Oncology (General Cancer)/Osteophytes in Spine

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QUESTION: Patient Age-75(Female),suffering from pain for a long time.MRI of LS Spine was done,Radiologist report shows Osteophytes.But the attending Doctor has advised for CT Guided Needle Biopsy.Another Doctor is saying at this age CT Guided Needle Biopsy is RISKY ,better go for a PET.
My questions
1)   But so far as I know PET Scan is no alternative to Biopsy and gives only a rough idea,although  CT Guided Needle Biopsy involves some risk
2)ANOTHER DOCTOR SAYS CANCER(IF DETECTED) IN BONE CANNOT ORIGINATE IN THE BONE ITSELF FIRST.THE ROOT MUST BE ELSEWHERE
  We are confused    Please help by answering (1) and (2)with a suggestion

ANSWER: osteophytes are usually benign, but may cause pain.  Radiologists can recognize these without biopsy.  Cancer in bone in patients this age almost always originates somewhere else.  If there is the suspicion of cancer, studies should be done to look for another primary -- in a woman, most likely the breast, the lung, or possibly, the kidney.  My own suggestion if these are really osteophytes is to try to treat the pain with medications and not do a lot of diagnostic tests.  The PET will not demonsrate whether it is cancer or not.  In fact, inflamed osteophytes might very well show activity in the PET.  Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Thank you.If you kindly help me with the following.My Family Physician friend(not an expart)has intimated that if a person suffers from bone cancer his blood parameters like the following will change
[A]1)Alkaline phosphatase isoenzyme
  2) Parathyroid Hormone
  3) Serum Phosphorus test
  4)Blood Calcium level
       Whether these tests can give some idea
B)Whether Vertebroplasty can keep her pain  better to some extent
 Please help by answering (A) and (B).Thank you

Answer
The tests you mention might be abnormal if someone has advanced bone cancer, but could also be normal, especially if the cancer is not advanced.  The Alkaline phosphatase and blood calcium level are more sensitive.  So if they are abnormal, you might very well have cancer involving bone, but if they are normal, it doesn't prove you don't. Vertebroplasty is useful if there is collapse of a bone; someone who has bone cancer might profit from this, but someone who has collapse from injury or osteoporosis might get some benefit as well.  Vertebroplasty is a way of hardening and stabilizing the bone.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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