Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 141: A 51-Year-Old with Stage 3 Breast Cancer
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Apr 10, 2025 A patient with a history of stage 3 breast cancer develops new mid-back pain, sparking a deep dive into diagnosis. The discussion highlights distinguishing her symptoms from typical discomfort and includes potential causes like spinal metastasis. The hosts explore the critical nature of recognizing compressive lesions and the importance of timely treatment. MRI's role in identifying spinal metastases is emphasized, along with the unique challenges posed by metastatic breast cancer lesions in imaging and management.
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New Thoracic Pain Signals Recurrence
- New mid-thoracic spine pain in a breast cancer survivor signals possible metastatic recurrence.
- This pain differs from chronic low back pain by its sharpness, midline location, and nocturnal worsening.
Prioritize Compressive Spine Lesions
- Distinguish between compressive and non-compressive spinal cord lesions to prioritize urgent treatment.
- New persistent thoracic back pain, especially worsening at night, should prompt evaluation for vertebral metastases.
Common Cancers and Spine Metastasis
- Breast, lung, prostate, kidney cancers, lymphoma, and myeloma commonly metastasize to the spine.
- Thoracic spine is most frequently involved, except prostate and ovarian cancers preferentially affect lower vertebrae via Batson's plexus.
