Day 198 | Hip Biopsy

Why biopsy?

I am having a hip biopsy, and I've had a lot of people ask about the biopsy...so, here's all I know.

Why MRI the area in the first place? 

The area of my hip lit up on the PET (showed a soft tissue nodule within the left thigh as well as soft tissue mass)...but areas of inflammation can light up and my hip's been hurting for about three years. 

History of Pain

The pain started with training for the Nike Women's half marathon in April 2014 and then running the Baltimore half in October 2014. The pain was consistent with IT band - going from hip to knee and down my left shin. 

I iced, foam rolled, etc. Then, I just stopped running. [Retired]. 1 half marathon + 1 half marathon  = 1 full marathon, aka, enough running for any one person to do. 

The pain persisted. It got better when I did spin class... (Godbless Zengo in DC), I attribute it to extra stretching after class.

In late 2015 - shame on me for letting it hurt this long (I know, I know) - I saw a doctor for it in DC, who told me it was likely an IT band issue that caused hip bursitis, which is inflammation leading to extra fluid on the outside of your hip. I had x-rays done (no MRI) and they were normal, so it was treated as an IT band issue. 

The orthopedic doctor gave me a cortisone shot on in my hip on my 32 birthday. The shot did not help at all. It actually made it hurt worse (the doctor at OSU said it may have been administered in the wrong location). I've been in PT off and on for it for the last year and a half, which seemed to help. The pain flares if I do too much activity (running is a no-go) or drive too long or sit on long haul flights. 

Abnormal PET = MRI

Due to the abnormal PET, my oncologist recommended a MRI of the hip. It seemed super unlikely that it was anything cancerous, but better to be safe than sorry. No rush on the scans because of the unlikeliness. 

I scheduled the MRI a month after the PET. I told the orthopedic doctor here about the scans, and had them sent to him...I thought it would be helpful in my PT. 

The results came back. The radiologist who read the report recommended a biopsy. The oncologist frankly thought they made a mistake. That the radiologist was being overly cautious. 

She had the scans sent to the head of radiology and the orthopedic doctors that deal with cancer. No mistakes. The scans don't look like normal inflammation - they all agreed, abnormal - they need a biopsy to rule out cancer. There are "rice bodies" present in the bursae, which is what caused the doctors to get all hopped up.*

How will they do the biopsy? 

The biopsy will be painful. I'll be sedated and they will give a local anesthetic too. They will take a core sample from the bursa and the soft tissue and probably the bone. More on soft tissue biopsies. They'll start with a core needle biopsy and do a surgical biopsy if needed.

What will the biopsy tell us? 

It's unlikely to be a metastasis of the breast cancer because (a) super weird place to first get a first instance of mets, though there have been journals about bone mets** being found in the hip bursa first...it's still really rare, (b) the pain way preceded the cancer, and (c) would be unlikely for the hip area cancer to grow while the rest of the cancer is responding to the chemo.

If it's not mets, it leaves either "chronic bursitis" (which is still what I think / hope / pray it is) or a DIFFERENT TYPE OF CANCER. W.T.F., amiright? 

Chronic bursitis means that I effed up my hip a while ago, didn't get treatment on time, and it got worse. There are surgeries you can do to help the bursitis, but it's mostly lifestyle changes that help the hip. Noteworthy that the hip got wayyyy worse in the last few months. I thought / think it's because I was waddling towards the end of my pregnancy. 

While a different type of cancer is probably LESS likely than mets, it would strangely be better than mets. It would probably require a different type of chemo and a different set of doctors and would probably preclude me from going back to work anytime soon....but, would most likely be treatable. 

The MRI also showed that I tore my hamstring at some point (wth), some spine compression (L4-L5), and ischiofemoral impingement (a pinching of soft tissues between bone prominences)....causing HIP PAIN. 


If I were a betting woman (and I'm not) - I would bet 85% shot it's non-cancerous. 8% shot of mets. 7% of a different type of cancer. These are just my best guesses - not actual percentages from the doctor. So, if you're praying or sending good vibes - we need all that we can get again (sorry if that's greedy). 

I'll send another update when I know more. 

* Rice bodies can be found in cancer OR bursitis. I guess the way these little rices looked made them unsure which.
** Bone mets is unlikely in TNBC. Only ~9% of mets in TNBC are in the bone. It's most likely to metastasize in the brain first, then liver, then lungs, then other soft tissue or visceral organs, thennn bones.