Oncology (General Cancer)/Thoracic Lytic Masses

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Question
Hello, I recently had a chest xray for workup of a chronic cough.  My physician wasn't concerned about the findings on the lungs but it also showed "several lower thoracic vertebral bodies have fractures of uncertain age or lytic masses. Recommend thoracic spine MRI or a nuclear bone scan."  I'm 55 and in general good health.  I have chronic mild back pain but no trauma to cause any fractures.  It's been about 6 years since I had a dexa scan but at that time my bone density was normal.

Nuclear bone scan didn't show anything abnormal.  What should be the next step, if any, in evaluating these findings on my CT?
Thank you for any information you can provide.

Answer
If you truly have evidence of a lytic process and bone fractures, at your age I'd be concerned about multiple myeloma and prostate cancer.  There are of course other diseases that could do this.  I would suggest a serum immunoelectropheresis (myeloma) and a PSA (prostate cancer). I"d do a serum calcium and alk phos as well.  Finally, an MRI would demonstrate whether there is abnormal tissue in the area, as opposed to "just" fractures.  Even if you have fractures, the question comes up as to why, especially if your dex scan was normal six years ago. It's unusual for a man 55 to get osteoporosis but it can happen.  Assuming all of the above doesn't give an answer, I might consider an endocrine consultation to evaluate causes of osteoporosis.  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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