Can a PET scan not see bone mets?

I just had my 3rd PET scan the first week of June. Everything is looking good and getting smaller.

About two weeks after the PET I noticed a very sharp pain in my left rib area. The type of pain that keeps you from sneezing it hurts so bad.

I mentioned it to my oncology nurse who said she would ask the Doc to request a bone scan.

I thought a PET could detect it in the bones. Am I wrong about that? If I am I wonder why I haven't had a bone scan before.

I was diagnosed stage 4 last June with mets to the skin and to the pleura.

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hopefully someone will chime in with more scientific answer but my understanding is each scan - PET, CT, BONE SCAN, MRI, MAMMO etc has its limitations and is not 100%. In fact many times cancer does NOT show up some scans unless its a certain size. PET measures metabolic uptake.

"Unlike other imaging techniques, nuclear medicine imaging studies are less directed toward picturing anatomy and structure, and more concerned with depicting physiologic processes within the body, such as rates of metabolism or levels of various other chemical activity. Areas of greater intensity, called "hot spots", indicate where large amounts of the radiotracer have accumulated and where there is a high level of chemical activity. Less intense areas, or "cold spots", indicate a smaller concentration of radiotracer and less chemical activity." http://www.radiologyinfo.org/en/info.cfm?PG=pet

on thing to ask about is a PET Bone scan. this is 3 dimensional vs 2 dimensional and may offer a better view.

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Hey Suz-

Get thee to a remedial massage therapist!

I have had the very same intense spasm-pains in one area of my ribs for over three weeks. I dared NOT sneeze, stretch,breathe in too deep or even stretch out OR I'd suffer extreme pain!

I have just had bone scans showing overall bone disease progression. I've had mets in all my ribs for 3 1/2 years and occassionally get dull pain if I sleep/lay down too long.

My fabulous massage therapist explained it was the cartilage between the ribs causing the problem. I've had two sessions of (painful-but-necessary) massage that, praise God, seem to have fixed it. I still stretch very careful, and bend before I sneeze!

There's a site I found recently called "cancergrace.org", by a bunch of oncologists who even have a forum where people ask questions - good info.
........................................................................... .....
This is part of a transcript I found when looking for info on PET/CT combined scans. In regard to bone scans it seems its 'horses for courses"-this is at:

http://cancergrace.org/cancer-101/files/2009/05/djang-pet-scans-podcast-tra nscript.pdf

"Dr. West: We don’t get bone scans as often as we used to. Does a PET scan replace a bone scan or does the bone scan still provide some useful information above and beyond a PET?


Dr. Djang: That’s a good question. The best way to look at this is based on the cancer cell type. For patients with lung cancer, there are a couple studies out that show that as long as you get the PET or PET/CT, that in most cases the bone scan really doesn’t add very much.
So, I think in most cases, if it’s a person with lung cancer, they probably don’t need a bone scan. If the patient has breast cancer, then it has actually been proven very well that certain kinds of metastatic disease will show only on a PET scan but not on
a bone scan. And other kinds will show only on a bone scan but not a PET scan.
So I think in patients with breast cancer, it’s very important to obtain both. Another very common type of cancer is prostate cancer and for this type it’s actually been proven that bone scans are more effective than PET scans.

Dr. West: So, cancer-specific answer

Dr. Djang: It’s a cancer-specific answer, exactly.
........................................................................... ....
On their home page in the 'About Us" section it states:

What is the Global Resource for Advancing Cancer Education (GRACE)?
GRACE is a nonprofit organization that was developed as a means of improving the overall medical care for cancer patients by democratizing cutting edge information on optimal cancer management and providing it directly to patients. We recognized that while there is an overwhelming amount of new information available to physicians, actually more than they could integrate, patients and their families often have a deep interest in their own care and often have the time and motivation to ensure that they are receiving the best treatment possible.
........................................................................... ..............

Good Luck! My massage bruises have been well and truly worth it!!

xxxGGC

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what is interesting about scans - they show different things. My Pet Scan in July 08 did not show anything in my neck area, but that is where i have pain. My cat scan showed something in the neck in Feb and in May, but my bone scan did not show anything in the neck in May and the mri show something ... Seeing the Rad DR tomorrow about it. I wonder if it's not cancer but something else because the pain doesn't feel like bone pain but something else - like a bobble head

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So interesting! I just last week had a bone scan and today a CT to determine the extent of progression as detected by the bone scan, but I cannot get my doctors to do a PET scan.

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Several years ago I had a PET scan that showed I was absolutely cancer free, but my bone scan showed extensive bone mets. My onc doesn't even suggest PET scans for me.

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in my case we started off doing both bone and pets. But I have a lot of arthritis in the same place I have mets. The bone scan just shows areas of activity in the bones and is not really able to distinguish between the two types of bone destruction very well.

At first my insurance company was making me get the bone first and then my doc had to request a PET to "distinguish" between the two diseases in my hip which was particularly damaged by arthritis.

So finally the insurance company saw the light of day and stopped putting me thru the totally unnecessary bone scan and we went straight to PET. However, that is hardly perfect either. Some times the report has increased uptake in my shoulder and shows nothing in my ribs. Next month they mention the ribs and my skull. The next month it is back to the shoulder and the sacrum. I have asked my doc to have the radiologist track each and every spot each time. I dont want to assume that if they dont mention it --it isnt active. Maybe they just forgot to put it in the area in the report , or does the omission in the report mean it didnt just change. Or maybe it means it is gone? I even made my onc sit with and show me my pet images on her computer. She wasnt always sure what she was looking at. And she is brilliant! She went down to radiology herself and got some additional training. There are a lot of ways to slip up it seems to me. They keep telling me how difficult it is to follow bone mets. Guess that is a good thing since I guess it might be easier to follow ones in the viseral organs.

I am going to get them to do a few new MRIs too, since that supposedly shows more structural features than the PET which just shows metabolic activity. I'd like to actually understand where the bones are weakest and comprimsed before I break one! Hang in there sister! b

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I had activity at C7 and T4 on a PET scan, but nothing in that area on a bone scan. The bone scan questioned T10, but nothing in that area on the PET scan. I figured they canceled each other out. I guess that may not be true from what you all are saying. Unfortunately, I can't have an MRI right now because I have expanders in waiting for reconstruction. I don't get the expanders out till the end of the year....now I'm nervous.

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WOW!!! It makes you wonder if any of these tests are reliable!
My original bone mets dx started with a bone scan that showed multiple mets to arms, legs, ribs, and spine. Bone biopsy confirmed this.
After 3 months, I got another bone scan that didn't show any progression of mets. My onc told me that bone scans were hard to differentiate between cancer lesions and activity that was occurring because the cancer was diminished and the bones were actively growing healthy bone tissue. She & the radiologist assumed that things were probably stable since there were no new sites.
Scroll forward another 4 months and my markers were rising significantly. Onc scheduled both a bone scan & a CT scan. The bone scan again showed no new sites & the radiologist pronounced the cancer "stable". However, the CT scan showed a totally different picture. It, too, showed no new sites, but it showed a significant increase in the size of the cancer in the original sites!
My med was changed from Arimidex to Aromasin that I have been on now for about a year. In January, I had a cervical spine MRI because of pain in my left arm. It did not show any cancer growing in the area that would affect the nerves to my right arm, but it did show some stenosis (arthritic type narrowing of the spinal opening around the nerves).
Then this spring I started having severe pain in my left hip. An MRI of the area again showed no lesions pressing on nerves, but it did show some stenosis in this area, also. Since I have extensive cancer lesions in my hip, my onc ordered a PET scan for the first time, to see if radiation therapy might be in order. Amazingly, the PET scan showed that almost all of my cancer sites were no longer showing as active (except for some moderate activity in the thoracic part of the spine)!
How does all this fit together? Well, my conclusion is that all of these tests can find cancer, but they seem to work differently in different people, and look at the cancer in different ways. The bone and CT scans can't differentiate between healthy or cancerous bone tissue, they just show that there is activity in certain areas (could be cancer growing, could be healing tissue growing, could be an old bone fracture, could be arthritis, etc.). The PET scan, from what I understand, uses radioactive glucose to light up areas that have active cancer. This is because glucose is attracted to cancer cells because the cells need sugar to continue growing. The radioactivity allows the scan to show these active areas. The brighter they are, the more active the cancer is in that area.
So, I guess we have to have faith in our onc to order the correct tests for us. When I first started have these mysterious "roaming pains" I assumed that each one had to relate to growing cancer. Now I think some of the pains are related to the Aromasin and some of them are related to just having a bad back that is growing older.
Hopefully they can find a source of your pain so that you can find a treatment. It's no fun not being able to laugh, sneeze, or cough!

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The way my oncologist explained it to me is that the bone scan shows problems in bone and Pet scan shows problems in organs or tissue. The CT and MRI show the specifics. When I was first diagnosed with a tumor on my femur, the orthopaedic DR sent me for a bone scan, CT scan and MRI of the femur and spine. All three noted the tumors were probably a metastatic process, which led my Dr to believe Breast Cancer. I was then sent to a Orthopaedic/Oncology specialist and she ordered a full body CT scan which showed the breast tumor. After that I of course had a biopsy of both the breast and femur tumors and it was conclusive for breast cancer. After surgery to put a rod in my femur I was assigned a medical oncologist which started me on the Hormone regimen, Tamoxifen, Zometa and Zoladex shots(I was premenapausal). They monitored me with Bone scans and tumor markers test every 3 months and CT scans every 6months and my disease was stable. After the first year I had a CT scan every year and bone scan every 6 months, and tumor markers every 3 months. I now have liver tumors and am on chemo so I have a CT scan every two months. When I asked my doctor about pet scans, he says they prefer CT scans because it gives them more specific information. Hope this explanation helps!

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Just to add my two cents! Hopefully not repeat to much.

PET/CT only measures active cancer cells, bone scan will show cancer activity and bone ware. If your Doctor wants a true report of what is going on an MRI is best to show everything active or not in your rib.

Bone scans Debi and I have found to be not very helpful for your money.

Hope that it helps.

GOD bless and our prayers are with you

Scott

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To add an additional 2 cents. I believe based on my experince that the roaming pain is from a combo of hormonal meds, zomata and menopause. I had horribel hip pain and could not walk the grocery store, had the MRI and then it went away. Moved to shoulder blade, then went away, now its in my knees and other joints... hopefully will go away. none of these areas show as cancer in any of the scans that I have had...

I do know that my capel tunnel has gotten extremely worse since being on Arimidex - this is a SE. But sleeping with my wrist bands and using them on and off during the day has helped...

Sunday I go for an MRI for the neck pain to see if I should do the Radiation... maybe its will turn out as a roaming pain....

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Wow lots of information out there. Thank you ladies for your responses. I will meet with my onc on the 16th and we will discuss having another test.
I think after reading everything I would really like to get an MRI.

This has been very helpful!
God Bless you all!

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