Bone scan results...

Okay, as I mentioned I had another bone scan earlier this week. I should be thrilled with the report. I picked up a copy of the films and the report yesterday. The report reads 3-lines. It states "small foci of increased tracer uptake at L4 and L5, likely due to degenerative joint diesases. There is low likelihood for metastatic bone disease."

I should be writing YES! I am thrilled. Why do I feel panicked and sick to my stomach. Believe me I want to believe that. I am not a glutton for punishment. I am not the martyr type (although you might have a hard time believing that from my posts--my guestimate).
No, the reason I am skeptical because after I had the bone scan I went over to the area where the films were on the screen and asked if I could have a look.
The gal at the screens, was about to do some measuring. I didn't say a word.
She began pointing out the darkened areas--on my shoulders and in the L4/L5 region stating that they were "unusual hot spots." Those were HER words. Of course she may not have been the radiologist and may have gotten them 'wrong' but I do not feel that her take is necessarily 'wrong.' I would have alot more faith in the report if it mentioned the uptake in the shoulder area. It is clearly visible--moreso in the left--the shoulder where I am having alot of pain--although it was in both. The PET scan that I had 3 months ago mentioned the uptake in the shoulder activity. This report said NOTHING about it.
Those spots have been on my shoulders for awhile. One research article I found reported that 18% of all women who have breast cancer get metastases to their shoulder. One of my shoulders (left) began hurting 13 mos. ago. It hurt intermittently until last August when it same upper arm began hurting daily.
It is my non-lymphedema arm. I am not favoring it more. I still carry my shoulder bag on my lymphedema arm--it just doesn't feel 'right' to use other one and it always fell off other one (I have narrow shoulders).
In my wanderings to other support groups--many have written they have had a single hot spot and have been treated for bone mets. I am guessing that what is going on here is that our HMO is looking to find multiple hot spots before treating. There is no other way to justify what might be going on.
Remember when I asked my oncologist how arthritic activity was differentiated from bone metastases. He did not answer my question. His response was it didn't matter in terms of long-term survival if one treated for 3 years or if one waited for a year and then treated for two. That's bullsh&%, and is contradictory to what the latest research is showing. What is true, though, is that if they don't identify mets early there is no way to say that early treatment can't help.
I would like to get a copy of the cassette that the bone scan video is on. I do not know if that is possible or if the hospital or institution has exclusive 'rights' to that. I am again feeling so dissed and frustrated. I would have felt alot better had their been some mention of it in light of the fact that I saw it with my own eyes, the technician called it an unusual 'hot spot' and pointed it out to me, and it was reported on the PET scan...

(imaging of any type) picture, if they are already treating something they don't know they have (or not).

Good question. I was given osteoporosis-prevention dosage of Zometa for osteopenia with which I was dx'd and is being recommended although not yet adopted as standard treatment.

K wrote << All I want is enough and the right kind of treatment for this to be put into long-term remission so that I can survive, which I believe can be done -- at least for now-- with the right type of treatment for 'me.'>>

More than anything, I would like for my concerns to have been proven as unnecessary and that my continued interest renders me a total 'nut case' (j/k--just kidding). I do have other interests and concerns but am fearful if
I let go that this (mets) will hit me with a vengeance that can't controlled, based on my pathology. Then again, that may happen anyway, but would be less prepared emotionally to deal with it...
Then again, I don't want to get into a philosophical discussion about that. I just want to do what I can to minimize that chance of that happening, if that is at all possible.

That does not appear to me to be statistically relevant.

<< A patient with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test has occurred, should be monitored carefully for evidence of the development of a more severe hepatic reaction while on therapy with CELEBREX.

I suppose the fact that my alkaline phosphatase did significantly increase during the first months I was on Celebrex, although at the lowest dosage which
I only took for a month, I should be concerned. However, that jump also occurred about 30 days after I stopped a year of Herceptin. Irregardless, I added Doxycycline to my regime, doubled the Celebrex, and had my first infusion, and the alkaline phosphatase level (the only one that had elevated but was at the upper limits of normal) stabilized and has steadily decline to what it was at time of dx. Last reading was 58. (At time of dx, it was 62.
After mastectomy it was 57, then it steadily increased, albeit slowly until it reached high pt. of 116. It had been in 90's for previous 6 mos. before it did that. I had not been on Celebrex then. However, it jumped from 70's to 90's after first unexplained attack of acute pancreatitis.
All I can say now--with combo of meds I am on is that it first stabilized after one month and has steadily come down. Blood levels are taken approximately every 6 to 8 weeks.

<< So when will you get the 'proper' result of the scan??
will you consider 2nd opinion too?
Wish you all the best.

We are definately going to check into other opinions. The problem is finding a nuclear radiologist that will be willing to give an honest, unbiased opinion.
It is hard to get one. It is not only me--but from what I've gathered the criteria for the usual metastatic pattern is having several mets in many different areas before one is dx'd with bone mets. However, some patients report that they have a single hot spot which they have been told is bone mets.
Apparently, there is lack of consistent criteria and/or different criteria for identification of bone mets being used by different radiologists and medical facilities.

My question would be how can a person ever expect to get a clear (imaging of any type) picture, if they are already treating something they don't know they have (or not).
http://www.rxlist.com/cgi/generic3/zometa_ids.htm
Multiple Myeloma and Bone Metastases of Solid Tumors
Zometa is indicated for the treatment of patients with multiple myeloma and patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy. y question would be how can a person ever expect to get a clear (imaging of any type) picture, if they are already treating something they don't know they have (or not).
http://www.rxlist.com/cgi/generic3/zometa_ids.htm
Multiple Myeloma and Bone Metastases of Solid Tumors
Zometa is indicated for the treatment of patients with multiple myeloma and patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy. []

See the word "documented"?

J wrote << > Did I get checked for 'what' and 'when' ?

You said colon..belllady answered about the tests..
Did you have any gastric tests or not?

No tests were given. The bleeding occurred. 2.5 years before I started
Celebrex. It started before I had chemo or surgery but 22 days after my breast cancer diagnosis and 2 days before my surgery (bilateral mastectomy, one side prophylactic). Tumor markers were taken either the day of the biopsy or two days later. Those were found to be elevated. I didn't learn until recently that tumor markers are generally NOT elevated in early stages of breast cancer.
I didn't know much about breast cancer, let alone any cancer at the time.
Now, my biopsy indicated a 2.5 cm invasive lobular tumor, stage II. After the surgery, they found that a lot more was going on. I had my first scans 2 weeks after the surgery which was when they noted the enlarged retroperitoneal nodes and the single liver lesion. And, as I mentioned, the tumor markers were elevated at that time. As far as the rectal bleeding, I had no rectal discomfort. I couldn't say if anything other gastric was going on---since nothing was tested. I was losing alot of weight suddenly which I couldn't do before. I did change my diet and was exercising but the amount of weight I was losing was drastic for what I was doing. I had tried to lose weight before but diets weren't helping much and the exercise I was doing was more than I had been doing but not that significant, at least not enough to lose that much weight. (17.5 lbs) in that amount of time. Prior to all this I had been on diuretics and potassium because of lower leg swelling of unknown cause. I was also quite bloated and 'felt' at night that I was 10 mos. pregnant. I think there was alot of fluid in my abdominal area which suddenly went down along with the weight loss.

Kaye, I'm sorry for cross-posting.
I thought the above meant you have been posting to other groups.
Since I just saw Howard Homler reply something to someone else about osteoarthritis on sci.med.diseases.cancer, I thought he might be a good one to run your situation by.

In addition, way, way back somebody here replied, they don't mind cross-posts.I guess I misremembered it as being you.
My apologies.
I don't know who or who doesn't get spam. It was my understanding that spambots

archives, e-mail lists and actually have a read here...AOL, bulletin boards, mailing lists http://www.turnstep.com/Spambot/info.html
My apologies, I was trying to help

Pancreatitis is inflammation of the pancreas and you're on an anti-inflammatory.
J-going in circles...>>

Test done were inconclusive. So they never found the culprit. It might have been gall stones that got through to the pancreas. However, I was NOT on any
NSAID at the time. I didn't start taking Celebrex until 6 mos. AFTER the last of 3 unexplained attacks of acute pancreatitis.

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I really don't know much about this or even care to know, but the change was sudden and it was very different than anything I'd experienced before. They were relatively larger than before and the size changed from relatively straught or smaller to perfect letter "C's" Excuse the graphics here--don't mean to offend or gross anyone out. I thought I might have a twist im the intesting, if anything but really have no clue. It is only in retrospect that
I am a bit more concerned that something else might have been going on in light of the elevated tumor markers, sudden onset of rectal bleeding about 3 mos.
after shape change, enlarged retroperitoneal nodes, and the fact that the type of b.c. I had was of greater likelihood to metastasize to the retroperitoneum and/or colon and rectal areas. In addition my paternal uncle had colo-rectal cancer. Again, I have absolutely no idea if something more was going on but with both the CEA and CA 27-29 being elevated, having 9 posiitive nodes and extensive lymphovascular invasion, it seems that the possibility of such is at least 'a tad' greater than the norm or what is generally expected.

J wrote << Why would you change your chemo regimen if it's working..your markers are down and there's no obvious signs of disease activity or symptoms. >>

I wouldn't, but I/we (private internist and private oncology consultant) are not sure that something isn't going on, albeit slowly. The reason to intervene further is so that activity doesn't pick up. I do not know how long the interventions I am on will keep this under control, it it still is. I do think that is possible. I would have felt more secure if it had been hit a bit harder and longer from the start and/or if I could have remained on Herceptin awhile longer.

I figured that and appreciate your thoughts. However, do you have any idea how I can get my name removed from other groups. Thanks in advance.

Kaye (me) wrote << At our HMO the patient never sees the radiologist. >>

I once naively asked to speak to the radiologist and was told that they didn't speak to patients. Apparently, for the most part, they don't speak to the dr's either.
I naively asked after we (my husband and I) spoke to the pathologists. We did that because we had both gone in to return pathology slides and there were 2 pathologists there and when we asked receptionist if that was possible, they both came over. We were asking about my Her2+ status since it had been recommended that be retested with FSH. They told us they were 100% sure that mine did not needed retesting and that they did that if there were any doubt.
My pathology was so unusual, that they 'all' remembered my case. (Gosh, how did I get so lucky--NOT)! My surgeon, a breast specialist, said that in the 1 year that they had been testing for Her2+ I was only her 2nd case that had tested positive at a +3 level. We were quite sure that our HMO was not going to allow me to have Herceptin, out-of-protocol, if they had any doubts about my
Her2+ status, not at a cost of sixty-six thousand/year.

lump in the marrow and tell how big it is - that or magnetic resonance is what my onc uses. >>

Thanks, I have had those, but think what is going on is somewhat of lack of communication amongst the different dr's--in part--along with lack of follow through. One repeated theme I've noted that has occurred both through our non-profit HMO and at least on a few occasions privately is that there is an error in the original information--i.e. in the clinical history that goes to radiologist who then reads results of scans (performed by technicians). One example was the latest bone scan. The clinical history stated that I had pain in my shoulder and also hip pain. Well, I did have pain in my shoulder--but one specific should, not both, and I also have alot of pain in my upper arm on that side. Occasionally that pain extends to the armpit, shoulder blade, or along to me neck. The referral did not mention that the pain was on one specific side. Then, the referral did not mention the low back pain (in addition to the sciatic pain) which corresponds to the L4/L5 area. The report came back not making any mention of shoulder findings, despite the fact that the technician had pointed out on her own initiative that these (what was going on in both the shoulder and L4/L5 region) were "unusual hot spots" Findings are often correlated with reported symptoms. That couldn't be done in the case of the L4/L5 since radiologist did not have that information. That happened on the first PET scan done 15 mos. ago. That showed the same L4/L5 area as increased uptake and said that it should be correlated with an MRI if there were symptoms. Huh??? I had reported symptoms for over a year at that time.
However, the oncologist had made the referral for the PET without mentioning such. I eventually did get an MRI of that area--8 months later--but for new symptoms. The same area, however, was still in question. The report stated that it was either a cyst or a mass.
Now, it may be possible that the findings are inconclusive, but if they don't have all the correct info. at the time the test is done and don't do what they can to get it, than that further reinforces the possibility of getting an inconclusive report.
That is the 'game' of managed care, I suppose.

J wrote << Well,here in Canada we can order up copies of films, then return them or pay a nominal fee to keep a copy.

I have copies of the films but was wondering if I could get copies of the actual cassettes since the films are not THAT clear and the cassettes seem to show alot more.

Whot??? I did develop the initial pain 13 mos. ago. It was intermittent but slowly increasing until 8/7/03 when the pain became intense and WAS daily for over 3 mos. It did begin to lessen AFTER the Zometa infusion. I had been on
400 mg/day during that time. I did increase the Celebrex to 800 mg/day. It seems to me like there was an injury of some sort that was never identified.

And the area does seem to be larger. The PET scan showed that. Even the bone scan shows that despite the fact that it was NOT mentioned.
If anything were going on, I would want to see the Zometa increased monthly.
That might prevent further worsening--at least that is what latest research suggests--without negative side effects. And, if there were something going on, I believe it would allow me to remain on the Herceptin or be eligible for clinical trials for new promising Her2+ vaccine.

<< , you are not getting ever increasing pain daily (despite not having rads) which I would expect if it was mets. >>

It was increasing daily until I increased the Celebrex and had the Zometa infusion. I also had a cortisone injection. That was before the MRI.
However, my internist said that the area that is involved would not be helped by the cortisone injection and the area that might benefit could not be easily reached to give the injection into. If that is the case, then why did he give me the unnecessay rinjection before sending me to the orthopedist or ordering the MRI first? Another way to look at it is that HMO's give unnecessary interventions first if it might be cost effective despite the rhetoric they use when you ask for intervention and they respond with all the negatives that an unnecessary intervention may cause..

Well NSAID's caused me to bleed, I had a colonoscopy and upper GI and small bowel follow through and they found nothing. Did you get checked?
Apparently Celbrex has the same warnings..http://www.rxlist.com/cgi/generic/ coxib_wcp.htm but it's never safe to assume.

Gross alert http://www.afraidtoask.com/bowel/color.html pancreas liver and GB are mentioned there.

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But that's just it--the image is still showing increased uptake or some type of activity. It seems to me that since I am already on the Celebrex that that would rule out the activity being due to an inflammatory process.

Would that coincide with any increase of Celebrex?

I had a single 1.5 lesion on my liver according to the first CT scan. That then increased to a 1.8 cm lesion on the next scan--an ultrasound--done one year later during an attack of acute pancreatitis. (By the way an ultrasound done 4 years before my b.c. dx. stated that there was "no visible lesion on the liver)." That first ultrasound was ordered because of unexplained swelling in my lower legs, for which no cause has yet to be found.
Another ultrasound was done 13 days later after 2nd unexplained attack of acute pancreatitis which showed the lesion to then be 2.0 cm. A 3rd CT was done 2 mos. later after blood levels went whacky. That report stated that there was a
2.0 cm lesion on the liver which was stable. It was only stable between the
2nd and 3rd CT scans, not between the first and third.
I was NOT on Celebrex when this was noted. They did do a tagged red blood cell study to rule out an hemangioma. The report stated that there wasn't enough resolution to do that in lesions less than 2 cm. My oncologist wrote in my records that an MRI was done. It was NEVER done. I did have chemo after that first scan. I learned that liver lesions malignant) can resemble an hemangioma after chemotherapy. Thus, what was going on in my liver from the start was
NEVER identified and nothing definitively ruled out. A few mos. after I started the Celebrex a second lesion was reported to be on my liver that was
"stable." It was first noted 5 weeks after I started the Celebrex and was on a low dose. The Celebrex may cause difficulty but it would not show up as a lesion, I was told. A subsequent analysis stated that it could have been a fold in my gall bladder.
Interestingly, Tony, another poster here whose wife was identified with the same type of cancer as I (although with less positive nodes) was reported to have had clear scans initially. However, she then had an MRI which showed 2 liver lesions. (They use same non-profit HMO for health care as we but in different area of state).
Now, right after my dx and before my surgery, I immediately stopped eating sugar and began a light exercise program. The weight I had not been able to lose with other diets came off at an unusual rate--17.5 lbs in 23 days. I was overwt. but not obese. I also started doing some weird rectal bleeding the day before my surgery (bilateral mastectomy). My first scan showed enlarged retroperitoneal nodes--reported not likely associated with breast cancer. They aren't for most breast cancer--invasive ductal which 85% have. However, that is 3rd most common site for metastases for 'main' type I had which was lobular.
Lobular usually has a better prognosis; however, I had a rare aggressive variant of that -- pleomorphic invasive lobular -- which supposedly has short relapse-free survival interval. By the way, I continued to have bright red bleeding from rectum --would pour out in small amounts into toilet bowl -- intermittently until after completion of first set of chemo. It was not associated with b.m.'s and there was no pain. It was unusual, though. (BTW, 3 mos. before my b.c. dx (and 6 mos. after I first pointed out mass in chest that was not further evaluated) I noted a weird change in shape of b.m.'s. At time of my dx, my oncologist evaluated tumor markers. Mine were elevated and that led me to wonder why that wasn't used for screening of b.c. I recently learned that those are not elevated if b.c. is in early stages. Elevated tumor markers imply significant possibility of metastatic disease. My CEA was 12.8 (at time normal was <3.0 (rating scale has since been revised that normal is <5.0).
Also my CA 27-29 was 58.9, I believe or something like that. Normal was <37).
Anyway, getting back to liver, that weight loss was unusual and the weight continued to come off quickly until about my second chemo (AC) when it began to stabilize. That is a bit suspicious. As I said nothing was identfied but the correlation between all the above does suggest the possibility of something going on that was NOT ruled out.
All I want is enough and the right kind of treatment for this to be put into long-term remission so that I can survive, which I believe can be done -- at least for now-- with the right type of treatment for 'me.'

J wrote << Are you one of those people who've decided to "live with" their gallbladder stones?>>

I was NEVER identified as having any. It was just suggested as a possibility.
The last test to identify that was NEVER done. The first pancreatitis attack was mis-identified or not correctly identified at the time. I didn't learn that it was pancreatits until the 2nd attack which was 13 days after the first when my amylase level went to 7,500 and I was told that I was in danger of going into shock. (After that I learned that my level had been 6,500 with the first attack. I was released from the emergency room before the amylase level had come back). They had me on Demerol for several hours. Then I was given me a medication cocktail of Maalox, Lidocaine, and something else that I can't recall. I was told that if I felt better I could go home. I was already feeling better after the Demerol. The Lidocaine numbed the area even further I was feeling better. That afternoon I had my first ice cream--and it was rich--in over a year. I had been on a low fat diet after my cancer dx. The ice cream never bothered me. We then went out to a Mexican restaurant for dinner. I was fine. The following weekend we went to a wedding and at the reception had my first glass of wine in over a year plus fatty h'ors deuvres (rhumaki). At this point we did not know that I had had pancreatitis. I was fine after the wedding. One week after that wedding, after I had gone back to eating a low fat diet I had the 2nd attack). Then another 13 days after the
2nd attack I had a 3rd attack. I didn't even need pain med. for that. My amylase level was only 5,500.
As I said they had recommended one other test which could have shown a blockage if it were gallstones. However, the test is high risk for rupture of the duodenum (which happened to my husband's aunt at the age of 85) and the test itself can cause either an attack of pancreatitis or chronic pancreatitis.
Although it was recommended they did not want to do it until after I was very well healed. That last attack was 18+ mos ago. I should be careful with my diet, though, although am not always...but diet didn't seem to be what caused it the first or second time. The 3rd time, though, I was experimenting and early in the afternoon of the attack had had my first French fries in over 2+ years. I just didn't eat fried foods. However, I had stopped at a small restaurant for a drink (iced tea) and saw the most delicious looking fries that
I had seen in ages and decided to try them. Big mistake. I felt the attack coming on by evening. U was out-of-town and left at 5:00 a.m. the next morning and drove directly to the hospital. I went to the ER and they admitted me.
That, however, was the only attack brought on by diet for sure. The second attack from hunger and then may have been exacerbated by diet...but at the time of that we hadn't known that the first attack was pancreatitis.

That can cause pancreatitis..stones blocking one of the ducts (to liver and/or pancreas). and chronic pancreatitis is a risk factor for cancer of same.

So when will you get the 'proper' result of the scan??
will you consider 2nd opinion too?
Wish you all the best.

Kaye, I went out to shovel snow and make my shoulders worse. It helps me think.
I think they are all "fence-sitting" due to the litigious environment in the US.

Mine says "No area is seen which would be worrisome for skeletal metastatic disease."

Think about it..you've had the pains for 13 months, nothing obvious has grown, you are not getting ever increasing pain daily (despite not having rads) which I would expect if it was mets. If you think back to Catharine, she put up with a lot of pain before finally starting rads. You've been tested "up the wazoo".
If your current chemo regimen is keeping things under taps, why would you have rads at the moment anyway, because you could (maybe) need them later. Why would you change your chemo regimen if it's working..your markers are down and there's no obvious signs of disease activity or symptoms.
My opinion..find a pain med for the bad days and let it be..let it be...get rechecks of whichever is the best test for bone mets (whole body scan)..at intervals..but let it be.

and small bowel follow through and they found nothing. Did you get checked?
Apparently Celbrex has the same warnings..http://www.rxlist.com/cgi/generic/ coxib_wcp.htm but it's never safe to assume.>>

Did I get checked for 'what' and 'when' ?
I experienced the bleeding of unknown source, about 3 weeks after my b.c. dx and 2 days before my scheduled surgery. I was dx'd with b.c. 9 mos. after a supposed normal mammo. However, within a day of that mammo I found a hardened area--mass which I showed my ob-gyn a few weeks later. He dismissed it by saying I had a normal mammo. 9 mos. later I experienced pain in that breast;
10 days after that my nipple began to change--daily. I had a b.c. dx 5 days later. I had surgery 23 days after dx. I was not on an NSAID, although may have taken Ibuprofin off and on at that time.
After surgery (bilateral mastectomy) I had chemo (4AC), rads (5 weeks w/no boost), and more chemo 2 Taxol and 2 Taxotere along with Herceptin, weekly, for one year. 2 mos. after last Taxane I started Arimidex. About 7 weeks later I developed benign paroxysmal positional vertigo. About a month after that I experienced my first attack of acute pancreatitis--no known cause although found out some relatives have had it. I had genetic testing--did not have pancreatitis gene but found out I was cystic fibrosis carrier which may have increased my chances of getting pancreatitis. I wound up having 3 separate attacks 13 days apart--never did find trigger, athough never had final test (which is risky test where duodenum can be ruptured and can lead to chronic pancreatitis). Since I I stopped having attacks, didn't bother to go for test. However, 5 weeks after last attack, my blood levels went whacky and I experienced severe burning pain in pelvic area--similar to pain I had felt in my breast just before it started to ache and nipple began changing. I then had a complete hysterectomy/Salpingo--oopherectomy, 6 days after last
Herceptin. 4 weeks after that I started Celebrex at 100 mg/twice/day. About 6 weeks later I doubled that dosage to 200 mg/twice/day. One month after that I started Doxycycline and also had first infusion of Zometa. 9.5 mos after that I again doubled that dosage to 800 mg/day.

Glad to hear your good results. With your history and concerns the
Radiologist would never put it wasn't mets unless he was certain it wasn't. A HOT SPOT is lingo for any abnormal area.....mets disease, arthritic activity, congential abnormalites or an area where a fracture occured.
There are distincive patterns with bone scans....my dad had pagets disease which had a lace like pattern...each type of disease has a different pattern...one snow flake, one dotted etc ...that is how they tell the difference.

The most definative way to know the difference is a bone marrow aspiration....if this is truely your concern I would ask your oncologist to perform one. It is the only 100% conclusive test.
Shopping your scan around will only gets more false positives or negatives since scan is an interpretation meaning two people can view the image and have 2 different answers. If your oncologist refuses I would ask why. If he feels that insurance wouldn't cover it offer to pay out of pocket and if it comes out negative you'll have piece of mind. If if comes out positive the HMO will pay since it was a conclusive test. If your oncologist refuses s/he feels this test is not needed - totally and you are truely worrying for nothing. If that is the case perhaps you need to speak to someone about your anxiety.

I would not go to a radiologist who I didn't trust, it sounds like you do not trust this radiologist. If you do not have faith in your team switch to another group of docs, most HMO do provider choice. Don't you have a choice of healthplans? Most places offer a few...switch to another that would accomidate your needs. It sounds like you need the ressurance of a major medical center...are you being treated at a world class center ? This could help you with the results and diagnosis your symptoms.

Anyway enjoy the good results Alex

At our HMO the patient never sees the radiologist. The techs do the scans and the measuring. The radiologists are not present. They interpret. The oncologists don't talk to the radiologists either. They read their reports.

The clinical history on the report stated: "51 year-old female with advanced stage breast cancer. Left shoulder and hip pain."

First, the age is wrong--am 52 <g> but more importantly I really don't have hip pain, I am having severe sciatic and lower back pain in the L4/L5 region.

Then the report findings state: "small foci of increased tracer uptake at L4 and L5...." Now the PET scan that was done om 8/02 reported same area of uptake. It recommended further studies should there be any symptoms. I was having symptoms back then--16 mos. ago but no further studies were done at that time. It wasn't until last April when the pain in that area became debilitating that the MRI's were first done. That showed either a cyst or mass in the L4/L5 area. I had a subsequent PET scan in September which showed the same. I am having symptoms, too. Yet, often they do not recommend further exploration if there are no symptoms yet. They are NOT coordinating the information that IS there.

That can cause pancreatitis..stones blocking one of the ducts (to liver and/or pancreas). and chronic pancreatitis is a risk factor for cancer of same. >>

I learned that after the 2nd attack (first attack was never identified). I was worried that what was going on was cancer-related. I was told that I am at risk for metastases to the abdominal area because of the b.c. being lobular in addition to all that I had going on at time of initial surgery (9 positive nodes, 3 aggressive types of cancer, and extensive lymphovascular invasion).
And, although the attack cleared up and nothing malignant was identified at the time, no reason was found for the pancreatitis either.