Oncology (General Cancer)/lucent lesion/bone cancer

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QUESTION: My foot got crushed. The xray shows lucent lesion in the proximal bone of my big toe.  About 12 years ago I had a bone marrow biopsy because of my WBC going up and down.  The biopsy came back as genetic mutation.  My last WBC was low. How can I know if this lesion is cancer or not? What tests, etc should i ask for?
Thanks
Victoria

ANSWER: The only certain way is to biopsy it. However, what you are describing is fairly common; when you crushed your foot, you probably cut off the blood supply to a small part of the bone, and over time the calcium leached out, leaving scar tissue, which is "lucent".  If the area is not particularly painful, or if the pain has been stable, I wouldn't worry.  It would be extremely unusual for any cancer to metastasize to the toe only.  I don't think your white cell count is related to the toe problem.  On the other hand if there is change (swelling, increased pain, etc) I would consider a fine needle biopsy of the area.  Hope this helps.

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

QUESTION: I neglected to say I am 57 year old female.  The X-ray was taken within 24 hours of the injury and showed no broken bones, just the lucent lesion was mentioned in the report. The report said it was likely an echondroma but when I looked that up online I saw that sometimes those were cancer, thus this question. The injury happened 4 1/2 weeks ago.  There is still swelling and yes, there is pain.  I see an ortho Dr tomorrow.  Should I ask for a biopsy?  Thank you so much for helping me.

Answer
Before you broke the bone,were there any symptoms?  If the lucent area was present just about when the fracture happened, it probably is an encondroma.  If you had no pain before, I would see how things are after you heal up.  Like I said before, it is almost certainly not cancer, not in that location, not if it was painless and without symptoms before you had the problem.  Hope this helps. (I would ask your doc to consider another xray in about six months and if the lesion is stable, I wouldn't biopsy.  If it has increased, I would.  Remember, if this is a metastatic lesion, or a lesion from a plasma cell disorder, it won't make any difference in the long run. But it almost certainly isn't either of those.)

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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