Dr. Rakesh Mittal
Medical oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My chief complaint is severe lower back pain and pain in upper thighs. My medical history is as follows. Carcinoma of the breast three years back, followed by surgery, chemotherapy, and radiotherapy. I am on Tamoxifen for past 3 years, and now I am taking Arimidex. I have been suffering from osteoporosis for over 7 years. Before six years, I had severe osteopenia with maximum bone loss of 21% on L3 and spine, ribs, trunk, and arms with more on the left side.
I had undergone the following investigations. Before three years, I had FNAC which showed invasive ductal carcinoma, right breast ER+, PR+, Hercep score "0." Last month, I had an x-ray and MRI, which showed focal altered marrow intensity lesions seen in B/L pelvic bone, sacrum, and left upper femoral shaft consistent with metastasis. I also had a PET scan which showed metabolically active ill-defined lytic destructive lesions in post cortex shaft of left femur, right inferior pubic ramus, B/L iliac bones, sacrum, D5, 7, 11 and L1, 4, sternum, right 3, 5, 7 post ribs with mid-right paravertebral soft tissue lesion at D7 level likely metastasis.
Hello,
Welcome to icliniq.com.
I do not have full information regarding the case from your query.
The conclusion I can make from the information which you have given is that the patient has bone metastasis only. The treatment for such a case is a change in hormone therapy.
Your medication has already been changed from Tamoxifen to Arimidex. I do not know since how many days or months you are taking Arimidex. Has it made any difference in intensity of your back pain?
You also need to take Zoledronic Acid injection (Zometa). This also helps in bone metastasis. You also need adequate pain medications, maybe Morphine preparation to control your pain.
Patient's Query
Hi doctor,
Thank you for your opinion.
I am hereby attaching the conclusion of PET scan report done 10 days ago, the medicines provided and the old discharge summary given from the hospital where the breast cancer was treated three years back.
I am also having temperature around 100 daily and leg pain. I am pleased for your advice.
Hi,
Welcome back to icliniq.com.
I saw all your reports (attachment removed to protect patient identity). You are on correct treatment.
Do not worry about fever. It will settle down as it is common after injection of Zometa (Zoledronic Acid injection). Take tablet Paracetamol three times a day. If it does not settle down in a few days, do consult your doctor for physical evaluation.
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Medical oncology
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