Bone Mets vs Arthritic Activity

[MizLiz]

With a CT or bone scan, how is arthritic activity differentiated between bone metastasis?  Is it an art vs a science?  I was diagnosed stage 3 with a large tumor back in March of 2002. I am 42 years old. I have recently developed severe back pain - sciatic nerve involvement.  Scans show no cancer in lumbar area,  but pain continues - is at it's worst when sitting or lying down.  Pain diminishes the more I move!  I don't recall exact terminology, but scan reports indicate activity consistent with arthritic activity, degenerative disk disease. I am treating with anti-inflammatory and physical therapy, but don't notice much if any improvement.   Would an MRI or PET scan be warranted at this time?  I am trying to decide how concerned I should be.  I know I am at hight risk for recurrence.  Thank you for any advice you can provide.

[tessa0825]

I think you should without a doubt persue an MRI....I'm not saying this to scare you, it is something I witnessed in a very good friend this last year...She had masectomy and chemo and had recovered very well and was back working full time...She started having alot of pains in her leg, her oncologist sent her for a bone scan. He told her she was clean for cancer and started treating her for arthritis.....She also worked for the same company where I'am a supervisor so I got to see her at work as well as she and her family being very good friends personally with my family..She was having excruciating leg pains and was repeatedly given more and stronger doses of NSAIDS and Cox-2 inhibitors for her arthritis..I have had arthritis for 30 yrs. and was almost certain that what she was feeling was alot worse than any arthritis pain I had felt...She finally was sent for an MRI and it revealed metastatic disease to her femur and pelvis...She had surgery that same week for a steel brace to be inserted for her femur and I'm very sorry to say that Jean was one of the unfortunate ones who did not survive her disease.....I guess I don't understand why MRI isnt more routine in a cancer pt. experiencing new pain after treatment...I do understand that we have to take alot of reponsibility for our health care. I wouldnt, if I were you, blink an eye over demanding an MRI....Good luck and please take care....

[CCF-RN,MSN-JS]

Dear MizLiz, A bone scan is a good general overview of what is happening in the bones, and an area in the bone that is cancerous shows up differently or more pronounced than an area that is strictly arthritis or degenerative changes.

[surgeon]

As you imply, the distinction is not absolute, and context plays a role. Bone mets are usually multiple; and certain patterns of activity are seen. However, I don't think it's possible absolutely to exclude tumor by a bone scan. It might well be that additional imaging should be considered. MRI would be a good start.

[omacar]

I had a bone scan  and a cat scan  and both were negative  for bone mets.  However the PET scan picked it up  and MRI  confirmed it.  keep looking!!!!  hugs  trudy