Topics:
Radiation Oncology • Gynecologic Cancers • Cervical Cancer • Medical Oncology • Rheumatology • General Rheumatology • Polymyalgia rheumatica
How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?
Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.
Answer from: at Community Practice
The question raises the concern for paraneoplastic PMR, an interesting subject in and of itself. Standard texts reference this relationship, especially in relation to multiple myeloma and Waldenström’s macroglobulinemia. One study (Muller et al., PMID 23842460) reports a 69% risk of the d...
Answer from: Radiation Oncologist at Academic Institution
I agree with starting with a biopsy given the history and potential for non-oncologic reasons for FDG uptake. I think I (and you) want the patient to not have metastatic disease, but it is worth making a good-faith attempt to 'prove it' in this scenario.
If biopsy is negative, treat the pelvis with...
Comments
Radiation Oncologist at Allegheny Health Network
I agree with @Ashwin Shinde for the most part, exc...
I agree with @Ashwin Shinde for the most part, exc...
Answer from: at Academic Institution
In this clinical scenario, lytic lesions in the ischial tuberosities require us to assume they are due to metastatic disease. This does not rule out the possibility of concurrent PMR. Although PMR can sometimes be isolated to the hip girdle area, I would seek additional information. For example, doe...
How would you sequence the RT to the pelvic mets?&...
I would include it in the primary fields and proba...