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Topic: Sclerotic lesion on CT scan

Forum: Stage IV/Metastatic Breast Cancer, Open to All To Contribute —

Topics here are started by members with a Stage IV/Metastatic Breast Cancer diagnosis, but open to all members to contribute to discussions. Please note that there is a separate forum, Stage IV/Metastatic Breast Cancer ONLY, where topics are open only to those members.

Posted on: Mar 9, 2020 06:03PM

Rambros wrote:

Hello, I hope it's okay I post this question here because I'm at a loss about what I should do. I had a CT scan in December (to check my Thyroid) and it showed a sclerotic lesion on my L3 (which was not on my 2014 pre-chemo PET scan). I had a MRI which showed no enhancement. The MRI radiologist said that the area shows some modest heterogenity but that old sclerotic metastisis is considered possible. I've been on letrozole for the past almost 5 years. I've also been on prolia and my bone density in the L1-L4 area has changed from osteopenic to normal going from -1.2 to -.5. My questions are:

(1) Would bone density repair/increase from Prolia look like a sclerotic lesion or heterogeneity (thats another phrase the MRI report has about it) on a CT?

(2) Could a sclerotic bone lesion be biopsied?

(3) if you have any suggestions about what my next step should be I'm all ears

Thank you in advance!

Dx 10/8/2014, IDC, Left, 3cm, Stage IIB, Grade 3, 1/10 nodes, ER+/PR+, HER2- (FISH) Surgery 11/16/2014 Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 1/5/2015 AC + T (Taxol) Hormonal Therapy Femara (letrozole) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Surgery Prophylactic ovary removal Radiation Therapy Lymph nodes, Chest wall
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Jun 8, 2020 11:07PM GiGiL wrote:

I was just told I have several sclerotic foci on my vertebrae. That was after being pretty carefree for 9 years. I have a 3-D mammo and an ultrasound today, which were normal. Lymph nodes are normal feeling. I am scheduled for a PET scan in 2 days. I too am wondering about these sclerotic lesions. I have heard they can show up in arthritis. Here’s hoping it is something benign for both of us

Dx 5/6/2011, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Dx 5/2020, Stage IV, metastasized to bone, ER+/PR+ Hormonal Therapy Femara (letrozole)
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Jun 9, 2020 08:54AM Rambros wrote:

I’ll keep you in my thoughts GiGiL, fingers crossed for a clear PET scan.

I don’t know if I’m out of the woods completely, but I had a bone scan with SPECT of my spine which was clear (although the bone scan & hip MRI found a benign bone tumor in my hip). For now I’m done with scans until the end of the year. That’s good that you’re having a PET scan - in hindsight I should have done even if I had to pay out of pocket instead of all the others types of scans.Take care

Dx 10/8/2014, IDC, Left, 3cm, Stage IIB, Grade 3, 1/10 nodes, ER+/PR+, HER2- (FISH) Surgery 11/16/2014 Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 1/5/2015 AC + T (Taxol) Hormonal Therapy Femara (letrozole) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Surgery Prophylactic ovary removal Radiation Therapy Lymph nodes, Chest wall
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Jun 15, 2020 10:12AM GiGiL wrote:

Rambros thank you for the good wishes. Since my last post I found out my mammo and ultrasound were clear. My PET shows multiple sclerotic lesions which lit up throughout my bones, but no organ involvement. I now have to have a bone biopsy in a week. After 9 years I was just starting to breathe easier. I have been blessed with good health for 70 years, except for the lumpectomy and rads. I am having trouble with anxiety and dread.

Dx 5/6/2011, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Dx 5/2020, Stage IV, metastasized to bone, ER+/PR+ Hormonal Therapy Femara (letrozole)
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Jun 15, 2020 02:47PM BevJen wrote:

GiGIL,

I posted a response to you on the other thread, but there you didn't say that your PET showed sclerotic lesions. This is a question that I have had for my MO, and I've now also consulted two other MOs about it. So far as I can figure out, sclerotic lesions means healing lesions, as opposed to new lesions. That means, from what I understand, that they are reacting/healing, from some prior treatment. Have you been on something else? I can't remember and your history doesn't show.

If you are interested, Living Beyond Breast Cancer (LBBC) had a virtual metastatic breast cancer conference this past weekend. On Saturday, a doc from Pittsburgh, Dr. Adam Brufsky, spoke on bone metastasis. His presentation was excellent. I think starting this Friday (but I could be wrong on the date) LBBC is making the tapes of all of the presentations available on their website - just google and you'll come up with the website address. This could be too much info to take in right now before your biopsy, but once you get through that, I'd recommend watching.

And breathe. You will come up with a plan, just as before, and it will be fine. You just have to deal with going back into active treatment again. Take care.

Microwave Ablations,Liver 3x ;Radiation Therapy to Femur (Both) April 2021; total hip replacement (R) and placement of rod (L) to stabilize femur both sides; immunotherapy (single agent - keytruda) Dx 11/2003, ILC, Left, Stage IIIC, 13/18 nodes, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+, HER2- Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/4/2019 Targeted Therapy 7/31/2019 Ibrance (palbociclib) Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Femara (letrozole) Radiation Therapy Immunotherapy
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Jun 16, 2020 01:24AM GiGiL wrote:

Thanks BevJen. No, the only active treatment I have done lately is taking daily doses of turmeric in my smoothie as a preventative. Thank you for letting me know about the presentation on bone mets. I have been looking for any information available. Also thanks for the advice. GiGi

Dx 5/6/2011, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Dx 5/2020, Stage IV, metastasized to bone, ER+/PR+ Hormonal Therapy Femara (letrozole)
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Jul 5, 2020 05:13PM - edited Jul 5, 2020 05:16PM by JFL

All of my healed bone mets (my skeletal system is filled with them) are also referred to as sclerotic on the PET scan. They are inactive, healed bone mets. Healed bone mets present as some sort of scar tissue. It makes sense that healed osteopenic bone may present similar but I don't know for sure.

However, less commonly, the term can be used to describe blastic (overgrowth of bone) mets as opposed to lytic (degradation of bone). Most people have a mix of lytic and blastic bone mets, with a predominance of lytic mets. The only way to know for sure whether the lesions are active or inactive would be a PET or other scan that shows metabolic activity to see if the lesions light up and are active. It is possible you have had the bone mets for many many years, that they were missed on a prior scan and were treated by the treatment you did for early stage disease. Lytic bone mets heal to present as sclerotic.

Chart your own course. Dx at 30. Dx with mets at 38 while pregnant - extensive liver & bone involvement. Currently on Enhertu & XGeva. ER+/PR+, HER2-low (IHC equivocal, +2/FISH negative). Y90 liver radioembolization in 2018. Dx 9/2006, IDC, Right, 1cm, Stage IIB, Grade 3, 1/16 nodes, ER+/PR+, HER2- (FISH) Surgery 9/22/2006 Mastectomy: Left, Right Chemotherapy 11/6/2006 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 3/15/2007 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 12/2014, IDC, Stage IV, metastasized to bone/liver/other, Grade 3, ER+/PR-, HER2- Surgery 12/26/2014 Prophylactic ovary removal Hormonal Therapy 12/26/2014 Aromasin (exemestane), Faslodex (fulvestrant) Targeted Therapy 6/18/2015 Ibrance (palbociclib) Chemotherapy 3/10/2016 Xeloda (capecitabine) Hormonal Therapy 5/14/2017 Aromasin (exemestane) Targeted Therapy 5/14/2017 Afinitor (everolimus) Chemotherapy 8/18/2017 Abraxane (albumin-bound or nab-paclitaxel) Chemotherapy 3/23/2018 Doxil (doxorubicin) Chemotherapy 4/26/2019 Navelbine (vinorelbine) Hormonal Therapy 4/26/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Chemotherapy 11/27/2019 Gemzar (gemcitabine) Hormonal Therapy 8/25/2020 Faslodex (fulvestrant) Targeted Therapy 8/25/2020 Piqray (alpelisib) Targeted Therapy 10/2/2020 Enhertu (fam-trastuzumab deruxtecan-nxki)
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Aug 31, 2020 10:53PM beep7bop wrote:

GIGIL, I am sorry about your news how did the biopsy go? I have question for you, What brought you to the Mets diagnosis? The reason I ask is my serum calcium levels are high and my liver test were high also. I see oncologist tomorrow. I am having terrible knee and leg pain.

Dx 3/11/2019, ILC/IDC, Both breasts, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right

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