Mods, before you close the thread automatically, please bear in mind that I’m seeking INFORMATION, not ADVICE. Any answers I get in this thread will be used to help me better **understand ** the situation, **not ** to help me decide what to do. I am not the ill person, nor am I the person making the treatment decision.
So here’s how it is:
My mother was diagnosed with breast cancer in December of last year and had a double mastectomy in January of this one. For a few months now she’s been feeling a great deal of pain in her legs and hip; she was admitted to the hospital last Friday. Today an orthorpedic cancer surgeon told her (and me) that X-rays have confirmed the presence of a tumor in her hip, which, he said, was likely but not certainly the result of the breast cancer having spread to her bones.
Asked his plan of action, the doctor said that they’d be taking additional x-rays of her shoulders, arms, legs & feet to find any additional tumors, and that tomorrow she would be undergoing a needle biopsy. As I understood it, the purpose of this biopsy is to definitively identify the type of cancer involved, prepartory to deciding whether radiation therapy or hip replacement surgery is indicated; also, one of the purposes of today’s x-rays is to find the best spot on her body to perform the biopsy.
My sister is vexed by this. Our mother had an MRI three weeks hence, and she feels that any cancer should have been found then; she has consulted one of our cousins–a nurse, not a doctor–and she (my sister) believes that the doctors are lying, merely using this procedure to churn the system and gain charge the insurance company. Is this likely, or is my sister merely paranoid?
I’m not an oncologist, but a tissue sample of tumor from the distant metastases is often subjected to testing to see what chemo drugs it would be most sensitive to, and also whether it is of a type sensitive to radiation. These sensitivities can be different from the sensitivities of the primary tumor. I think.
So as far as I know, it’s a common procedure, done to help optimize treatment.
I’d welcome input from other medical types who have more knowledge in this area than I.
Well, I’m not a doctor of any type, whatsoever…but, my aunt is in a similar position to your mom - she has lung cancer which has moved into her hip (oddly enough)… She also had an MRI and a CT scan as well I think. What we were told is that the MRI can detect a problme, but the biopsy is necesary to CONFIRM that its cancer. I guess there are other problems that can present similarly.
FWIW, we’re in Canada so I dont think the docs here get attitional $$ for adding tests - they get a flat rate per type of patient, so there would be no reason for them to run unnecessary tests just to jack the price up.
I hope everything works out ok for your mom. A radiation therapist of my aquaintance has suggest that bone cancer (if thats what she has) can be treated fairly well. I’m sending positive vibes your and her way.
I work in a molecular oncology lab, and we do all sorts of DNA and RNA testing on needle biopsies to help, as you say, nail down the exact type of cancer.
It would be malpractice for them to proceed with therapy without *some *sort of tissue diagnosis. Sure, they can assume that the tumor is metastatic breast cancer and proceed accordingly, but we all know what happens when we assume…
The MRI can say that the hip is abnormal in such-and-such a way that is consistent with or even suggestive of a tumor of type XYZ, but it can’t give a definitive diagnosis. It’s not clear what your sister thinks the MRI should have been able to find - does she object to the new X-rays looking for additional tumors? Cause the MRI was likely only looking at the hip; it would give zero information about her other bones.
Probably I should have specified which sister I meant. My baby sister is afraid that “all these x-rays will give Mama more cancer”; and one of my older sisters (the one mentioned in the OP) thinks the MRI should have found everything involved and that the doctors are gaming the system.
MRIs are certainly an advancment in diagnosis, but they are not the be-all end-all. You didn’t say what they did an MRI of. If they were looking at soft tissue, even if the scan was of the hip, it wouldn’t have shown bone involvment.
MRIs have computer programs for each area scanned, so to find a bone tumor, they have to use the correct scan program.
Biopsies are done in many cancer patients to determine the grade and stage of cancer – which is important in terms of prognosis, diagnosis and to find whether radiation and/or chemotherapy might be helpful. It is reasonable to do a biopsy; in fact, I would be concerned if this was NOT done.
Taking multiple X-rays to determine possible bone cancers? I’m sure the orthopod knows what he/she is doing – doesn’t seem unreasonable. I’d probably get a bone scan instead – but I can get this quickly, and MRIs not so quickly.
An MRI can show you what tissues look like, but a biopsy will provide a piece of the actual tissue. Kind of like judging if there’s enough oregano in your spaghetti sauce by tasting it vs looking at it in a photo.
In my case, the lump in my knee could have been a liposarcoma or fibrous histocytoma, with liposarcoma also coming in mixoid, well-differentiated or lipoma-like flavors. From what I understood, prognoses, treatments and survival rates can be very different for these different types, and an MRI alone will not reliably tell you which one you’re dealing with.
My SIL went through the same thing recently. The doctor told us it was to determine exactly what kind of cancer it is so they can determine how aggressively to treat it. It is standard procedure (and my SIL reported that it wasn’t all that horrible a procedure). Good luck to you and your mom.
In addition to what people have said above about the diagnostic value of MRI, it is also true of MRI that it doesn’t subject you to ionizing radiation the way an X-ray or CT scan does.
Sounds like to me your sisters are trying to outguess the MD’s. Not a good idea, since most of the time the MD’s aren’t guessing, and when they do it’s a very educated one. Listen to them.
I also think they are trying to outguess the MDs. I understand their being upset, but my older sister, in particular, is basically accusing the doctors of nonfeasance.