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

SandyBB · 09-20-2006, 10:08 AM

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 · 09-20-2006, 06:14 PM

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 · 09-21-2006, 06:50 AM

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 · 09-21-2006, 08:50 AM

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 · 09-21-2006, 09:30 AM

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 · 09-21-2006, 09:35 AM

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 · 09-21-2006, 11:36 AM

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 · 09-21-2006, 11:52 AM

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 · 09-21-2006, 12:03 PM

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 · 09-22-2006, 03:04 AM

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 · 09-23-2006, 12:56 PM

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 · 09-23-2006, 09:27 PM

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 · 09-25-2006, 07:53 AM

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 · 09-25-2006, 08:21 PM

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 · 10-01-2006, 04:51 PM

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 · 01-20-2007, 07:16 AM

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 · 01-20-2007, 08:21 AM

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 · 01-20-2007, 08:45 AM

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 · 01-20-2007, 08:54 AM

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 · 01-20-2007, 10:05 AM

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,