Bone Mets

[JOhn]

Do bone mets on scans ever go away? Or do they show up as scars from active disease. My wife has had bone mets from the beginning. She has been pretty stable, but it always concerns me every scan time. Does it go away?

John

[Esther]

From what I understand, the only sure way to tell if bones mets has healed up into scar tissue is to have a pet/ct scan done. The ct scan pinpoints the scar tissue, and the pet scan determines if it lights up as active bone mets.

That's what it took for me to show NED in my bone mets. The bone scans couldn't differentiate between active bone disease and healed up scar tissue.

[Unregistered.]

I am not sure it is known. A PET or PET/CT shows whether an area has increased metabolism of glucose--thus it is useful to show whether something is a tumor and using lots of glucose to actively divide or just inactive scar whch doesn't need glucose for activity left over from the killing of tumor cells. (other things can cause the PET to light up such as infection, fracture or tumors of the bone itself)
But noone knows how many tumor cells could still be left within the scar without lighting up on a PET or PET/CT. With lung scans I believe the nodule has to be more than 3-5mm before it will show up on PET/CT.
Another question is whether an old-fashioned bone scan would be more sensitive--a question I would have to bring up with a friend who is a nuclear medicine specialist.
But it is clear that even with that scan, noone knows what minimum population of cells is necessary to light it up--just that it is much less than those needed to see an abnormality on Xray.

If the bone is one that has marrow and is Axial vs peripheral (part of the central skeleton like the spine, pelvis and rib cage vs middle parts of the arm bones, leg bones, wrists, ankles hands and feet ) there is always the question of whether there are dormant slowly dividing "stem cells" left. That used to be determined by a bone marrow aspiration-- a test which seems to have fallen out of fashion.

As I understand it, what one sees as bone mets on an Xray has mostly to do with chemicals that the tumor secretes and its effect on the marrow cells or matrix, causing the cells which destroy bone normally to become more active than the cells that build bone normally thus "eating away at the bone" That is why drugs like Zometa work by making the osteoclasts(bone dissoving cells) less active. I think they are actively researching how many tumor cells it takes to secrete these chemicals to have this effect and they seem to think the Zometa has a second effect besides the effect on osteoclasts--it actually slows the cancer's growth. I am not sure they know the mechanism of that, but I know it is an area of active research

I am sorry if my answer seems very nit-picky and academic and not very practical.

But the good new is that her scans are not getting worse which would be worrisome that her present or previous treatment is/was not working and that certainly does not seem to be the case.

Not being able to say with CERTAINTY that there are no microscopic tumor cells left is nothing new for the participants on this forum. Having her2neu as a marker may be an adverse prognostic marker, but at least there is something to follow (vs those who are her2-ER-andPR-) -- the serum her2 test elevation and depression seem to occur with metastasis and response to herceptin, respectively.

I am obviously not an oncologist but hope my speculation answered some questions at least, or at least didn't confuse you more.

Now here is a topic for discussion:
Is it better to know what/that they don't know or to get a dogmatic answer which you later find is wrong?

[Unregistered.]

Blood Markers To Detect Bone Mets Earlier--will They Become Adopted?

ABSTRACT: The Relative Use of Eight Collagenous and Noncollagenous Markers for Diagnosis of Skeletal Metastases in Breast, Prostate, or Lung Cancer Patients [Cancer Epidemiology, Biomarkers and Prevention; Subscribe]
The present study was sought to assess the relative use of eight biomarkers for the detection of bone metastases in cancer forms frequently spreading to the skeleton. Participants were 161 patients with either breast, prostate, or lung cancer. The presence and extent of bone metastases was assessed by imaging techniques (computer tomography and/or magnetic resonance imaging) and Technetium-99m scintigraphy. Serum or urinary level of the bone resorption markers (??CTX, ??CTX, NTX, and ICTP), formation marker (BSAP), and osteoclastogenesis markers (osteoprotegerin, RANKL, and TRAP5b) was measured by commercially available immunoassays. When assessed on a group basis, all biomarkers, except for osteoprotegerin and RANKL, were significantly elevated in patients compared with those without bone metastases (P < 0.05). Biomarkers had greater diagnostic value in breast and prostate cancer patients, yet ??CTX, NTx, and ICTP were able to discriminate lung cancer patients with or without bone metastases (P < 0.05). Strong linear associations were seen between the extent of skeletal infiltration and levels of the different biomarkers, except for osteoprotegerin and RANKL. Furthermore, all biomarkers (except for osteoprotegerin and RANKL) were indicative at the early stage of skeletal involvement (one to five metastases). When expressing sensitivity as the percentage increase in biomarker level relative to patients without bone metastases, ??CTX showed the largest relative increases at each stage of the metastatic disease. These results suggest that closer monitoring of cancer patients with serial measures of biomarkers might facilitate the timely diagnosis of skeletal metastases.

[Lani]

The omentum is a membranous sheet in the abdomen which is utilized sometimes for things like peritoneal dialysis as it has the ability to filter substances differentially.

Surg Today. 2006;36(2):175-9. Links

Omental transposition for lymphedema after a breast cancer resection: report of a case.

Nakajima E, Nakajima R, Tsukamoto S, Koide Y, Yarita T, Kato H.

Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Lymphedema of the arm and hand is one of the major complications after a breast cancer resection. Conservative treatment for the treatment of lymphedema, such as compression garments and centripetal massage, is very important for these cases. However, if the lymphedema is difficult to control with conservative treatment and the patient's quality of life (QOL) is compromised due to swelling of the arms, surgical treatment should be considered. We used omental transposition to improve the status of lymphedema in the present patient whose left arm and hand had been swollen for 5 years, which thus prevented her from being able to lift her arm. After the operation, she was able to lift her left arm herself and perform tasks with her left hand, thereby obtaining a better QOL than before the operation regarding her left arm movement.

PMID: 16440167 [PubMed - in process]