Bone Scan - Maybe Occult Primary

I have a friend who was a year out from chemo, rads and a double mx when she suddenly developed pain in her right (cancer) side. Scans revealed a fractured rib - but she'd never hurt herself. Her tests were normal and other scans revealed no mets which was, of course, the fear. She met with the radiologist who explained it was a fracture of unknown origin - no accident or injury to explain it. It could have happened coughing, bumping into something, etc. Apparently those things do happen, even if we never really learn why.

A bone scan will not find an occult primary, but it will light up for a variety of reasons, including injury (mine always lights up where my wrist was fractured and pinned). Sometimes arthritis may show up, too. It does not always mean mets.

An occult primary typically isn't found by any means - rather the loco-regional (lymph nodes) or distant mets are found. Blood tests can reveal liver involvement (liver levels) and increased calcium levels can be an indication of bone mets. My MO swears that if my blood levels are good, then I'm good.

It's hard not to worry about cancer, and while it's possible (because almost anything is possible) that you had an occult primary that has now metastasized to your ribs and caused a broken bone, it's even more possible that that is not the case. my hope is your scan is clean and you can relax

I've had two bone scans. My experience with the bone scans is they know - or don't - if what they see is indicative of metastatic disease (or not). I watched the bone scan on the screen near the machine and saw a bunch of areas that appeared to "light up". My radiologist was more than happy to explain to me what each one was and why it was lit (previous injury, arthritis, etc.). Both scans were done after I complained of hip pain - where there was nothing on the scan at all. At that point my doctor wasn't willing to order any further tests because he'd already ordered those that would have uncovered metastatic disease. Perhaps, though, that might be a time for you to ask for a DEXA scan as kayb suggested. Good luck on Monday

It's not common, but you can have bone density issues in your 40s, so as long as the bone scan comes up clear (let's think positively that it will), then ask for a dexa scan. It is a super quick, simple test.

A good friend of mine had a bone disorder she never knew about until her femur fractured while she was just running. She was 39. Sometimes through cancer, we find incidental things that have nothing to do with cancer.....hoping that's what this is!

I just wanted to chime in on the DEXA issue, since I can't add anything to what the others have said.

An increasing number of younger women (including in their 20s) are showing osteopenia and osteoporosis. Unfortunately, most MDs haven't revised their thinking on the issue and still dismiss it out of hand in younger women. This might be affecting your MD's decisions.

Secondly, DEXAs are relatively inexpensive so even if your insurer won't approve one for you due to age, the out of pocket expense shouldn't be too high. I know that MDs are sometimes reluctant to RX tests due to insurance pushback and perceived expense/drain on resources but if your bone scan's clear, they really should do a DEXA. Take care.