• In some breast cancer patients, the bone lesions themselves produce extra bone (blastic lesions) instead of
"holes" in the bone (lytic lesions). Here it is not possible to determine healing by looking at x-rays because
healing is also associated with the laying down of extra bone. Again, healing may be signified by the failure to
develop any new lesions elsewhere.
The "Flare" Response Hormone treatment and also chemotherapy can sometimes produce worse bone pain during the first few weeks of therapy, and the serum calcium level may also rise. This endocrine "flare" may be early evidence that the cancer is responding to the hormone treatments.
If possible, pain medication is given to allow therapy to continue while the elevated calcium level is evaluated and treated. Usually the calcium returns to normal and the pain decreases, confirming a response.
Similarly, the bone scan sometimes becomes temporarily worse in a patient who is clinically improving. The increased uptake on the scan may represent healing of the diseased bone. The x-ray appearance may not change for several months even in patients with a good response to treatment and whose pain has decreased.
In a similar way the tumor markers CEA or CA 15-3 may rise temporarily in patients who respond.
