Bone healing or cancer growing?

[Dragonmew]

Hello all,

this is my first time posting a question in this forum. I would appreciate your time for reading it and giving me your thoughts if you could. 

My mom was first diagnosed as adenocarcinoma metastatic to bone in February when she had a fracture in her right hip. A hip replacement surgery was done right away, and 5 day radiation was done after about 3 weeks from the surgery.  Then she was on xalkori for Met 14 skipping mutation.

She had a CT scan when evaluating xalkori in June, and that scan shows main tumor in lung was reduced by 70% in volume, and tumor in spine is stable.  However, they also found some increased sclerotic lesion in her right hip, and the tumor in her left hip was growing from 1cm to 1.6cm.  During that time the doctor couldn’t determine if the sclerotic lesion in right hip was caused by cancer or bone strengthening injection.  He said bone healing and cancer growing are somewhat Looking similar.  So he decided to switch to Capmatinib for her, treat left hip by another 5 day radiation, and give right hip some time to see if it can respond to Capmatinib well.  In addition, my mom will continue the bone strengthening injection every three months. By that ct scan, she had done one injection.

After about 5 months from the replacement surgery, my mom’s main complaint is weakness of the leg, and she feels she’s having difficulties to bend the right knee. However, after walking for a bit, she feels better and can walk normally. Right now she can walk without any supporting tool. X ray has shown thigh area and knee area are fine. The doctor is worried about Capmatinib is still not working as well enough as he thought, although he also said the discomfort could also be caused by the muscle which is still recovering from the surgery (done on 2/14/2020). He suggested another ct scan in two weeks.

My question is: can next ct scan differentiate cancer growing and bone healing? If so, why the previous one couldn’t tell? If not what other scan will tell better? Pet scan? I asked this question to the doctor, and he says “let’s see the ct scan first and go from there”.  He thinks the ct scan will give the answer.  The ct scan will be in about two weeks.

 

[Tom Galli]

Dragonmew,

Great question and I don't have an answer. I'll ask a radiation oncologist I know and post the answer.

Stay the course.

Tom

[Tom Galli]

Dragonmew,

I had a series of email exchanges with one of LUNGevity's Scientific Advisory Board radiation oncologists on your question: "can next ct scan differentiate cancer growing and bone healing? If so, why the previous one couldn’t tell? If not what other scan will tell better? Pet scan?" 

He asked if radiation was performed to the bone area after the hip implant and I said your post indicated that post surgical radiation was performed. 

His response was "This is a very tricky dilemma. Both the CT and PET scan can be misleading. I think the best 'test' to order here is a re-evaluation by the orthopedic surgeon."

Your mom's cancer and hip replacement surgery and a met in proximity of the replaced hip appears to be a very complicated medical situation. So perhaps involving the orthopedic surgeon in the symptoms and test results is a good plan.

Stay the course.

Tom

[Dragonmew]

Hi Tom,

I want to let you know that my mom has the ct scan this morning, and dr just sent the results - stable! The discomfort from leg is caused by surgery or radiation or the rod itself.  No new cancer is growing over there. I’m so happy with the result.

 

—————————————————————-
 

 

Thank you Tom for your timely response.  I will discuss further with the oncologist and keep you and the forum posted.