Several subcentimeter bone lesions; when do you biopsy and/or treat? - 1295059

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jojo
Several subcentimeter bone lesions; when do you biopsy and/or treat? - 1295059

Dr. West or other oncologist:

I am a 60 yo, post-14 yr stage 2 breast cancer patient. I went to my oncologist in March with a complaint of an off and on burning sensation across the front of my chest and down BOTH arms (feeling like a bad sunburn). All of this has since resolved, except now I have a small area in my thoracic spine that when pressed on, presents a slight burning pain.

Resulting thoracic and lumbar MRIs showed several degenerative changes, but no obvious neurological cause for my thoracic burning. However, the MRIs did show several spinal lesions ranging in size from 4mm to 9mm. They are round lesions with smooth margins. There are several in my thoracic spine, one on L4, and one on my sacrum.

A PET scan detected ONLY the L4 lesion (3.2 SUV) and one on my sternum (1.7). Both are subcentimeter in size. The sternum spot was biopsied in June by an interventional radiologist because it was the easiest and least risky to access. It turned out to be a NON-CASEATING GRANULOMA.

Would you hold off on treatment and keep doing follow up PET scans and MRIs until one lesion grew large enough to be safely biopsied?

And IN GENERAL TERMS, what is the MINIMUM size of a SPINAL lesion you would consider biopsying? Would you be comfortable biopsying a spinal lesion of, say, 1 cm? Some of my vertebral lesions are posterior and the one in L4 is anterior.

Thank you so much!

Jo

JimC
Hi Jo,

Hi Jo,

Welcome to GRACE. I'm sorry that these concerning scan results have come up so many years after your cancer diagnosis. Unfortunately, I don't think there is a clear-cut answer, because there are many factors which may be weighed before choosing a course of action.

Lesions that appear in the context of a previous cancer diagnosis certainly raise a greater suspicion for recurrence, but the length of time since the original diagnosis tempers that, as the risk of recurrence drops as time passes. In addition, symptoms from cancer don't tend to improve in the absence of treatment. Also, a specific finding of something other than cancer in a biopsy of one lesion can influence the decision on whether to biopsy other lesions.

Growth of lesions over a reasonable interval also tends to raise the likelihood of cancer, leading many oncologists to follow lesions over time to see if they remain stable or increase in size.

The size of a lesion is a factor, although as Dr. West points out (in the context of a question concerning a core needle biopsy of a small lesion):

It is a function of not only the size but also the location of the cancer. Some are easier to access than others and can therefore be biopsied at a smaller size, while others are in a very hard place to biopsy, such as right alongside important blood vessels or right behind bone, and need to be bigger. Something in the range of 1 cm is about average, with several other variables involved. - http://cancergrace.org/forums/index.php?topic=8892.msg68804#msg68804

As you point out, there is also the issue of whether a specific lesion can be safely biopsied. That involves a consideration of the specific location of the lesion, and the associated risks.

I hope that you can have informative, thorough discussions with your medical team which will lead to a plan with which you are comfortable.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

jojo
Jim,

Jim,

Thank you so much for your thorough and timely reply. While I have convinced myself that it is, indeed, cancer just because there are so many lesions (“How can so many lesions all be benign?” my mind keeps saying,), you have actually given me some hope! So thank you very much for that!

I also appreciate the article link. The interventional radiology department at my cancer center (which is a NCI-certified center) says 1 cm, as well, so I suspect as soon as one reaches that size, we will go after it. Hate that I have to have a second biopsy, however!

I read your story and was very touched by it. You are a VERY GOOD MAN! And the fact that you volunteer your time to maintain such an outstanding website for people with advanced cancer speaks volumes, as well.

Thank you for what you and the other staff members do. We patients owe you a great debt of gratitude!

Hugs,
Jo

JimC
Hi Jo,

Hi Jo,

Thank you for your kind words. The doctors who contribute to this site are amazingly caring and dedicated, and I think that Dr. West has created an excellent resource for patients. I feel fortunate to be able to help him in any way I can.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

cards7up
I had back pain for a few

I had back pain for a few months and kept complaining to my primary. This was approx. 2.5 years after my stage IIIA adeno local recurrence surgery and chemo. Never thought of it as being related to my cancer dx.
My primary sent me for an MRI and the results were also sent to my oncologist. She ordered a biopsy as there was a compression fracture. Thankfully it wasn't cancer but osteoporosis. Not that it's a walk in the park but glad it's not cancer. Coming up on my 5 year mark since my recurrence and doing well.
Hoping yours is just from aging or even an old injury. They found those also on my MRI. Good luck!
Take care, Judy

catdander
Excuse the quick hijack.

Excuse the quick hijack.

Congratulations Judy on the coveted 5 year mark! What's the date? I wish we could celebrate in person.

JimC
Hi Judy,

Hi Judy,

Congratulations on reaching the five-year mark, Judy! That's an excellent milestone.

And thanks for adding your personal experience to help show that these types of scan findings don't necessarily mean a cancer recurrence.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

cards7up
My surgery date was August

My surgery date was August 29th and finished chemo just before Thanksgiving. So far, so good! But I never say never. Thanks all!
Take care, Judy