Over the course of six weeks, the man developed painful swelling in his right middle finger and right big toe, with numbers taking on the shape of a club. The strange swelling turned out to be a rare sign of cancer that spread across his body.
A case report published on July 16 in the New England Journal of Medicine revealed that the 55-year-old had been diagnosed with metastatic squamous cell carcinoma before the onset of swelling. This type of cancer begins with flat, thin cells lined up in the airways, in which case the cancer reaches an advanced stage, spreading or metastasizing to other parts of the body.
After noting the swelling in his fingers and toes, the man reported to the hospital for examination. The doctors found that the tips of each affected digit were red and swollen. They also noted that the ulcer formed near the affected toe nail. The swelling area was soft and firm to the touch, doctors reported.
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Scans of the affected hands and feet in men, “a completely replaced destructive lytic lesions” and bones at the tip of the middle finger and large finger. A lytic lesion is the area where bone has been destroyed, leaving holes and voids in the skeleton. Such lesions are usually driven by disease processes such as cancer.
Cancer spreading to the bones of the fingers and toes can mimic gout and osteomyelitis on physical examinations, but the patient’s doctor noted that scans, called radiographs, can help diagnose the condition. Gout is a type of inflammatory arthritis, and osteomyelitis causes inflammation of the bone, but since it is often caused by infection, both conditions can cause visible redness and swelling.
Based on his radiograph, the man was diagnosed with scapulasis, a relatively rare spread of cancer that occurs under the shoulders or knees. According to a 2021 review, it accounts for only about 0.1% of cases where cancer has spread to the bone.
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In most cases, this rare condition is seen in patients who are already known to have cancer, like in recent cases. However, sometimes, scapula symptoms are the first sign of a previously undiagnosed cancer. Reviews show that it is mostly related to cancers of the lungs, gastrointestinal tract and urogenital tract.
A review of approximately 250 cases of conditions published between 1986 and 2020 shows that men are seen much more frequently than the shoulder blades. This gender difference has also been flagged in other reviews of the literature. The bones of the fingers and toe were more likely to be affected than the other bones of the hands and feet, the literature suggests.
The shoulder blades are rather rare as they are usually drawn in the bone marrow when the cancer spreads to the bone. This is because it is mainly seen in the long bones of the arms and legs, ribs, backbone, sternum and pelvis in adults. By comparison, the bones on the fingers and toes have much less marrow. It may also help explain why cancer spreads less frequently to the fingers and toes, as it flows less blood than bones close to the heart, reviews suggest.
Agesia is usually seen in late stage cancer, and is associated with poor survival. In many cases, it is less than six months after the condition is diagnosed. Therefore, treatments usually focus on relieving the patient’s pain and retaining as many functions as possible. At age 55, doctors began palliative radiation therapy. This is intended to relieve symptoms in a person rather than cure illness.
Doctors reported that the patient died three weeks later from complications of fire-resistant hypercalcemia. This is a dangerously high calcium level in the blood that does not fall out depending on standard treatment. This condition is often linked to cancer, but not always.
This article is for informational purposes only and is not intended to provide medical advice.
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