A breast cancer patient has dull-achy midline back pain that is progressively more intense over several weeks. The patient has a normal neurological examination. The first diagnosis that should be ruled out is:
a) Carcinomatous meningitis
b) Epidural metastases
c) Malignant pleural effusion
d) Malignant hypercalcemia
Epidural metastases Progressive midline back pain in a cancer patient must be evaluated for epidural metastases, (spread of cancer into the epidural space). The time from onset of pain to onset of neurological deficits (spinal cord compression) is typically many weeks or longer. The incidence of epidural metastases is highest in those cancers that frequently spread to the axial skeleton: breast, lung, prostate, myeloma, melanoma and hypernephroma.
See Fast Fact #62: Epidural Metastases