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Arthritis vs. Bone Mets

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  • prayrv
    prayrv Member Posts: 362
    edited April 2009

    Barbe,

    When I had my CT scan it showed a "bone island" on one of my vertibrae.  The report stated to watch it for mets, so a CT scan would show things on your bones as well as soft tissue. 

    My vote would be arthritis (if we were voting, of course)

    Hugs,

    Trish

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009

    Trish, for this CT scan I have to drink something. The other ones I had years ago I didn't. I guess those were for bone and the drink one is to highlight soft tissue? Do you think this scan will pick up something in the bone if it's there? 

  • westiesmom
    westiesmom Member Posts: 1
    edited April 2009

    Dx 10/07,lft breast 2cm 2+/8 nodes, stg2/grd2 ER+,PR- HER2+, finished my chemo 2/08, Bilateral Mast w/Expn/silicone 7/08. Have a lump under left arm pit with some discomfort and the veins pop-up on my left arm. BS said nothing to worry about. I also have a  big hard bump on my lower back bone. It doesn't hurt. BS said it's nothing. I never had a CT Scan or Pet or Bone scan since my BC was dx. I had a bone scan several years ago for some hip pain I was having. I also am having balance issues, tripping, stumbling, tingling in feet and word confusion, (reversing words). Also, doing opposite moves, like going to the right when I need to go to the left. Sorry for the babbling on, but so many things do not feel right to me. I had a brain MRI 3 weeks ago which was norm. Should I ask my Onc for a bone test for the bump on my back bone? The Drs. answers lately seem to be 'your too skinny'. Oh, so that is what's causing all of my problems.

  • MREanes
    MREanes Member Posts: 18
    edited April 2009

    Hi Barbe,

    Sorry for being so late in replying.

    I know that one way to determine a bone met is an MRI.  Mets are very easy to see.  If I knew how to extract a picture from my scans, I would post it.  I think that you could probably find an example by doing a search on bone metastasis and MRI.  Such as: meddean.luc.edu/Lumen/MedEd/.../curriculum/Surgery/Met_bone_list1.htm

    I also have arthritic pains from my hormone treatment.  I am taking Lupron, Faslodex and Aromasin.  I am taking three because, as I finally discovered, men react much differently to a single hormone therapy than women.  My onc thinks that the Aromasin is the culprit.   

    I plan to find a substitute for the Aromasin in the future.  I don't want to switch immediately because I have a serious problem with the C2 vertebrae and a less severe problem with C3 and C5.  The problem with C2 is inoperable so we decided to do radiation and hope that the vertebrae doesn't break or collapse before the bone regenerates.  I finished radiation about 3 weeks ago.  New bone growth should begin within the next 3 weeks. It will probably be August or September before there is enough growth to get me out of the critical phase.  By year-end, it should be completely regenerated.  We'll probably do a CT scan or x-ray around mid-June to see how things are progressing.  If all goes well, I'll work with my onc to find a substitute next Fall.  I will just have to deal with the arthritis until then.

    Talk to your onc and get an MRI; you'll know if the problem is bone mets.  If it is bone mets and you let it progress too far, you may have to have surgery to stabilize the bone.  I've been that route and I don't recommend it.

    Take care,

    Mike

  • heatherpalmerton
    heatherpalmerton Member Posts: 26
    edited April 2009

    Laura very good question, I am really questioning this these days. My tumor markers have risen the past few months. My SED rate was at 57 which is very high for scleroderma.  I had PET/CT scan Wednesday they had alot of stuff that I could see. Could alot of what I saw be the scleroderma??. which can be like a arthritis. I really would love to talk to someone who could answer these questions.  In reading the boards I have seen alot of varies arthritis and autoimmune arthristis.  Heather

  • heatherpalmerton
    heatherpalmerton Member Posts: 26
    edited April 2009

    Mike that is one thing i haven't had is an MRI. I will have to ask my ONC. thanks Heather

  • barbe1958
    barbe1958 Member Posts: 7,605
    edited April 2009

    I can only get an MRI if something shows up in my CT scan. Not that I'm hoping something will. I have to drink stuff for soft tissue imaging so I don't know if that will show bone as well. I do know that I have a "rather large" kidney stone so I'm hoping they pay a lot of attention to the reading of the scan to see if there's anything else.

    Keep us posted Mike on your progress, it sounds like you have a good plan in place. I don't have an onco as they figured my bilat mast was enough. I may get a second opinion, especially as I'm back in surgery on Tuesday to get rid of some excess breast tissue on the cancer side. I'm curious to see if there is residual cancer.

  • MREanes
    MREanes Member Posts: 18
    edited April 2009

    Hi Barbe,

    I think that a CT scan will pick up bone tumors.  If I remember correctly, several years ago I had a CT scan to check for any 'soft tissue' involvement after having a bone scan that showed mets.  The CT did show the mets, but not in good detail.  My orthopedic surgeon then ordered a '3D reconstruction' CT scan of the lumbar and thoracic sections of my spine to get the necessary level of detail to make decisions.

    If your hip is the problem area, be sure to tell them so that the hip is included in the CT scan.  If they see something suspicious, they can always order another more definitive scan,

    Thanks for your support.  There are not a lot of options for my current situation, so I do think that my current plan is the best choice.  I am also very lucky to have a great team of doctors and nurses working to help me.

    Good luck with your surgery!

    Mike

  • sharebear
    sharebear Member Posts: 14
    edited April 2009

    After reading everyone's posts....now I'm wondering.  I've been having pain in my left ankle and my left pelvic area since chemo in 2007.  My left pelvic area lit up during a bone scan and they sent me for an x-ray where they agreed it was just arthritis. They say the ankle and my lower left back area are neruopathy from taxotere.  I try and ignore it during the day but I take pain medication at night but it does wake me up around 3 o'clock every night in pain. This was my 2nd BC. I had my first at age 32 the second at age 44. So I guess next month I better mention the pills aren't helping and maybe it's time for anther scan?

  • Analemma
    Analemma Member Posts: 139
    edited April 2009

    Hi, Mike!

    You are the same Mike from NoSurrender, right?  Welcome.  This is a much busier place, and it's easy to get lost here.

    I have just in the past couple of weeks been dx with bone mets.  I had regular CT scans scheduled for the 24th of March, and I almost did not bring up the pains that were making me metspicious.   I ended up sending an email on that Monday to the nurse, that I was having worrisome pains in my ribs, and was expecting bone mets.  She asked the onc, who scheduled a bone scan along with the already scheduled chest, pelvis, and abdominal CT's.  As it turned out, the CT did not show the (very early) mets.  The bone scan showed two hot spots, one on the rib and one on the spine.  When the nurse called that Friday with the results, she ordered a regular x-ray to confirm bone mets.  Then, the onc ordered a full spinal MRI before my meeting with the rad onc. 

    Now it's now, I start radiation next week for the two spots.  Follow up bone scan in early June.

  • MREanes
    MREanes Member Posts: 18
    edited April 2009

    Hi Analemma!

    Yes, I am.  I was at Breastcancer.org originally and was told about No Surrender.  Edge has been such a big help to me that I have spent most of my time there.  Are you Analemma there also?

    I hadn't checked in here in a while, but I wanted to see if there was any information that I could offer to other males with bc on this site.  I have learned quite a bit from my experiences, my oncs and Edge and hoped to share with others in my situation.  I also wanted to check in on some friends on this site.

    I'm sorry to hear about the bone mets.  It sounds like you caught them very early.  It was very wise of you to send that email.  A little radiation and you should knock them out. 

    I understand about the pains.  You try not to worry every time you have a little pain, but if something stays around for a couple of weeks, it's worth getting checked out.  I try to get copies of my scans so I can check for existing mets in the painful area before running off to my onc.  However, I've learned the hard way that if something doesn't feel right, get it checked.

    Sharebear - I am no doctor, but I think that bone mets to the ankle would be extremely rare.  The pelvis, spine and ribs are fairly common.  Hopefully, neither are mets.

    Take care,

    Mike

  • wallycat
    wallycat Member Posts: 1,239
    edited April 2009

    Laura, have you had tumor markers done?

    I know you are on tamoxifen.  It took 1-1/2 years of my tamoxifen (I'm an intermediate metabolizer) and now, I walk like an old woman, especially in the morning...and it is my feet/ankles.

    I pray it is just old age...hahahaha, funny how saying that on these boards is a good thing Tongue out

  • brena
    brena Member Posts: 5
    edited April 2009

    Ladies,
    Question, how long would you say a bone scan is valid? before needing newer results.

    Same question for an x ray?

    Example, if my girlfriend was in remission from BC and she went for a bone scan 1yr (?) ago and now has bone pain (ribs) would another bone scan be in order? or should she depend on her prior 1yr ago?

     thanks

  • ravdeb
    ravdeb Member Posts: 277
    edited April 2009

    I had thigh pain back in 2006 while doing rads. I went to my onc who sent me to the bone cancer doctor who sent me right away for a regular x-ray. I have a benign tumor in my femur. I asked him how he could know it's benign without a biopsy and he said he knows. I went to a specialist and he said the same thing. It was not the cause of my pain. It was either radiated pain from a herniated disk or bursitis. Another doctor said it's bursitis.

    ya never know but Ladies..don't worry about it. They say regular x-rays show the best for bone mets. Well..that's what my orthopedist said to me. That's what the bone cancer doctor said and the bone surgeon said.

    I've been told they can tell the difference between arthritis and mets on a bone scan. I will take their word for it. They also told me I have arthritis. Who doesn't???? :-(

  • mke
    mke Member Posts: 20
    edited April 2009

    I think bone density determines the difference between osteopenia and osteoporosis.  A few years ago my family doc said I had bone loss and told me to take calcium and Vit.D.  I had osteopenia.  After chemo, she said I signficantly more bone loss and now I'm on a presciption med., she's not calling me osteoporotic yet.

    I complained about rib pain and went in for a bone scan.  They didn't seem that interested in my ribs but my knee drew their attention, so now I am scheduled for a MRI.  I've kind of reconciled myself to at least arthritis and osteopenia. 

  • Analemma
    Analemma Member Posts: 139
    edited April 2009

    Brena, I had a bone scan to dx mets two weeks ago.  It was confirmed by xray.  Now I'm getting radiation, but my onc scheduled a followup bone scan for two months. 

    I think I'm going to email the nurse and see if that is really necessary.  It's a lot of radiation, I think.

    But in the case of your girlfriend, I would think a bone scan is appropriate.  I had my last one in August, and it was clear, and then seven months later had bone mets show up in ribs and spine.

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009

    wallycat - NO - I never had tumor markers done... darn... had I known back then what I know now, I would have insisted on it. Can tm's only be done at time of dx? I don't know alot about them.

    brena - If she's having rib pain, I would suggest another scan. Things can change at any time.

  • candie1971
    candie1971 Member Posts: 2,467
    edited April 2009

    Laura, tm's are done with each blood test done by onc. Do u still see your onc for checkups?Then he is doing tumor markers...ask him. On the script is says...CA27-29. I dont know what my tm's have been. all I know is that they are ok. When I go see my onc again I am going to ask what are the #'s.

    Hugs and prayers

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009

    WTF WTF WTF - If tumor markers are being done and I have not been made aware of this - then  I am really pisse* off. I feel that I should be aware of EVERY test - CRIPE....I AM outraged right now...help....

  • brena
    brena Member Posts: 5
    edited April 2009

    Ladies,

    Thanks for your input and I will pass along your comments and suggestions.

    take care 

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009

    I will definately ask my Onc... I hate it when tests are done that I don't know about. I hope I didn't seem too irate! lol But I just want to know everything about my tests, etc.

  • Analemma
    Analemma Member Posts: 139
    edited April 2009

    TUMOR MARKERS ARE NOT DONE BY ALL ONCOLOGISTS!!!!!

    I had my first tumor markers done last November, after I had had mets for a year.  None were done at my first cancer episode in 2005.  They are often unreliable, and some oncologists don't ever do them.

    My oncologist decided to test them once, when CT showed my mets were recurring.  They were in the normal range, even though I was known to have mets, based on CT.  Since they were not reliable then, she has not repeated them.

    I am treated at Cleveland Clinic, recently ranked #4 in the US.  So, I'm fairly confident that I'm getting quality care. 

  • MREanes
    MREanes Member Posts: 18
    edited April 2009

    I had tests run frequently after developing bc.  I think that they were the CA27-29.

    Unfortunately, they were completely unreliable for me and we finally quit running them.  My tests were always low even when I had bone mets spreading rapidly.

    I think that they do work for some people, but there are so many erroneous results that many oncs just don't run them.

    MIke

  • marshakb
    marshakb Member Posts: 796
    edited April 2009

    I have extensive bone mets and a spot on the liver.  Every single test they have ran since the dx in Dec has been in the normal range.  Tumor markers, liver enzymes, regular blood work, the whole works, all in the normal range.  They broke my femur moving me around in the hospital so were able to biopsy the femur when they took me to surgery for a rod in the femur.  I had severe nerve like pain in my leg and when I  asked my onc why I never had pain anywhere else he said the pain being so severe in the leg probably was the reason I didn't feel it in other places.  As soon as he told me it was in the spine, etc those places started to hurt too.  I have never had an MRI, bone scan etc, just PET/CT. 

    So I guess I am lucky in a way, I do have a biopsy that confirmed, for sure, the mets.  Unfortunately we can't monitor it with TM's and blood work since I  am so damn healthy otherwise!

  • asuhammer
    asuhammer Member Posts: 7
    edited April 2009

    I'm so glad you asked this question as I have been wondering the same thing myself.  I'm 41 years old and recently went in for a thoracic MRI due to constant neck and back pain as well as pain across my chest and sternum.  The MRI show possible metastatic process or multiple myeloma by way of abnormal bone marrow signal at the sternum, clavicle, and T5.  Thankfully, the multiple myeloma seems to have been ruled out.  My bone scan lit up intensely at the sternoclavicular joint and T5 as well as my right knee.  I had seen an ortho a month ago for a sudden onset of right knee pain seriously interfering with walking and other activities.   I then had a CT of my chest, abdomen and pelvis.  Two non-scary looking nodules appeared on each of my lungs which they only want to watch for 12 months. Everything else was fine.  The sternoclavicular issue was not detected. I'm having a PET scan soon.  My lab work came back mostly looking fairly normal with only some spikes in the tests.  None of them showed any cancer definitively.  My oncologist (I had hyperplasia with atypia removed last november, no cancer per se) said it is probably nothing but that a PET scan should be done.  I keep being told it could be arthritic, but I was on anti-inflammatories for my knee pain for 6 weeks without any relief.  The pain in my chest is definitely worse at night and has become significantly more severe over the past few months, but does fluctuate in severity.  I want to believe it is probably nothing because of the labs, but it sounds like my story is not exactly unusual for metastatic process.  Any insights?

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009

    asuhammer - I'm sure some of the girls will chime in here with info/advice. Best wishs with your PET scan...

    In the meantime...I still can't help but be surprised by how many young bc girls have "arthritis"... I supposedly do... but have no family history of it, I exercise, eat well, take vitamins...

    And...I'm curious to find out if my Onc has been TM' all these years. I think I'll call him, because my next Onc appt isn't until June.

  • candie1971
    candie1971 Member Posts: 2,467
    edited April 2009

    Laura, you have raised a curious question...I now think, how can we all have arthritis...yet maybe it is from th AI's or the Ai's make it worse. I do have arthritis in my family, so I didn't question it. Very interesting!

  • asuhammer
    asuhammer Member Posts: 7
    edited April 2009

    Thanks for the input.  I'm still waiting on the PET scan to be scheduled.  Has anyone had similar radiological findings that ended up being nothing?  They won't give me any other possible differentials.  Every time I ask if it could just be arthritic they tell me it would present differently.  I'm trying to stay positive and hopeful it's nothing, but they're not making it very easy.  Thanks for responding!

  • [Deleted User]
    [Deleted User] Member Posts: 4,011
    edited April 2009

    asuhammer - I'm hoping for you that someone with a similar situation chimes in. Keep us posted.

    HERE'S SOME INFO FOR ALL OF YOU (can't have too much of that, now can we!) -

    Here's some questions I found posted at q&a sites:  

    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 being treated 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.

    Dr's answer: 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.

    Hi, I went in for x-ray of knee because of possible Arthritis, and as a result of x-ray they saw what they call a bone island in my tibia.  I now have to go for a bone scan because my doctor said that no doctor is willing to say the bone island is not cancer without further follow-up because of my previous cancer.  What are they looking for on a scan, can they tell the difference between a bone island and bone mets on a scan?

    There are two answers, depending on the nature of the bone island. An indolent bone island will show no increase uptake of the tracer. So if your bone scan is negative, then it is likely a bone island. If the bone island is growing, it can take up the tracer.  A positive bone scan will not be very helpful to differentiate whether or not it is a malignancy.

    I also went for an xray a couple of years after treatment.  I had a compression fraction of the T12....but...because I had a history of breast cancer, they looked at my arthritis, decided I MUST have mets and suggested a bone scan....it came back inconclusive....so on to the MRI (inconclusive) and a CT (inconclusive).  It took a PET to convince everyone I did not have mets.

  • candie1971
    candie1971 Member Posts: 2,467
    edited April 2009

    wow the whole thing scares and confuses me. They say I have arthritis,scoliosis and 2 herniated discs...sure hope so! Thanks for doing all the research Laura.

    Hugs and prayers