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Arthritis vs. Bone Mets

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I am really confused...I have read many, many posts from girls who were originally told they had Arthritis and now have bone mets. Maybe this is ridiculous, but... I can't help but wonder if some are being treated for bone mets when it's actually just Arthritis or vice versa. How do they know the difference between the two? Especially when the dx is made just from a bone scan? Are the two easily distinguished from one another? What does bone cancer look like on film as opposed to Arthritis? I have had several bone scans over the past few years. Each time, the report comes back stating that there's "uptake" (I hate that frickin' word!) in my right hip, both knees and both feet. It also states that the uptake is PROBABLY due to Arthritis. I have this sinking feeling that perhaps a couple of years from now, I'll be told the uptake is actually bone cancer. I have only seen one post stating that a bone biopsy was done to confirm bone mets. Why aren't biopsies performed to confirm every bone cancer diagnosis?
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Comments

  • lexislove
    lexislove Member Posts: 277
    edited April 2009
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    This is such a good question Laura. I'm sure you are not the only one with these questions.I hope some woman can answer this.Smile
  • Kindergarten
    Kindergarten Member Posts: 2,883
    edited April 2009
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    Wow, that is such a great question and an issue worth investigating. When I had my first bone scan at diagnosis, they told me I had arthritis in my knees. I have had one bone scan since and it still confirmed the arthritis in my knees. I have the same fear, that the scan may change in the future. Maybe I would insist on a bone biopsy. Do you remember Mimi from Breast Cancer.org? She posted in the Stage IV forum. Her mother, she thought, had been misdiagnosed with not only bone mets, but liver mets as well. I have not seen Mimi post in awhile. Great post, Laura and I hope someone comes along with some opinions about this. God bless, Kathy

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    Apparently, I've been told, arthritis is in the joints and mets is somewhere along the bone but not in the joints. When I had my scan I lit up so bad that the tech came out and asked if I had pain in my hip. I said no, as I was on heavy pain pills. They put it down as bursitis. Now I wonder if I had said YES I am in pain, they would have called it differently.

  • rosesinwinter
    rosesinwinter Member Posts: 7
    edited April 2009
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    I agree - this is such a good question!  I am writing this down to ask my oncologist when she goes over my recent bone scan with me next week.  My educated guess, but only a guess,  is that bone mets are usually closer in to the main body (i.e. spine, ribs) at least at first.  I have not heard of mets to the knees or feet.  Can anyone tell us the answer to this?

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    I've also heard on another thread that someone was told by her onc that mets from breast cancer rarely go below the pelvis.

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009
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    It's great to know I'm not the only one concerned about this!

    Hi Barbe!

    Kathy - I will look back through old posts to see if I can find Mimi's.

    Janet - Please let us know what your Dr says...thanks.

    ---------------------------------------------

    Mets can definately go below the Pelvis... some girls have it in the thigh/Femur. BUT... I have heard that it rarely goes below the knees.

    Let's hope more girls chime in with info (hint-hint)! Thanks! 

  • RobynK
    RobynK Member Posts: 1
    edited April 2009
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    I don't have all the answers but I can tell you my story.  I had horrible back/hip pain and thought I threw out my back.  After a few weeks of continuous pain, I had an x-ray done.  It showed I had osteopenia.  Mild rotoscoliosis to the right, centers at L2-L3 of the spine. Mild DJD of bilateral SI joints.  Artifacts overlie the pelvis.  Patchy lucency over the pelvis and left hip may be from summation artifacts, though underlying osteolytic bone lesions cannot be excluded.  Need clinical correlation.  So then I had a bone scan done.  That showed abnormal uptake in the right sternoclavicular joint region, left scapula, multiple ribs/costovertebral junctions, L3, L5, and mid left femur.  Findings suspicious for bony metastasis.  So then I had a PET/CT Scan that said widespread metastatic bone disease with multiple moderately hypermetabolic lymph nodes in the right cervical chain and mediastinum.  So then I had Tumor Marker tests done as I had never had them done before.  They were elevated alot, so that confirmed this was indeed cancer and not just arthritis.  When I asked about a biopsy I was told that I did not have "tumors" so a biopsy would not be easy to do.  The Onc. said this was typical of how breast cancer spreads and felt strongly that mets was what I was dealing with.  So to answer your question.....I wouldn't base anything on just an xray or a bone scan.  If you can't get a biopsy, all these tests work together to give us a clearer picture of what we are dealing with.  I hope this helps.  I didn't mean to get too technical but I wanted you to see how the results were more explicit with each test done.  I now feel comfortable knowing that I'm dealing with mets and not just arthritis even though I haven't had a biopsy of any kind. 

  • BrendaLea
    BrendaLea Member Posts: 2
    edited April 2009
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    This is interesting...I was told by my gp (not a very reliable source sometimes...lol) that mets are usually in the joints and that is what causes the pain.  I just had a us,bone scan and ct scan done because of swelling at my collarbone and all was clear so they are chopping it up to be bone thickening and arthritis. 

    I am relieved but I'll be sure to keep an eye on it....you guys are great with all this info.

  • swimangel72
    swimangel72 Member Posts: 142
    edited April 2009
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    When I was first dx'd, my breast surgeon sent me for a bone scan. I've had pain in my right hip for a few years already - when it showed uptake, they sent me for an MRI which they then said showed arthritis. Has anyone else had an MRI done after a bone scan showed "uptake"??

  • Analemma
    Analemma Member Posts: 139
    edited April 2009
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    I was just dx with bone mets (last week).  I had notified the onc that I expected bone mets because of the pain I'd been having, and she ordered a bone scan along with my scheduled CT's.  The CT did not show the bone mets.  But the bone scan came back with uptake in two spots, and they confirmed mets with a regular xray.  On Tuesday, I had a complete spinal MRI to confirm, and to make sure there are no additional spots that were missed by the bone scan and xray.  Tomorrow I will see the rad onc to get a tx plan.

  • wayover20
    wayover20 Member Posts: 191
    edited April 2009
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    Analemma, when you say "because of the pain I'd been having"  what specifically do you mean??  Was the pain constant and not helped by say tylenol or motrin or was it the intensity of the pain? Just curious.  I have arthritis in my back and left hip which is like a dull pain, off and on and may even go away for several weeks. But I've never mentioned it because when I get bone scans they actually report "degenerative processes" or something similar. 

    Pat

  • nancyd
    nancyd Member Posts: 557
    edited April 2009
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    The two PET/CT scans I had before my surgery mentioned areas of arthritis that corrolated with previously diagnosed arthritic sites. And they do tend to be joints like knees, hips, shoulders, and feet (which have so many little bones that they are megajoints).

    I may have a follow-up PET/CT in the next few months, which will be about a year from the last one. It will be interesting to see if there are any changes. Certainly, the Arimidex I'm taking makes it FEEL like every joint has developed arthritis.

    It's so hard, when you KNOW you already have some arthritis, to tell if a new pain is something you should worry about, or just learn to live with.

  • Analemma
    Analemma Member Posts: 139
    edited April 2009
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    Pat,

    A couple of years ago I had some knee trouble and I was talking to the ortho about the pain of bone mets.  He told me that it usually is worse at night, and keeps you up or wakes you.  That's what began to happen with my rib.  It had actually been achy for a month or more, but I thought it was muscular.  When it got worse, and started waking my up in the night, I knew I had a problem.

    Now, the spinal met is different.  I'm still not sure I would be able to distinguish it from arthritis, because I do have spinal arthritis.  But this one hurts more, and especially when I cough.  It was severe when I was pulling weeds a couple of weeks ago and bent over, and really, really hurt as I was trying to get up.  That's when I thought I might have a problem with it.  But without the different quality of the rib pain, I might not have called that one in.

  • wayover20
    wayover20 Member Posts: 191
    edited April 2009
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    I agree nancy, at least I already know how this pain comes and goes so if it changed then I'd say something. When I was on arimidex back in 04, you're right....EVERY joint ached all the time! Ugh!

  • wayover20
    wayover20 Member Posts: 191
    edited April 2009
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    Oh wow Ana....that is weird about your dr. saying the pain wakes you!  that is exactly how my reocurrance to the sterum started. I actually sat straight up in bed one night during a deep sleep, and had a hard pain to my chest. But being alseep I just fell back on the bed. In the morning I remembered this and noticed my chest felt bruised but didn't do anything about it.  In the months that followed the pain became worse where I wouldn't want to laugh or cough or sneeze since it would hurt more. Plus this thing started pooching out of my chest. Result....7.5cm mass!

    I will never again poo poo any pain that wakes me in the night!

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009
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    Wow... thanks so much for all the info! And a special thanks to the girls here who have mets and were nice enough to share your stories. I know me and everyone here REALLY appreciates your responses.

    Robyn - Thanks for ALL the info... and based on your advice, I won't just assume that all is well  based only on a bone scan and x-ray. I will call my Onc and hear what he has to say.

    Swimangel... It's great that your Dr automatically ordered the MRI.

    analemma - Good luck with your appt. tomorrow.

    I don't think we can ever have TOO much information!

  • rosesinwinter
    rosesinwinter Member Posts: 7
    edited April 2009
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    Thanks so much Laura for asking this question AND thanks to all of you who answered with so much detail!  This is so incredibly helpful to all of us trying to sort these issues out.  Often I don't think that the oncology team members can describe these things nearly as well as those who have experienced it first-hand. You are all such intelligent women too!

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    Laura, good point about the femur! Of course I've read about that. The term must be "below the knees". See what happens when I pass on gossip?

    I am getting a CT scan at the end of the month, but as I'm drinking the stuff I assumed it's for soft tissue and not bone. I did have 2 places light up on my chest with the bone scan, but they weren't mentioned in the report though that is where I have some chest pain now.....sigh. 

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009
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    Nancy - You are sooooooo right... it really is confusing and frustrating trying to distinguish routine pain from mets pain.

    Barbe - Is your CT because of a specific complaint? Or just routine?

    ----------------------------

    BTW - ALWAYS get copies of your scans and blood reports and read them in detail. If something shows up, and your Dr feels it is insignificant, he/she may not think it's worth mentioning. They may just make note of it and at a later date, suggest a f/u scan or blood work. However, if they overlook their notes and fail to suggest the f/u, or if you switch Dr's, you would not know a f/u was even necessary!  

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    I've had heart/chest pain for almost 2 years. I am on a lot of blood pressure and angina medication. I finally wondered last June if the pain was breast related and called for a mammo that I got in October. I was sure the pain would stop once the tumour was out as it was at 6 o'clock on my left breast right over my heart/pain area. I was so upset when it started up again and I had to increase my angina medication. It is faster for me to get a CT scan than see a cardiologist! An MRI would take about 6 months, but if anything weird shows up on the CT I'll get an MRI faster. 

  • MREanes
    MREanes Member Posts: 18
    edited April 2009
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    Hi Ladies!

    My name is Mike and I have ER+ breast cancer with mets to my bones.  My left femur and L5 were the first site of mets.

    The mets were originally missed on an xray, but were very easy to distinguish on an MRI.   The mets can be found with xrays if you know what you are looking for. 

    My initial pain was in my left leg and lower back.  The initial diagnosis was mild arthritis.  Since the pain began in Sept 06 and was so bad by early December that I could barely walk (with pain pills), I told my gp that the minor arthritis diagnosis was not acceptable.  It did not explain the intense levels of pain that I was having.  I was referred to my orthopedic surgeon who ordered an MRI after reviewing the xrays.  The morning after the MRI, I got a call from my surgeon telling me to immediately go to the hospital.  He also said to use a wheel chair or crutches because my left femur was ready to shatter.  He did surgery the next day and inserted titanium rods into my leg for stability.  After radiation, I had a vertebroplasty on L5.

    My mets have since spread to my pelvis, ribs, spine and skull.  I get regular bone scans with followup CT scans, xrays or MRIs for potentially serious problems. 

    I have been getting the hospital to burn a copy of my bone scans on CD/DVD so that I can review them at home.  If I get a pain that lasts more than a couple of weeks, I'll check to see if there is a spot on the scan.  If there isn't, I talk to my onc.

    From my experience, if you have serious pain that continues to get worse for more than several weeks, get an MRI.  By the way, one reason for the late detection of my mets was that my cancer counts stayed in the normal range and a bone scan in July of 06 had been clean.  However, once the mets began, they spread rapidly. 

    Thankfully, they are stable for now.

    Take care,

    Mike

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    Yikes Mike! Then how do we know that the pains we've had before diagnosis aren't already bone mets without us knowing it? I've been treated for arthritis....but I have been given a time-release pain med as it hurts me so much to walk. My bone scan lit up, but they figured it was just bursitis in my hip though I was lit from hip-to-hip. I wish I could stop worrying about bone mets.... 

  • HensonChi
    HensonChi Member Posts: 68
    edited April 2009
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    My problem is I was feeling great until I started FEMARA and now my lower back hurts.  I sleep at night no problem, but I have been in constant pain.  The Onc. gave me some Naprosyn and didn't mention any scans.  But METS are the first thing that crosses your mind when you are in pain.

  • nancyd
    nancyd Member Posts: 557
    edited April 2009
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    Since many of us are on AIs, which cause pain, it will be a five year vigil of waiting and watching, and trying to determine if the ongoing pain is something other than an s/e. I think I will use some of the questions my dr asked me when diagnosing my original osteoarthritis: Is the pain greater in the morning when you first get up? Does it diminish or go away with use? Do OTC meds alleviate the pain entirely?  If I can answer yes to all those questions, I won't worry or bother my onc about it.

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    I'm not on AI's ! I answered NO to all that. Even my narcotics don't alleviate the pain, they just make me not care too much until I have to move. Waaaaaaaaaaaaah!  

  • nancyd
    nancyd Member Posts: 557
    edited April 2009
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    barbe, is your arthritis rheumatoid or osteo?  RA is so much more difficult than OA.

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009
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    OA thank goodness! But, I guess that's like saying thank goodness I "only" got breast cancer! LOL 

  • sher
    sher Member Posts: 76
    edited April 2009
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    I have degenerative osteoarthritis in both knees - they are pretty much completely shot and need replacing.  So I have pretty bad pain that does keep me from falling asleep at night, but in the morning when I first wake up, I feel fine.  It's only after I've been up and around and walking that the pain starts and then increases throughout the day.  The more I'm standing or walking, the worse the pain.  But the pain is often from thighs down to feet, not just in knees, so I've had a lumbar MRI.  Arthritis there also, couple disks bulging or ruptured so they feel this is the reason for much of my pain.  Bone scans just show arthritis. 

    I'm scheduled for knee replacement in May, but the possibility of bone mets keeps nagging at me.

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009
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    This is very interesting... so many of us are concerned about this topic... and based on the posts, I think a revised title is in order:

    Arthritis vs. Bone Mets vs. Osteoporosis/Osteopenia - How Do We Know?

    Again, I appreciate all the responses/info... it's still so confusing - each case is so individualized. And ... don't forget there's that famous cliche' - nothing is black and white when it comes to BC. However... keep 'em coming... we really appreciate ALL the info/stories. Thanks so much!

  • candie1971
    candie1971 Member Posts: 2,467
    edited April 2009
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    I have been having pain in left hip,lower back and where the thigh bone meets the socket (how do u like that for describing), oh and also in bone in my butt. First my PCP did exrays..pelvis all clear, arthritis in hip and back. Had lumbar spine MRI...shows 2 herniated discs,scoliosis and arthritis. PCP and onc say no cancer! The tech who did the MRI says bone mets shows as black holes in the bones...I don't have that..I saw the pics. Onc says my bloodwork is fine,also. But mets hangs in the back of my mind every day!!