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Old 09-14-2010, 04:56 PM   #1
KorynH
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Best imaging method for dx mets?

I finished Herceptin in Dec. 09. End of July began having pain on right rib cage side. This has now been going on 6 weeks. This pain is oddly familiar to me from when my liver enzymes were 3x elevated during chemo Spring of 09. It is a dull achy pain. Comes and goes but is definitely every day. Rib x-rays and ct of abdomen show nothing. Liver function test normal. Onco is leaning towards a pet scan but also mentioned ultrasound or mri. Is there a gold standard for diagnosing this area (liver) after bc? My bc was missed for 2 years because it didn't show on imaging so I am understandably concerned that they just aren't ordering the correct imaging study. I am in the military system of medicine so insurance/money no problem. They are not restricted in what they can order. ANy advice greatly appreciated!
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45 Y.O./Dx 10-01-08 IDC & ILC Tumor gr. 3, Stage 1b, multi focal tumors, er+/PR+/Her2+++ Bilat. Mastectomy 10-28-08 w/TA Began Taxotere,Carbo,Herceptin 12-29-08, completed TC 4-15-09, Herceptin through 12/09, TA replaced with silicone implant 7/09
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Old 09-14-2010, 05:26 PM   #2
Rich66
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Re: Best imaging method for dx mets?

An "eye to thigh" PET/CT scan would probably give the most information overall. If money is no object, an MRI might give additional detailed information on the specific area...without added radiation.

Looking at your history, have you considered a hormonal therapy?
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Old 09-14-2010, 07:34 PM   #3
KorynH
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Re: Best imaging method for dx mets?

I tried Tamoxifen twice in the last year for months at a time with debilitating side effects. I'm not sure what that has to do with my imaging question, though.
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45 Y.O./Dx 10-01-08 IDC & ILC Tumor gr. 3, Stage 1b, multi focal tumors, er+/PR+/Her2+++ Bilat. Mastectomy 10-28-08 w/TA Began Taxotere,Carbo,Herceptin 12-29-08, completed TC 4-15-09, Herceptin through 12/09, TA replaced with silicone implant 7/09
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Old 09-14-2010, 08:56 PM   #4
Rich66
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Re: Best imaging method for dx mets?

Just being nosey Actually, I was just curious if there were oncs that didn't value that part of pathology when her2 +. Wish there were more endocrine options for adjuvant.
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Old 09-14-2010, 11:07 PM   #5
Chelee
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Re: Best imaging method for dx mets?

I would request PET/CT if your really concerned. Also just wanted you to know that so many of us women that have had mastectomy have experienced rib pain. Seems to be a common complaint with so many of us. But it's good to stay vigilant and get things checked out if your worried...nothing like peace of mind. Once dx with bc ever new pain we feel worries us...it's so hard at times. But it really might be nothing more then the fact you had a bilat mastectomy. Hang in there.

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DX: 12-20-05 - Stage IIIA, Her2/Neu, 3+++,Er & Pr weakly positive, 5 of 16 pos nodes.
Rt. MRM on 1-3-06 -- No Rads due to compromised lungs.
Chemo started 2-7-06 -- TCH - - Finished 6-12-06
Finished yr of wkly herceptin 3-19-07
3-15-07 Lt side prophylactic simple mastectomy. -- Ooph 4-05-07
9-21-09 PET/CT "Recurrence" to Rt. axllia, Rt. femur, ilium. Possible Sacrum & liver? Now stage IV.
9-28-09 Loading dose of Herceptin & started Zometa
9-29-09 Power Port Placement
10-24-09 Mass 6.4 x 4.7 cm on Rt. femur head.
11-19-09 RT. Femur surgery - Rod placed
12-7-09 Navelbine added to Herceptin/Zometa.
3-23-10 Ten days of rads to RT femur. Completed.
4-05-10 Quit Navelbine--Herceptin/Zometa alone.
5-4-10 Appt. with Dr. Slamon to see what is next? Waiting on FISH results from femur biopsy.
Results to FISH was unsuccessful--this happens less then 2% of the time.
7-7-10 Recurrence to RT axilla again. Back to UCLA for options.
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Old 09-15-2010, 08:15 AM   #6
Joan M
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Re: Best imaging method for dx mets?

Koryn,

While a PET/CT can be indicative of cancer if the nodule is about 1 cm and therefore has a greater chance of lighting up, I'd prefer a liver MRI. The MRI would give a detailed review of the liver and reveal any nodules, including benign nodules, that might have been missed by a CT scan. Overall, my sense (and it's only my gut feeling) is that if you're experiencing pain, the cancer would be big enough to show up on any of these tests. And a second test can really help rule one way or the other.

What does the radiologist's report say? His or her impression? Does he or she give a recommendation for follow-up? Six months? etc.? It's important for you to get all copies of your reports. Perhaps only a follow-up is necessary.

Also, in reference to Tamoxifen, you were blessed in being ER+/PR+. 70% of breast cancers are. The reason it's a blessing is because Tamoxifen and related endocrine drugs have cut the rate of breast cancer recurrence by 50% in 25 years of use. By recurrence I mean the cancer spreading to stage 3, or locally advancing to lymph nodes, for example, or becoming stage 4 and invading another organ (not to be confused with coming back in the other breast, which would be another primary breast cancer, not a recurrence). That said, you should speak to your onc about an alternative to Tamoxifen.

It's possible that the rib pain was caused by the mastectomy and silicone implant. I had DIEP flap reconstruction and my ribs bothered me for quite some time.

Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity. No cancer, only fungus. Still continuing on only Herceptin. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Living with MBC for 11 years. Praying for NED forever!!
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Old 09-16-2010, 12:17 AM   #7
Jackie07
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Re: Best imaging method for dx mets?

Koryn,

My recurrence was missed for 4 years because they thought the shadow was 'scar tissue', so I understand your concern.

Earlier last year, I had gone throught similar worries and discovered a hepatic hemangioma in my liver. I think the 'ultrasound' is recommended because it will confirm the nature of the mass, if there's ever one showing on the CT because hemangioma would show on one scan but not the other.

Since all your lab work was good (just like mine last year), I'm thinking an ultrasound will solve the mystery and get rid of your worry.
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

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Old 09-16-2010, 11:18 AM   #8
SunDiego
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Re: Best imaging method for dx mets?

MRI with contrast and PET/CT as Rich said.
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