believe the CT is the more accurate picture of what is going on. The doctors are going to review the pictures and come to a prognosis but  my question is what if the pain is something else and what could that be? Should I be worried about the bone scan result as the CT was as the last one?

[Fernando Roque, MD]

Hi.  For detecting metastatic tumor in other organs, CT scan is usually the procedure of choice, but for detecting bone metastases, I think the bone scan is superior to the CT.    When bone metastasis presents as a diffuse erosion or infiltration of the bone, and not as an obvious mass, CT may not be able to detect this, but a bone scan can.  So at this point, I would probably believe the results of the bone scan more than the CT results.  

What kind of chemotherapy regimen did you receive? Herceptin alone?  If you already have breast cancer recurrence in the liver and bone, and the bone metastases seem to be progressing in spite of the herceptin, you probably need to have some cytotoxic chemotherapy added to the herceptin.  A good choice would be taxanes such as paclitaxel or docetaxel, if you have not yet been given these drugs.