Is a Calcaneus Metastasis Possible? - 1265179

Possible? yes. It's possible to have a metastasis anywhere, but the radiologist is correct that it would be very unlikely to spread there.

-Dr. West

YES IT IS POSSIBLE, and however "unlikely", it can happen and IT HAPPENED TO ME!!

My first symptom of S-4 NSCLC was what was then believed to be plantar fasciitis in April 2014. The orthopod tried an injection, but my foot pain only got worse over the next 3 weeks. When I went back to the doctor and told him the pain was worse and that I needed a boot and a handicapped placard, he ordered a CT of my foot, which showed a "mass" on the anterior of my right calcaneous.

He referred me to an orthopedic oncologist who did a biopsy of the "mass". Pathology came back as squamous cell carcinoma. The next week I had a PET, which showed a 3cm tumor in the upper lobe of my left lung, and they identified it as the primary tumor, with the foot tumor being a MET from the lung.

By now it is mid-June 2014 and I was referred to an medical oncologist who started me on gemcitabine, carboplatin, and zometa. At this time, I was unable to put any pressure at all on my foot. I was using a knee walker (kinda like a scooter). By the time I had completed the 2nd cycle of chemo, I had graduated from the walker, to crutches, to a cane, and then to walking and running pain-free. A comparative CT in August also showed a 60% reduction in tumor size for the one in my lung.

It is now 7 months later, and I still have no symptoms of lung cancer. I have no foot pain whatsoever. I tolerated the chemo very well, and only lost a bit of body hair, along with an increased appetite that led me to gaining over 30 pounds in the last 6 months.

On Thursday 1/1/8/15, I will undergo surgery for a lobectomy (upper left). If that all goes well, they are going to do surgery on the foot on 2/5. Not sure how much of the foot I will have left, or if it will be functional/pain-free. Have done a lot of internet research, and can only find one other reference to this particular occurrence. Here is a link to the article: http://www.spandidos-publications.com/ol/8/2/736

Hi jt,

Welcome to GRACE. Thank you for sharing your situation. As Dr. West often says, "lung cancer can do anything", and your case proves it. I'm glad that you have responded so well to treatment, and I hope your surgery goes well and that you can proceed with successful foot surgery to alleviate your pain.

Please let us know how it goes.

JimC
Forum moderator

Good Morning Jim,

Thank you for the good wishes. Just wanted to let everyone know, especially "gramme", that however rare a calcaneus mets may be, it should never be ruled out. From what I have read, MBD's are more likely to be misdiagnosed for more common problems.

Will keep the blog updated on my progress.

JT

Which is exactly why it's so important to be your own advocate. In my case I'm my husband's because our personalities work best that way. Either way, having or being an advocate that can run down everything that happens is something no full team of doctors can do for patients. Dr. West and all the good doctors who contribute to Grace know this, hence they work overtime for nothing more than to help us advocates. We know and see too much to explained in an onc visit but with the help of a community like Grace we can make big problems become bumps in a longer road. We can keep an eye on those unlikely problems because cancer is full the unlikely...not often enough but the good as well. My husband went into the cancer arena in very bad shape 5 1/2 yrs ago dx s IV and is either cancer free or he has an indolent case that may be treated as chronic.

Thanks so much JT for providing an example for others. It's a big deal! And it's just another one of those million and one things about cancer that every patient and caregiver should know.

You didn't ask and please forgive is this if overstepping. I wonder if seeking a 2nd, 3rd opinion on the foot is a good idea, get as many heads as possible into the thought process of what's best. Following is a really amazing blog post on the subject written by Dr. Weiss, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

Look forward to hearing progress report,
Janine

Janine,

Not sure if folks would call this a 2nd opinion, self-greasing wheel, or peer review, but it works for me. I am a patient at Dallas Sammons Cancer Center, and the decisions on my treatments and surgery was after a complete presentation of my case and a review of a "tumor board." So far, they have been very smart about this, and I credit them with the mindset that they have a chance to save me.

Based upon my conversations with several of the doctors that were part of the board, I am convinced that the decision that resulted was a concensus of critical thinking, instead of a "group-think" mentality. The surgery decisions, which are huge in stage 4, was only made after I continued to show now symptoms 6 months after diagnosis, and subsequent CT scans showed continued shrinkage and stability of the two tumors, and no further spread of the disease. When I say no symptoms, I mean that for my lung, I have not since the beginning nor do I now have a cough, fatige, etc that would normally be associated with lung cancer tumor 3cm x 1.7cm. I continue to have zero pain in my foot from the mets tumor there, and have been walking and running pain free for the past 4 months.

Before deciding to recommend surgery, the doctors wanted to wait and see if the cancer spread anywhere else and it did not (last C/A/P scan on 12/12/14). Subsequent scans, including brain scans, have shown absolutely no spread. I have a final PET scan tomorrow, which we expect/hope will be unremarkable for further mets. That will be my final green light for surgery on Thursday.

I have been very fortunate so far, and am hoping and praying that my luck holds out. Will post PET results on Wednesday.

JT

One more thing...

When I presented 8 months ago to my orthopedic doctor with pain in my foot, he was quick to realize that my pain was likely more than plantar fasciitis. Had it not been for his critical thinking, and willingness to order a CT scan early on, I may have been doomed to going home to die within the next 8 months.

As it is, I have a chance and I am going to take it. I credit that orthopedic doctor with giving me that chance, and possibly saving my life by getting me to the oncology team so quickly. I also credit myself with knowing my body better than anyone else, and knowing when something is wrong, or just not working right. I encourage everyone to realize that you know your body best, and are best equipped to know when something is not right with it. The best doctors understand that, and listen to patients when we tell them.

The best example is the poor woman in China that was misdiagnosed with mets in her calaneous that I posted in my first blog. She was intitally misdiagnosed for 6 months, and only lived another 6 months after they finally figured it out. Maybe that was just socialized medicine in a communist country, but the results cannot be disputed. She was misdiagnosed. She did not speak up. She died.

Again, here is a link to the article for those who have not seen it.

http://www.spandidos-publications.com/ol/8/2/736

Thanks JT, I'll read it. It does my heart good to read posts like yours. You have control of your situation and have a trusting team to support you. :)

All the best of luck and hope,
Janine

I think it really does sound like the recommendation from the tumor board was a carefully considered consensus opinion in a complex situation. There will never be a clear right answer, so the best you can hope for is a very careful judgment from thoughtful people. I think the recommendation sounds very reasonable.

Good luck, and I hope you'll keep us posted.

-Dr. West

Sorry that it took so long, but wanted to update everyone on my progress.

As last reported, I was scheduled for a upper left lobectomy on 1/9/15. Surgery went very well and I went home the next day. The biopsy of the lobe showed all negative margins, and the primary tumor was 90% necrotic (thanks to chemo). Two weeks later, I was back on the eliptical machine for 1.5 milies in 15 minutes, twice a day. Never did really have any sortness of breath after the 3rd day. On 1/26/15, I had surgery to remove the tumor from the underside of my calcaneus bone. Biopsy report on that was 100% necrotic material and no malignant cells whatsoever. Again, thanks to the chemo. After the foot surgery, I developed an infection/inflamation in my lungs most likely due to the breathing tube used in my second surgery. That has cleared up now and am breathing just fine.

I did not know how bad I felt from the accumulated effects of the chemo, until I stopped the chemo and started feeling better. We stopped chemo just prior to the first surgery on 1/9, and then started it back up 3 weeks after my foot surgery on 1/26, for 2 more cycles. Have not had chemo since April and now have my energy level back, and am doing the activities that I enjoyed before I got sick.

About three weeks ago, at the age of 61, I took up golf for the first time. I may not be very good yet, but I am playing at least 32 holes per week (18 at a time), and sometimes more. Because our home is on the 3rd fairway, my wife and I will go out and play 4 or 5 holes in the evening after supper several nights per week. And yes, we walk it with a speed cart for our bags. Last week I played 52 holes. Doing just fine on the breathing and cannot tell the difference.

My oncologist has officially declared me to be in remission. My checkup (CT and Blood) last week was very good. The Doctor told me to come back in August. Will post again when I get the results of my next check.

I forgot to mention that the surgery on my foot did not require any removal of bone or tissue. The tumor had been completely destroyed by the chemo, so all they did was remove the dead tissue and fill the hole in my calcaneus with bone cement. Had to take it easy for about 6 weeks, but all is good.

What a wonderful story jtbufford! Thanks so much for sharing. We need to hear as many of these success stories as we can. I'm so impressed with your recovery from the lobectomy, so good.
Keep up the golfing.

Janine

Janine,
Congrats to your husband on NED. It has been a while since I checked in here, so hope all is still going well for him.

Golfing - played 32 holes so far this week. Shot a 90 on Monday and 93 on Wednesday..

To All:

My checkups have been going well. I am NED since Feb 2015, June 2015, and August 2015. Next checkup next month.

Had follow up for my lobectomy (Jan 2015) today, and they did a PFT on me. The results were spectacular. The doctor does not understand why I am at 104% of expected values. Oh well. I am not complaining.

JT

This is wonderful news :) We all need to hear life can move to normal after such an horrific diagnosis and a 90 and 93 as certainly par. (right?)

Keep it Up!

Janine