They can't figure out where the cancer started.

obs · Regular Joined: 10 Aug 2007 Posts: 28

Is it excuseable that these doctors cannot figure out where my fathers cancer had started? my dad recently had a bone scan done and it shows that he has cancer that has spread to his spine his rib cage and his limbs. Prior to the bone scan he had gotten MRI and CT scans oh his chest and abdominal area and he also got his prostate tested and all these sites had no cancer. My dad was absolutely fine before injuring his back during a golf outing over 2 months ago. He originally thought he had hurt his disc or something. Anyone with any good cancer knowledge or experience know what is going on? My dad is gonna get his stomach tested tomorrow, but all images showed the stomach had nothing. I am going crazy here, I am in constant stress. I just wish we would get some answers.

obs · Regular Joined: 10 Aug 2007 Posts: 28

also could the test for the prostate be misleading? the test was done using a blood test from the prostate, i read that this is inaccurate. also should my dad go and get a PET scan?

Muttsmom

Hi,

A PET Scan picks up tumors smaller then other tests do, but they also give false positives. They pick up on abnormal activity, which means inflammation, if an area is healing from an injury, and of course cancer.

Have they done a biopsy on what they are saying is cancer? They can easily do biopsies of the bone. I know I've had a MRI to rule out bone mets because of changes in my bone scan, and in my case ended up being a herniated disk, thank God. Bone scans light up with degenerative changes as well. The MRI and CT Scan show his ribs to be normal, but the bone scan is the only test that was read to say cancer in the bone? I'd want a PET done if that's the case.

Someone correct me if I'm wrong, but wouldn't a biopsy and all the DNA info they get from tumors know show what kind of cancer he has? I know it could be something like multi myleoma, but one of my best friends had that and they could tell what kind of cancer it was from the biopsy.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

brainman · Last edited by brainman on Tue Sep 11, 2007 8:14 pm; edited 1 time in total

Obs, I am very sorry for your father's cancer. Finding a primary site is not that uncommon. A biopsy of the bone mets will help a lot because the doctors can at least say what kind of cells the original cancer is... maybe not specific organ in some cases. Unfortunately, knowing where the primary is would probably not help very much. It has already metastasized so some form of chemotherapy will be used.

A PET scan might help spot other sites that have the cancer. Continue to work with your father's medical team and continue to ask questions.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

obs · Regular Joined: 10 Aug 2007 Posts: 28

went with my dad to his doctor and he suggested that even though the ct scan report of the abdomen came out good, he had sent the images to a personal friend in the medical field and said that the stomach looks as though it has some abnormalities. my dad has absolutely no pain in the stomach, he wants my dad to go to the hospital and get the stomach examined using a little camera goin down his throat. also he said that doing a biopsy of the spine is a very difficult thing to do? he suggested that he get a biopsy of the lung in the area in which the reports state that there is some pleural thickening and pleural effusion. any ideas guys?

obs · Regular Joined: 10 Aug 2007 Posts: 28

this is the lung MRI he was going with, is there anything on here that says he can possibly have lung cancer?

FINDINGS: Imaging is suboptimal due to extensive motion artifact seen throughout the images. There are multiple bullae and blebs seen in both apices and upper lung fields, more prominent on the right. Emphysematous changes are seen throughout much of the right upper lung field. The overall left lung volume is decreased when compared to the right. No masses and no calcifications are seen in the lungs, although a small subtle lesion may be indiscernable due to motion artifact. There is pleural thickening seen in the left apex. There is also a small left pleural effusion. No other focal pleural lesions are seen. Mediastinal structures are intact and there is no evidence of mediastinal adenopathy.

IMPRESSION:
1. Emphysematous changes are seen in the lungs, most prominent in the right lung.
2. Left apical pleural thickening and left-sided pleural effusion of uncertain etiology. Clinical correlation and follow up are needed.
3. No mass lesions are seen in the pulmonary parenchyma. However as noted above a small or subtle lesion could easily be obscured due to motion artifact. Clinical correlation and follow up are both recommended.

brainman

It sounds like your father's doctors are moving in the correct direction. Spinal biopsies a difficult because of the danger involved in doing anything around the spinal cord. Hopefully, they can find out what they need form a biopsy of his pleural effusion.

Your father moved a lot during the MRI making it hard to get good images.

Still thinking and praying for him and you. Keep us informed.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

obs · Regular Joined: 10 Aug 2007 Posts: 28

can anyone tell me how long it should usually take to get diagnosed with cancer after it is suspected? My dad got the EGD last friday and his stomach and surrounding areas are absolutely fine. Now the family doctor wants him to get his chest x rayed to see if the pleural effusion in his lungs has enough fluid to get a biopsy. Is that really necessary? Why not just do a biopsy? I just want to know what the normal steps are to get diagnosed, and how long that usually takes, it seems like its taking forever for my dad to get diagnosed, and that worries me that the cancer can spread to other areas.

also do you have to do everything with your family doctor and get diagnosed before you go to a oncologist to get treated?

Muttsmom

I don't know a lot about lung cancer, and my only experience with lung biopsies are from ladies with Breast Cancer and lungs mets are suspected. My guess is the reason they want to do an x-ray to see if there is enough fluid for a biopsy, instead of just doing a biopsy is because that's invasive, and I'm sure they don't want to put him through anymore then necessary.

What are they saying the pathology is showing, as far as the DNA make up and at least the best evidence as to where the primary cancer is?

I'm no doctor, but the fact that they the results are showing a "lesion" is why they want to rule out it being lung cancer. It sounds to me like they are saying the obvious is that he has Emphysema, but they want to rule out cancer as the cause of the lesion.

Waiting is so very hard. I pray you get answers soon. Have you posted the report on the Lung Cancer forum to see what they think?

You and your dad are in my thoughts and prayers and will be waiting to hear what you find out.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

obs · Regular Joined: 10 Aug 2007 Posts: 28

well the bone scan showed metastasis, and my dads doctor said he has cancer, and that they just have to figure out where the primary is, my dad has no cancer in any organs in the abdominal area, prostate psa test came out good, and the CT of lung has no mention of cancer, however my dads has been having a loud cough lately. Anyways if someone can, please can you answer my questions in my previous post. Thank you

Muttsmom

Sorry. I thought I did answer your question as best I could. They don't want to do a biopsy if there is not enough fluid, because it's invasive.

There is such a thing as bone cancer, multi myleoma..... I'm assuming the DNA of the pathology isn't saying it's primary bone cancer, but is it suggesting what it is?

I don't think there is any set speed at getting a dx. Have they done a biopsy confirm it is cancer in the bone or are they going by the bone scan, which shows degenterative disease etc. as well as bone mets.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

obs · Regular Joined: 10 Aug 2007 Posts: 28

Sorry I do not understand what DNA of the pathology means, can you please explain?

What happen was that, my dad started to have pain after he played golf, he took a swing felt slight pain but kept playing through it. After about a week the pain started to get really intense in his lower back and legs, resembling that of sciatica. He got an MRI of the L and T region of his spine, and the report stated that a few vertebrae were highly suspicious of metastatic disease, it also showed a fracture in the vertebrae which was suspicious for metastatic disease in the Lumbar region. He then got a bone scan to see if it just cancer or it was some kind of infection in the vertebrae and the bone scan showed metastasis in his spine, rib cage, and I think leg. However my dad got CT scans of his chest/lungs, his abdominal area and pelvis, which showed no cancer. Since prostate cancer is common in men and common for metastasis in the areas my dad has, he got a PSA test which came back normal. Then he got a EGD to check his stomach and its surroundings which was normal also. Now his primary doctor wants to go back to the lungs and take a look at the area in which the CT scan says there is pleural effusion and pleural thickening. I have read that pleural thickening occurs in people who have come in contact with abestos, but does pleural thickening always mean cancer?

Muttsmom

When I was dx, the DNA breakdown of the tumor showed exactly what kind of cancer it was. Not just breast cancer, but what kind of breast cancer. Pathology tells so much. If someone had a primary cancer, and years later they found cancer some place else, through a pathology report, they would be able to tell if it was a new primary or if it was mets from the original cancer. That's why I'm confused about why they don't know what kind of cancer he has. I would want a biopsy done to vertify it is indeed cancer.

I would say the MRI is more reliable then a bone scan, even though a bone scan can show mets, but a biopsy is the only way to be 100% sure it is indeed cancer. I've known people who had biopsy of the bone, and they have all said it was a painless procedure. I'm really surprised it wasn't recommended that he have a PET (even though they can show false positives), which picks up smaller tumors then any other test and see where hot spots show up and find out with 1 test, where the suspicious areas are and go straight to them.

Here's a good site that talks about plural thickening.

http://www.medcyclopaedia.com/library/topics/volume_v_1/p/pleural_thickening.aspx
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

obs · Regular Joined: 10 Aug 2007 Posts: 28

could it be possible that my dad is dealing with doctors who are totally incompetent

Muttsmom

I would get a 2nd opinion if it were me. I'm not saying they are wrong, but it's strange that he's golfing and twists just right and he starts hurting and it just happens to be at the exact time that he has bone mets and they start hurting? As long as it's been, me personally, I would talk to friends and family and get a referral and that way you know it's someone who trusts the doc you go to for a 2nd opinion.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

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