alta
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Posts:15
My daughter has stage 3a breast cancer. Back in January when she was first diagnosed her bone scan and MRI showed "moderate focal uptake in L3 corresponding to lytic lesion". She had a FNB and core of that area and was found negative. She has had 3 different PET/CT scans and they all show "photopenic in the L3" with the last one stating "photopenic area of L3 unchanged" Her last bone scan says the same thing as the initial one back in january "moderate focal uptake in L3 corresponding to lytic lesion. Her oncologist is just scanning the area for now.
Can you tell me what this means? What are the chances that she is stage 4?
I don't if if makes any difference that she has rheumatoid arthritis.
Thank you.
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Reply # - October 6, 2013, 09:42 AM
Reply To: Photopenic area
Hi alta,
In the context of an existing breast cancer diagnosis, the scan finding may be suggestive of a bone metastasis, but since the area has been biopsied with negative results and does not appear to be growing in subsequent scans, continued close surveillance seems to be a reasonable course of action. There can be other causes for such abnormalities, and without scan evidence of cancer spread anywhere else in the body, a non-cancer cause may be likely.
JimC
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Reply # - October 6, 2013, 10:17 AM
Reply To: Photopenic area
Thank you Jim for your prompt response. I am worried about this day and night.
One thing I must mention is that her onc said that maybe not enough cells were taken to have conclusive result of the biopsy...but the biopsy report does not say inconclusive. They also did a core biopsy which I understand to be a much larger area.
Also would the biopsy be the cause of the photopenic area since they did hammer away in that area? The dr. That did the biopsy said those were the hardest bones he had ever worked on.
Reply # - October 6, 2013, 10:43 AM
Reply To: Photopenic area
Hi alta,
Yes, it's always a possibility that the cancer cells were missed, but as you say the larger the biopsied area, the less chance of that. And inflammation can cause uptake on the PET scan, but I'm assuming the uptake showed up before the biopsies were performed.
Watching and waiting is always a worrisome process, but try to focus on the positive indications - no cancer cells found in the biopsies, and no growth over time.
JimC
Forum moderator
Reply # - October 6, 2013, 11:40 AM
Reply To: Photopenic area
Yes, it's definitely concerning that this finding could represent a metastasis and that a sampling error missed it on a biopsy, but the biopsy is the best test, and you have to take it at face value if it's negative. There are certainly benign causes of bone lesions.
The core biopsy wouldn't cause that finding.
Otherwise, it sounds like they're proceeding with treatment on the presumption that she's curable, and I agree it's appropriate to give her the benefit of the doubt. But even if the bone lesion isn't cancer, there's still a risk of the cancer recurring , so in the end you need to do the best you can and hope for the best.
Good luck.
-Dr. West
Reply # - October 6, 2013, 12:36 PM
Reply To: Photopenic area
Thank you Dr. West.
Yes she is been treated as curable and of course we understand the future risk and will do everything we can to minimize it.
What is "Photopenic". I understood to be a cold spot. Is that what it shows when a lesion has healed? I have been under the impression that the Photogenic area was from the actual bone biopsy.
in an MRI a schmorl node was mentioned but not much detail. Right after the mention of the L3 it said ."there is indentation noted within the mid portion of the inferior endplate which made be representative of Schmorl node"
She is willing to go through with another biopsy but with mastectomy coming up next week the the radiation, we think its best to concentrate on curing the main site then proceeding to finding out about the L3.
Thank you everyone...I just found this site and I getting so much information which is helping me calm the anxieties over my daughter's terrible ordeal.
Reply # - October 6, 2013, 12:39 PM
Reply To: Photopenic area
Another positive thing is that her tumor markers have always been normal and her phosphatase were normal levels.
Reply # - October 6, 2013, 04:23 PM
Reply To: Photopenic area
"Photopenic" just means that the area doesn't show up as picking up any signal on a scan like a PET scan, so it has very low or no metabolic activity, even less than normal tissue, like a dead part of a cancer or a hole where there's no tissue at all.
-Dr. West
Reply # - October 7, 2013, 04:33 PM
Reply To: Photopenic area
Thank you Dr. West. Sorry to keep asking you questions, but this is my final one since I am confused about photopenic and your explanation left me wanting to ask the next question.
If they do a biopsy of a photopenic area...will they find cancer if its dead and if there was cancer there and and now its gone, if she didn't have treatment how did it go away? Her first scan was before treatment. and the PET was photopenic.
Her chemotherapy didn't do anything for her breast tumor and lymph nodes except for the k167 which is now at 4% instead of 70%.
Thank you again.
Reply # - October 7, 2013, 08:56 PM
Reply To: Photopenic area
It's sometimes possible for a cancer to die spontaneously from a lack of blood supply, in which case a biopsy may show "necrotic tissue" (dead cells). But it's just not possible to say with certainty that a negative biopsy is a guarantee that there is no cancer.
-Dr. West