Could this be recurrence....so anxious - 1264627

maddy21
Posts:11

Hi Doctors and members, I am new here and was told to ask you guys as you are likely to be able to have some thoughts. I had LC 3 years ago Right Upper Lobe removed, it affected first rib but he took 4 as caution, pathology came back and other 3 ribs were clear. Unfortunately the last 3 weeks have been a little unsettling for me. I wretched my back sneezing and I am not sure if the pain I had was there before this, it certainly hurt really bad afterwards. Anyhow this pain did not go away so I checked in at the ER who gave me an X-Ray and said everything was okay and no change from previous X-Rays. Anyhow, I then experienced chest pains accompanied by the back pain so I checked in again at the ER who on Friday last 19 June gave me an X-Ray and said no recurrence of anything and nothing suspicious seen. They wanted to do a Thoracic CT just in case which they did and they said no recurrence or anything suspicious. I was due my bone scan which I attended this Monday just gone and Dr called me to say that a couple of posterior right ribs are changed since my last bone scan 2 years ago, 2 hot spots they say,they put on the report this could either be possible recurrence, osteoarthritis or post op changes.(I didn't think it could be that as it was 3 years since the operation). So Dr then said maybe we should get another x-ray of ribs but this was before she realised I had an X Ray as well as CT last Friday 19 June, 2 days before bone scan. She said that it's up to me what I want to do, she was saying maybe not to bother or then maybe to go for x-ray in a month? She doesn't feel that it is recurrence because CT and X rays were all clear. I have tumour markers done periodically and no change in those. Please help someone, just your thoughts would maybe ease me a little thank you

Forums
Full Archive

Reply # - June 27, 2014, 05:10 PM

JimC
Posts: 2753

Hi maddy21,

I don't really see that repeating an x-ray this soon after the last one would be all that enlightening. Cancer is very unlikely to grow much in such a short time. Short of a biopsy, which your doctor is not recommending because of the lack of any other evidence of recurrence on your scans, the usual strategy is to watch closely over time to see if there are changes which are suspicious for cancer.

JimC
Forum moderator

Reply # - June 27, 2014, 08:05 PM

maddy21
Posts: 11

Thank you for replying Jim, that was very kind of you. This is what she said basically because I had already had the x ray and like you say, no evidence anywhere else. It was nice to see that someone else is having the same thought process, I am hoping it is post op or Osteoarthritis for obvious reasons. I do have scoliosis due to the operation and lack of ribs so maybe it s related? Thank you again

Reply # - June 27, 2014, 08:32 PM

Dr West
Posts: 4735

For what it's worth, I no longer order chest x-rays as surveillance for recurrence, as they are really a very poor test for that. A chest CT gives unfathomably greater information, so much so that I really think a chest x-ray is almost just going through the motions of doing something. You are just not very likely to find something early enough to have it be helpful using a chest x-ray as a surveillance instrument.

The absence of any evidence of recurrence on chest CT is reassuring, even in the face of an ambiguous or suspicious bone scan, which is a notoriously non-specific test.

I personally value interval CT scans for surveillance, and three years out I'm generally doing them every 6 months in my patients (and then usually moving to annual scans after 4 years), and surveillance chest x-rays pretty much never.

-Dr. West

Reply # - June 27, 2014, 08:53 PM

maddy21
Posts: 11

Thank you so much Dr West I really do appreciate your reply and reassurance
I have been,getting great care since 3 years ago and scans every 6 months plus all the relevant blood tests so,seems the care plan you offer is likened to mine. They gave me 2 Cts on Friday 19 the second was slightly different as they thought I had some tear in an atery turns out it was my heart valve and was suppose to be there I also had the dye with both. I was more worried as wasn't sure if cts would catch anything in/on bone. Well thank you again for reassurance and taking time to write to me.

Reply # - June 27, 2014, 09:24 PM

maddy21
Posts: 11

One last thing if anyone can advise, would it be at all likely tat anything would be displaying itself as scar tissue? all CTs have been no change since all the ones I have had over three years so I presume not but just thought I would ask?

Reply # - June 28, 2014, 08:02 AM

JimC
Posts: 2753

If it hadn't been seen on CTs over three years, I wouldn't expect scar tissue to appear on a scan now, especially if there was no treatment in the interim.

JimC
Forum moderator

Reply # - June 28, 2014, 08:45 AM

maddy21
Posts: 11

Sorry Jim, I said that wrong, what I meant was I have always had scar tissue and was thinking could something be hiding amongst the scar tissue that isn't being picked up? Sorry for the Questions

Reply # - June 28, 2014, 11:53 AM

maddy21
Posts: 11

Thanks Catlander, I read that thread? Its seem unrelated? I was just concerning myself with the fact that I am obvs very worried about hot spone on bones but no recurrence on CAT scan. I was trying to ascertain for peace of mind could it be possible that there was something hiding in my scar tissue, would that be picked up on a CT..sorry

Reply # - June 28, 2014, 11:53 AM

maddy21
Posts: 11

Thanks Catlander, I read that thread? Its seem unrelated? I was just concerning myself with the fact that I am obvs very worried about hot spone on bones but no recurrence on CAT scan. I was trying to ascertain for peace of mind could it be possible that there was something hiding in my scar tissue, would that be picked up on a CT..sorry

Reply # - June 28, 2014, 12:43 PM

JimC
Posts: 2753

CTs are high resolution, so I would think the chances are good that it would be visible. Also, if it was there early on and it hasn't changed over a long period of time (still hiding and not visible), it's probably nothing to worry about.

JimC
Forum moderator

Reply # - June 28, 2014, 11:52 PM

Dr West
Posts: 4735

Exactly. Seeing scar tissue or what we suspect is scar tissue is very normal. If it's not changing over years, it's very reasonably to conclude that any residual soft tissue is just scar tissue. The key issue is whether anything is changing in a worrisome way (growing after prior shrinkage or stability). Seeing stability for years is very reassuring.

Good luck.
-Dr. West

Reply # - August 9, 2014, 05:05 PM

maddy21
Posts: 11

Hi Drs and All

I had a rib x rays different views were done and it did in fact come back as arthritis, what I noted on the original bone scan was that it said 'periosteal changes in the femurs, possibly reflecting hypertrophic pulmonary osteoarthropathy but nothing was recommended about looking into this? I am reading right about his condition in that it presents with cancer? I apparently have no cancer? Any help would be appreciated thanks so much in advance.

Reply # - August 9, 2014, 07:59 PM

JimC
Posts: 2753

Hi maddy21,

Often scan reports include reference to possible complications of cancer when the radiologist is aware of a patient's history of cancer. The fact that your other scans show no evidence of recurrence makes it more likely that the mention of hypertrophic pulmonary osteaoarthrothapy was an overcall by the radiologist.

You can read about hypertrophic pulmonary osteaoarthrothapy in a post by Dr. West here: http://cancergrace.org/lung/2009/02/10/hpoa/

JimC
Forum moderator

Previous PostNext Post