53 year old Caucasian female with bone metastases
Step 5: Communication
Objective :Understand the need for urgent surgical attention to the hip, and longer term treatment of her cancer.
Because of your concerns, you call the radiologist to review the X-ray. He tells you that the pelvis X-ray is very suggestive of metastatic disease.
What do you do now?
Consult with the orthopaedic surgeon on-call to get her hip fracture fixedTip 1
Yes, she needs to have her hip fracture addressed surgically, and as part of the management a biopsy and systemic staging will most likely be done.Close
Refer to a medical oncologist for treatment of her breast cancerTip 1
Yes, but once the fracture has been treated urgently and the diagnosis confirmed. Modern treatment of breast cancer can produce good results.Close
Urgently refer to a multidisciplinary sarcoma centreTip 1
No. While a multidisciplinary sarcoma centre would be available to advise, this patient can be managed by a local orthopaedic surgeon in the first instance.Close
Arrange for her to have radiation to the hip before surgeryTip 1
No. While she will likely get radiation therapy, there is already a fracture and so it will need to be given post-operatively in her case.Close
The patient asks you to tell her more about her possible diagnosis and what’s going to happen?
It is important to be honest with her about what you think, but also not to tell her things you suspect as though they are inevitable. While you can discuss the probability of this being cancer, most people would wait for a tissue diagnosis before being definitive about it.
Survival ratesTip 1
Prognosis is very dependent on the extent of disease, which will be assessed by CT examination of her chest, abdomen and pelvis.Close
After staging, she might be offered chemotherapy depending on the extent of metastases to other organs.Close
Radiation TherapyTip 1
Radiotherapy is often given a few weeks postoperatively after surgical fixation of her fracture.Close