Q. My husband has stage 4 unknown primary cancer in bones. Will cancer spread and cause fractures?

Answered by
Dr. Rajesh Gulati
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 03, 2021

Hi doctor,

I wondered if someone could help me interpret the following recent CAT (computerized axial tomography) scan. My husband has stage 4 unknown primary cancer in bones and lymph nodes. Is this report saying he now has cancer in the lungs, and how will this disease progress? He is not doing conventional treatment, just riding it out on Morphine for pain. The widespread osseous metastatic cancer, a stable small right pulmonary nodule with metastatic disease, is not excluded in this clinical setting. The lung nodules are suspicious for metastasis, lymphadenopathy potentially secondary to neoplastic involvement, and mild lactic change at the lung bases. A new nondisplaced, probably a pathologic fracture at the right anterolateral sixth rib. Does this mean ribs will keep fracturing, and if cancer is now in the lungs, does that mean there is faster growth?



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It is a stage 4 cancer with bone metastasis (attachment removed to protect the patient's identity). He should get a biopsy done to confirm the type of cancer and then plan chemotherapy protocol along with Zoledronic acid (zoledronate). It is stage 4 cancer, and it cannot be cured, but the intent should be palliative.

Hello doctor,

He already had numerous biopsies done, and they cannot find a primary. He has cancer all over his bones and in his lymph nodes. He is on Morphine to manage the pain and palliative care to ride out the disease. I asked in my above question, is it in the lungs now, and if so, will this move faster, and will the pathological fracture in the rib heal, or will his bones just continue to fracture now?



Welcome back to

If cancer is left untreated, it will spread further, and bones could fracture even more. In many cancer, the primary is unknown. He should be started on empirical chemotherapy, and it will slow down the growth of cancer and help in relieving symptoms. Rib fracture does not need any specific treatment, and it might heal on its own. He should be started on an injection of Zoledronic acid (Zoledronate), which is given every 28 days, irrespective of cancer type, for bone metastasis and make bones stronger, and if empirical chemotherapy works, there will be a lot of improvement in the lung, and lymph nodes metastasis. Injection Paclitaxel (Taxol) and injection Carboplatin (Paraplatin) are commonly used as empirical chemotherapy for unknown primary. It works in 80 % of unknown primary cancer.

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