Could this be related?

[katarina777]

I was diagnosed with IBC almost a year ago, and have completed 6 rounds of chemotherapy, mastectomy with 18 positive lymph nodes. (after chemo), and 33 radiation treatments. About a month ago, I suddenly developed this intense right leg pain which I have discussed in a previous post. "How accurate is an x-ray for picking up bone mets."  I had an x-ray, and ultrasound for blood clots, since I also use Tamoxifen since February.  The tests were negative but the pain keeps on getting worse and I can only limp with two Percocets and not walk otherwise.  So finally I had a bone scan and it says that the intense abnormal labeling involving the lateral condyle of the right femur is highly suggestive of osteochronditis desiccans, and that I need to have an MRI and see an orthopedist.

My GP told me that my femur did not get enough oxygen and this has resulted in necrosis of the femur.

My question:  Is it possible that this condition is related to the cancer and/or any of the treatment?

Thank You,

Kat

PS:  I have also had insulin dependent Diabetes for 32 years.

[HeinrikMD]

Hi,

It would depend on what is the causative agent. Some of these cases are due to trauma on the limb, others may be related to small blood vessel damage (this may be a complication of diabetes). The cancer would have some problems with blood vessels, but it would affect blood vessels going back to the heart more than the vessels from the heart feeding the bone. The same can be said for Tamoxifen.

The cancer may involve bone (or spread to the bone commonly in breast cancer) and cause breaks in bone. Its features though would be seen in the bone scan.  

[katarina777]

Thank you very much for your answer. i had the MRI and the test suggests, that although on the bone scan the area showed up as hot vs. cold, he thought this is more likely a case of osteonecrosis. it also said there was bone marrow edema and a large Baker's cyst. (no structural changes, or problems) today I saw an orthopedist and he answered all my questions with "I don't know."

Like you have done, I am not interested in certainties, but suggestions based on your training and experience. (Thank you for doing that)

Would this change in diagnosis change your response to whether there may be a relationship perhaps between the inflammatory nature of my cancer, the chemo/radiation/steroids/tamoxifen, and/or any of the above?

Also, if you are willing, would you say just a touch more about what you said in regards to venous and arterial blood flow, and the relationship?

Thank you very much ahead of time, even if you don't respond. Kat.

[HeinrikMD]

Hi,

One of the known causes of osteonecrosis would be prior use of steroids. This is because the steroid could upset the normal regulation of small blood vessels causing them to constrict thereby depriving the bone with required blood. With limited or no blood, the bone starts to rot. This would more commonly affect the hip bone, the head of the bone of the thigh in particular because of its unique anatomy. Since you presented with disease elsewhere, there may be other causes which would have impeded regular blood flow.

Looking at this scenario of limited blood supply, a cancer (which requires as much blood as possible) would unlikely thrive under such scenarios. However, a cancer may grow large enough to compress feeding blood vessels on the bone – but this would mean a cancer that is too obvious to miss. So if it isn’t there – then it is likely not related to the cancer itself. The treatment you received may be contributory (the steroid) the more so if you took it for a long period of time.