Bone mets to only one site and no other signs of mets?

[SandyBB]

Have any of you heard of bone mets appearing in only one spot at first discovery/with no other evidence of metastatic spread?

I was diagnosed as stage 2B in Sept 2003, with 3 positive nodes. Had partial mastectomy, and finished aggressive treatment in April of 2004. Then in the fall of 2005, my onc called and told me she wanted to start me on Herceptin - which I did in Oct of last year. Two months ago, I experienced bad pain in my rib area, right under where my cancer was and I had no recollection of any recent trauma to the area. My onc did x-rays, which were fine, but the bone scan showed significant uptake on one rib (exactly on the spot where I had marked the pain). My two prior bone scans in 2003 and 2005 were totally clear (so it isn't from past trauma). She then ordered a Catscan which was clear, and blood tests were fine - including tumor markers and enzymes.

So - my onc feels that the uptake on the bone scan is most likely NOT evidence of bone mets because it is the only site in my body and she says it is highly unusual for metastatic disease to evidence itself in only one isolated location.
I am waiting a total of 6 weeks and then will have a new bone scan done to see if the spot still lights up. She strongly feels it will not and that I must have bruised the area and not remembered doing so.. if it does light up again, and there are additional spots - it is bone mets. If only the rib still lights up, she said I would probably have to have the rib removed for biopsy (a needle biopsy of ribs is unreliable).
As most all of you know, the waiting is the pits! And I can't help but be pessimistic - I know I did nothing to bruise the area (at least I think I didn't!)and what are the odds that it would light up right under where my cancer was?
Have any of you heard of bone mets appearing in only one spot at first discovery/with no other evidence of metastatic spread? Any of you had a bone biopsy?

[MCS]

Sandy,

I have stage 1 but they found a spot on my sternum. mri found it during an mri for breasts and pet ct did not.

i'm having a bone scan and another sternum mri this friday.

needless to say i'm concern that it will be bone mets.

maybe others will tell you if they palce you on zometa or radiation if they find small spots like this.

i'm just as scared as you are.

LOVE

MCS ( maria)

[Lala]

Hello Sandy,

I am sorry you are dealing with this question of possible bone metastases. I can tell you about my experience regarding bone mets.

In my case a PET scan found a 'single bone met' located in my thoracic vertebrae. A bone scan was then ordered and the results confirmed the finding of the PET scan. I then had a bone biopsy on my thoracic vertebrae; the results confirmed that the cells were consistent with breast cancer.

I now monitor my bones using the bone scan and the MRI of the thoracic and lumbar. I am taking the drug Zometa once a month for my bones.

Unfortunately, I think it is possible to have a single bone metastasis as it has to start somewhere. I would suggest that you get a second opinion immediately.
I do not think waiting 6 weeks is the best advice; if this is a metastases get it under control now. Especially since you have pain, please get this checked as soon as possible.

Best of luck to you

[Sheila]

Sandy

I had a questionable mets to the ribs on the same side as my mastectomy during a bone scan....I had sreness to the area, but also had sneezed hard about 3 weeks before...after 2 bone scans and RIB xrays, it was determined that it was a fractured rib (from sneezing) that lit up as a hot spot on the bone scan....any inflammation, even arthritis can show on a bone scan!
Hope this helps

[SandyBB]

Lala, how did they do the bone biopsy - via a needle aspiration or core biopsy? Also, from your profile, it looks like you have liver mets too? Was the bone mets after they knew you had the liver mets? My onc said that a single bone met site was unusual if there were no other signs of any kind of mets...so if you already had mets to the liver, your single bone mets site would not be as relevant... but I sure do appreciate your sharing that bone mets can be found in only one isolated spot. As another reply stated - it has to start somewhere, right?

Thanks for the other replies - I thought about a second opinion, but the scan is now 2 and half weeks away so I figure I will wait til then...and consider a second opinion based on what transpires. The extra 6 weeks I will have waited should not actually make much difference in disease progression if it is bone mets...And I am actually not in that much pain anymore - still feel it but not anywhere near as bad as it was - which is also why the onc thought it was a trauma.

With the reply on the broken rib for sneezing - sorry I forget your name - did you have an x-ray too and did that show a fracture? My x-ray showed nothing...
thanks again to all.

[SandyBB]

forgot to add that in- I hope you find the spot on the sternum is nothing but it sure is crappy having to wait to find out, isn't it?...
Also - Sheila, I realized you did mention you had an x-ray in your post. Did the x-ray show the fracture?

[Lala]

Hello Sandy,
In answer to your first question; I had a CAT Scan Guided Fine Needle Aspiration Bone Biopsy to my thoracic vertebrae bone.
My Liver metastasis was only discovered after the bone metastasis was discovered. Another PET Scan and Cat Scan of the abdomen confirmed the liver metastasis.

I would like to comment on your statement about it being ‘unusual for a single bone met site’. I know a few stage 4 ladies that have a single site of metastasis, and many others that have multiple sites of metastases. My reply to you about ‘it has to start somewhere’; is a reminder that all metastases start one place and can then spread. When a site of metastases is suspected proper scans need to be done as soon as possible. Also the possibility of further scans such as CAT scan of the abdomen or a PET scan should be considered. I am a firm believer in checking head to toe.

Again Best of Luck to you,

[wiesia]

Sandy,

My mother is in a somewhat similar situation. She was dx almost five years ago (at age 65), ER+, 17/19 nodes positive. Treated agressively. Her tm (CA 15-3) would flactuate between 17 and 25. But in the last year they crept up from 22
to 41. We did PET/CT that showed to spots of uptake in the bones (the rest was clear). One on L! vertebrae and one a rib. The PET radiologist thought that the spot on the spine did not look like met but that the one on the rib might be.
My mother's oncologist ordered a bunch of "focused" x-rays that came clear on the spine and with some kind of fracture on the rib. She said to check the markers in two weeks (my mother has a bad cold now) and to come and see her again in 8 weeks.

I am also thinking this seems a bid too long. Would bone scan be good at this point ? What about MRI ?


Good luck,

wiesia

[StephN]

I have two good friends who are fighting continually their stage 4 disease for about 5 years. One had a met in her arm and had no really bad pain until the bone broke due to growth of that met. As has been said - it had to start somewhere. Now she still fights a slow spread, containment, slow spread in other areas, change of treatment routine for years.

My other friend has a spot on her right rib near the mast scar that has come and gone for years. She later developed a couple of lymph nodes in a really bad spot way up under her arm that grow and shrink. She is finally on some harder chemo now with Avastin to see if that will put a halt to these mets.

So, your chances could go either way as in the case of the friend with the rib area her markers are not bad most of the time unless the nodes are acting up.

Best of luck that the spot will NOT light up. I had a very painful rib after Taxol and the scan showed no enhancement. It got better.

[Sheila]

Sandy
I did have an xray but it was a RIB xray...my fracture did not show up on a normal chest xray...it needed to be more detailed so a rib xray was ordered...it wa very visible on the xray when the right xray was done.

[MCS]

Sandy,

I had an MRI of the sternum this firday and it did show a spot, the same one with the breast mri two weeks prior.

The bone scan and the pet ct of the area did not show it. The pet ct did not show any other spots anywhere.

The oncologyst is not doing anything. He does not elieve it's metastasis. He believes it is benign, been there for a long time or killed by the chemo. He will not be doing a biopsy but will be following with mri /bone scans every three months to look for growth.

I feel like I have this big thing hanging around my neck, inside! waiting to light up and spread but I'm also trying to not escalate to ridiculeness either.

I should be ok today and yet I'm an emoitional wreck.

MCS
( maria)

[EllaD]

Sandy,

I only recently joined this site. I am on Herceptin since January, 2006 and will continue until this January. This past week when I had my treatment I noticed I had pain near my mastectomy scar. I didn't mention it. Now this entire weekend I have had such pain on that side, ribs back and front. As others have said I had no injury there. I have not called or anything because in my usual denial, I am waiting to see if it gets better. I wonder why it would start right after herceptin treatment.

It is good to read what everyone says on this site. I do get depressed from time to time. I try to keep up my normal routine now and be that perky positive girl everyone wants to talk about, but it's always in the back of my mind - could this have spread? (I did have 4 positive nodes out of 5).

Thank you for being here! I hope your news is good.

EllaD

[SandyBB]

The waiting really stinks - and trying to stay positive but all the time wondering if the cancer is pulsing somewhere..
Ella, please do call your onc if the pain continues - Herceptin can cause bone aching type symptoms. Plus, not sure if you are ER+, but I am on Aromsin and that makes me achy everywhere... but not all of a sudden in one spot...

[EllaD]

Thanks, Sandy. The pain seemed to get a bit better today. It still hurts if I cough or yawn. Doesn't that sound crazy? Maybe it is all psychosomatic(sp?) since it is one year this week since my first surgery.

Keep on posting. It is good to share feelings with others who understand.

EllaD

[Karen t]

I had mets to the lungs and on the sternum. Followed up with Navelbine and radiation. Am on wkly Herceptin.

My question is, when should the diagnostic tool be a CT vs an MRI? I told my onc I thought my sternum was swelling again, she ordered a CT that showed no change.

thanks.

[HavahJ]

I just read this - have been dying (haha) to talk to people with this. I've had two separate cancers, one 15 years ago in left breast, one in2004 in right. The new one was her2neu 2A, one node. After about a year and ahalf my marker went up, had a PET. I have a small met on my skull bone. It's been single for 14 months. I had Gamma for it 6 months ago. I am considering a chemo that they have done at M.D. Anderson for single met people with some good successes. I would love to talk to any of you! HavahJ (Jan Solomon)

[KellyA]

It was very strange to see this post come up this am. I just wrote Sandy last night regarding this post. Don't know what to do. I had a spot show up on my bone scan on a single rib (not the side I was radiated on) about 10 days ago. After an x-ray and a CT came in clear, they decided that it was nothing because bone mets "don't present that way." My marker was done and it was 20.3 About two days ago, the spot began to hurt. I just had my 3 week Herceptin infusion and don't know if it is that, or what? My onc. isn't worried and I am. My sense of judgement is wasy off and I can't tell whats what anymore. Help!!!!!! What do I do?


Kelly

[Becky]

Kelly


What did your onc suggest? Did he say he would rescan that area in 2 months, 3 months? How often do they run the tumor markers? If they only run them every 3 months, I would ask they run them every time you go in for a Herceptin treatment. This way, you can at least get an idea of how the tumor markers are running. I know we are all probably very much the same in that I know I would really want to be rescanned at some point to observe that area. I also would want some definitive answer that the spot was nothing and (hopefully) what it was. (For example, in my bone scan my ankles lit up. I did do high impact aerobics for years in my early 20's and ran but had no pain or problems). It was definitively ruled as arthritis even though I don't have any real symptoms yet.

Talk to your onc about this and get a forward plan together (ie: when the tumor markers will be run and when another scan will be done - maybe a Pet. How will a diagnosis be made (what I mean here is a benign diagnosis my dear - that this is arthritis, a bruise etc).

I really think this is nothing but personally, I think most of us think one thing when something happens (even a bad cold with swollen glands crosses my mind until I am well again - its natural!)

Rest, eat well and get some exercise and think through what you would like your plan to be and then call your onc on Monday (if you don't have an appointment already set up).

Big hug to you.

[KellyA]

Thank you so much Becky- am really worried about this one. The radiologist from the bone scan suggested maybe rescanning in 3 months, but my onc. didn't say anything about that. What would be a good scan to ask for? Another bone scan? If the area is still there, what would be a definitive test? I do know that the spot was not there in June, so it is relatively new. Also (one more thing), do you think that a 20.3 marker is a little on the high side? I know that it is within normal range, I was just thinking that it would be a little lower (I was still on radiation when I got it done however). Why do the docs make us have to fight so much just to be sure? I could see the resistance if there wasn't a cancer dx. It just seems like common sense to me.


Thank you again,
Love,
Kelly

[Lala]

Kelly,

In my opinion you need a second opinion immediately. The fact that you are experiencing pain is a sign that this needs to be looked at closer. The bone scan concurs with this location of your pain. I would ask for a complete review of scans and testing of the tumor markers cea and ca 27-29. Perhaps a bone biopsy can be done. The only other test I would recommend for further investigation would be the PET scan as this can pick up suspicious activity.

I do not think waiting 3months is the best advice; if this is a metastases get it under control now. Especially since you have pain, please get this checked as soon as possible.

Best of Luck to you,

[KellyA]

I feel the way that you do Lala- I just don't know what else to ask for. The bone scan showed the one spot. The x-ray and the CT were negative, and my marker was 20.3 The only thing left that I can think of is a PET, however, if I did knick this area, there probably hasn't been enough time for this to heal/change from the scan I had 10 days ago. What further testing can I do? I did read that the ribs cannot be effectively biopsied and that they would have to remove it to do that, which I don't think that we would do at this point.I don't even know what else to request...

Kelly

[Becky]

Dear Kelly


Hopefully someone on this board who has or had bone mets will respond because I don't know if a bone met will light up with a PET scan but, I do know mets in the lungs and liver light up. A PET scan tends to be very definitive EXCEPT (haha - always an except) if there is infection or injury. And, your rib could very well be a bruise or bump (as both the radiologist and your onc don't think its anything to worry about at all). Therefore, I am afraid if you ask for a PET now and its a bruise, it will light up and it still wouldn't be anything to worry about. If I were you, I would kick back until my next Herceptin. Ask the onc to run the bloodwork again. Ask the onc how long a bruised rib would take to heal because you really want another CT or bone scan or PET (ask him which one he really recommends as a repeat - make sure you tell him if the CT shows no change would a PET confirm things one way or another) and then go from there. I don't know how long it takes a bruised rib to heal (a break is usually 6 weeks though so a bruise couldn't really take longer).

For your markers:

20.3 is not too high. I have a stage 1 Her2+ girlfriend (hormone negative) who is over 4 yrs out and her CA 27/29 has always been 40 (above the highest normal limit by about 2 points) and she is completely fine. Her lowest one was 35. I run been 8-21 (last one 2 weeks ago was 16). My first one was 11 but it bounces all over the place between those #s.

I hope this helps a little bit.

[KellyA]

Dear Becky,

Thank you for your reply. I feel MUCH better. I agree with you in that if I have injured myself it would probably only show up again so soon on another scan (then I would really be upset!). I am going to do what you said and TRY to relax until my next Herceptin in a few weeks. I am a little suspicious because ever since they switched me to the 3 week dose I have had problems with pain- in my hip and now the ribs. Both feel like massive bruises.

What a wreck I am!!!!! I don't know what has happened to the calm cool collected person I once was. Level-headed was my middle name...:-) Now its Sybil! I hope you have a wonderful weekend and thank you again.

Love,
Kelly

[Becky]

You have really made me think alot so bear with me here. I know that I told you that I got a bone scan about 16 months ago or so because my hip hurt me too. I think part of it for me (hindsight) is that I started a rigorous exercise plan (and I am older than you - 48 now). But my hip started really, really hurting when I switched from weekly Herceptin to every 3 week.


One thing about Her2 protein is that we do need it. Everyone needs it especially if you are injured or healing as cells need to replicate for the healing process. Therefore, if you have aches and pains, theory says it should hurt more if you are taking Herceptin because you are having an immune response at the injury site with more Her2 protein (naturally) present. I think this is why some women get bone pain while on Herceptin (especially the hormone positive women who get pain from their anti- hormonal) - pain from bone loss in this case (I realize this isn't you but I am thinking out loud here) so that is intensified because the body always tries diligently to heal and repair itself.

Give yourself some time to heal (it shouldn't take more than 6 weeks) and get rescaned (whatever method your onc and you decide) and go from there. I have a good feeling that everything will be fine.

Have a great weekend.

[Sandy H]

I am in a trial so the protocal for me is scans every 6 weeks. In October my bone scan showed two spots on the ribs! My oncologist said it didn't make sense because my cat scan was clear. He said bone mets look two ways. They will show up as a white spot like a hole in the bone or a scape mark. Neither one of these showed that way. He said it didn't make sense and in that case he said usually its an error on the examiner's part. He said we would know in December 6 weeks later. He also told me if I was not in the trial he would scan me in two months for sure. In December the scans were clear. One of the secretaries in the oncology office had breast cancer 11 years ago and started having pain in her leg just below the back of the knee. It was a bone met (she has the same oncologist as me and he is the head one) and he told her its unusual to have a bone met in the part of the leg. But, they can occur anywhere. I hope my story helps that it maybe nothing but it is truly scary and I can understand how you are feeling. I will pray its nothing and it probably is but need to get it checked out. Please keep us updated. Sending you a big hug, from another Sandy.

[KellyA]

Thank you Sandy for your encouragement. It's a frustrating situation as I believe that "only time will tell" as I had many scans and a marker done. Unfortuneately waiting is not my srong point (as I think that it is with most of us!).

Becky, I thought that it was interessting that you made note of that with the Herceptin. My hip started to hurt with the first 3 week dose and hasn't let up since (sometimes I find it hard to even walk). The spot on my ribs did not hurt when I had the scans done, but after reflecting yesterday (all day :-) ), I realized that the pain began after my 3 week dose on Thursday. VEERRY INTERESTING. I am so grateful to be able to receive Herceptin and will deal with whatever it brings, as long as we know the cancer issue has been ruled out. ( I can handle the pain, just worry what the pain might be).

Anyways, I am going try try and think positive and wait until my next OV in two weeks and make a plan to investigate further. Nice thought- easier said than done. I almost had tood take a "happy pill" (from my old surgery meds) on this one. :-)

Thank you,
Love, Kelly

[DianaK]

Hi Kelly

I had rib pain when I was doing Herceptin.I completed my year of Herceptin last May-also every three weeks.I suspect it has something to do with the Herceptin.Since I have been off of it-no rib pain-in fact feeling MUCH better all around!I know the oncs try to play down the side effects from Herceptin,but having been off it for a while-the side effects are real and irritating!Will be praying for you that it is just an aggravated rib-Diana

[SandyBB]

I actually logged back on to this site today after a long absence because I wanted to see what everyone was saying about Elizabeth Edwards.
I realized I should post an update for those who do searches in the future and could benefit from hearing my outcome -

As background/reminder, I was diagnosed stage 2B in Sept. 2003 with no evidence of mets. Then in Aug of 2006, I experienced severe pain in my left rib area(cancer was in my left breast) with no memory of any injury. All my bone scans in the past had been totally clear. This time they did an x-ray - nothing, then a bone scan which found a big hot spot on the rib which we assumed was bone mets. But, my blood work and cat scan were fine, and my onc swore that bone mets rarely showed up in only one spot. So - I waited 6 weeks, had another bone scan. Still there (but maybe, a tiny bit less bright). But no other spots. So then had a Pet Scan - totally clear. My onc said she was 97% sure it was not cancer. Wait 3 months, have another bone scan - spot much much smaller, no new spots-
Diagnosis - broken rib from weakening caused by radiation. X-rays do not always pick up a rib fracture. I could have had a rib biopsy but very invasive. If this last bone scan had not been so conclusive, I might have needed one for peace of mind.