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Left flank pain
46 years old woman, slim/fit, generally very healthy.

Have the last ca 3 months suffered from pain in the left flank. The "inside" pain is dull, and varies somewhat in intensity.  In addition there is a very sore/tender area on my second lowest rib: It is very painful to press, enough to keep me from sitting on chairs with low backs. This point is approx 10cm from the centre of my spine. Pressing it is always painful.

Breathing is not painful, although exhaling completely hurts - but this feels like I'm squeesing something sore in the left flank.

Movement is not painful; I work out regularly with no problems.
Digestion excellent, urine tests ditto.

My left hip is somewhat painful from time to time, but nothing sharp or problematic. No pains in shoulders, groin, legs or otherwise.

However, I do have a perstistant cough (dry, loud, very tiresome), lasting 5 months now.

Last May I was operated for breast cancer (left side, 33mm infiltrating ductal grade 8, medial, some vascular invasion, 13 lymph nodes removed all negative). I've done FEC chemo and radiation. My cough started at the beginning of radiation, too early to be r.induced. Flank pain started after radiation.

Skeleton scintigraphy in Dec, liver ultrasound in Dec, and rontgen thorax in Jan were all negative. In Dec we found a 14mm lump in the left axilla, but fine needle aspirations were inconclusive (not enough matter). The doc says "probably lymph node or scar tissue or fatty tissue, don't worry". (Mind you: This is Norway, private hospitals or oncologists don't exist, and we have to accept what we're offered!)

My posteriar cervical lymph nodes are painless, but somewhat enlarged, and my right supraclavicular area feels very odd, "fuller" and lumpier than the left area. I also have a couple of funny very hard little (4-6mm) painless lumps in each groin: in the crease between leg and body, ca 3cm down from the hip bones.  

My questions: Am I being hysterical when I worry that there can be breast cancer metastases in my spleen, or wherever? What else could cause this (very tiring) pain? and the cough? If these are normal after-chemo/radiation problems, I'd be glad to know about it. Finally: should I do something? ...lie on the floor kicking until the blessed state allows me some tests? if so, which tests are worth kicking for?

Best regards,
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1 Answers
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233190 tn?1278553401
To answer your questions:
1) Breast cancer metastasizing to the spleen is not common.  If this is a concern, an abdominal CT scan can be considered.

2) The bone scan and chest x-ray would evaluate for most of the bony, musculoskeletal conditions.  You can consider looking at GI causes - including problems with the upper digestive tract, spleen or pancreas.  Initial workup can include an upper GI series and abdominal CT scan.

3) Difficult to say about the cough without examination.  Causes of chronic cough can include pulmonary causes (i.e. bronchitis, emphysema etc.), GERD, or post-nasal drip.  Further evaluation can include further chest imaging (i.e. a chest CT), an upper GI series, sinus imaging or pulmonary function tests.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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