Musculoskeletal Case: metastic disease in ribs
A 58 year-old woman presents to her physician complaining of rib and back pain
following a trip-and-fall accident. She was concerned that she may have broken
something. On physical exam, the physician notes some rib tenderness, but also finds a
palpable mass in her right breast. The woman says that she does not perform monthly
self-exams on her breasts and has not had a breast exam since her last checkup several
years ago. A mammogram and rib and spine films were ordered by the physician. The
mammogram shows a large mass consistent with cancer in her right breast and the bone
films show multiple osseous lesions consistent with metastatic disease.
Questions to consider:
1. Where may breast tissue be found?
2. Why does the physician order separate breast and bone films?
3. How can breast cancer spread or metastasize?
4. What route did the tumor metastases take to get to the ribs and other bones?
5. What lymph nodes might show cancer cells in them?
6. What other organs might be involved?
7. What might be evaluated in determining the prognosis of this patient's disease?
8. What types of treatment might she expect?