Weird swelling revealed first sign man's fingers and toes were ‘completely replaced' by cancer
It turned out to be a rare sign of cancer that had spread through his body - and the bones in his digits had been " completely replaced" by cancerous tumours.
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Prior to swelling, the 55-year-old from Australia had been diagnosed with metastatic squamous-cell lung cancer.
Squamous cell lung cancer is known for spreading to multiple sites, including the brain, spine and other bones, adrenal glands, and liver.
It's a type of non-small cell cancer, the most common type of lung cancer, and accounts for roughly 80-85 per cent of all lung cancer cases.
His case was published this month in The New England Journal of Medicine.
Six weeks after noticing swelling in his right middle finger and his right big toe, the man went to his local hospital.
Doctors found the tip of each was red and swollen, and an ulcer had formed near the nail of the affected toe.
The swollen areas were firm to touch and tender, the doctors reported.
Scans revealed his hand and foot contained "destructive lytic lesions that had completely replaced" the bones in the finger and toe.
Lytic lesions are areas of bone destruction that appear as holes or weakened spots on imaging scans.
While cancer that's spread to the fingers and toes may mimic gout on a physical examination, a scan called a radiograph can help identify lytic lesions, the patient's doctors noted.
The man was diagnosed with acrometastasis - the rare occurrence of cancerous tumours metastasising to the bones of the hands or feet.
Acrometastases account for about 0.1 per cent of all metastatic cancers, according to a 2021 review.
In most cases, the condition is seen in patients who already have cancer.
But in some instances, acrometastasis can be the first sign for undiagnosed cancers.
It's most often linked to cancers of the lung, gastrointestinal tract and genitourinary tract.
Acrometastases are seen more often in males than in females, according to the review.
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And it tends to be rare, because in most cases, cancer cells are drawn to bone marrow, which is found in the long bones of the arms, legs, ribs, backbone, breastbone and pelvis.
Finger and toe bones contain less bone marrow.
Additionally, the further a bone is from the heart, the less blood it gets.
Lower blood flow makes it harder for cancer cells to reach the fingertips or toes, so acrometastases happen less often there.
Because acrometastases are usually seen in late-stage cancers, they're linked to poor survival rate.
Treatments are typically focused on relieving a patient's pain and retaining as much function in the hand or foot as possible.
In the 55-year-old's case, he was started on palliative radiotherapy, which aims to relieve symptoms rather than cure the disease.
The doctors reports he died three weeks later from complications of refractory hypercalcemia - persistently high calcium levels in the blood that don't respond to standard treatments.
Common symptoms of acrometastasis
Acrometastasis, the spread of cancer to the bones of the hands or feet, can present with symptoms like pain, swelling, redness, and warmth in the affected area.
These symptoms can mimic benign conditions like arthritis or infection, leading to potential diagnostic delays.
Common symptoms include:
Pain: Often deep-seated, intermittent, and may not be relieved by typical painkillers.
Swelling: Can be localized to a specific digit or involve a larger area.
Redness and warmth: May indicate an inflammatory process, but can also be a sign of acrometastasis.
Tenderness: The affected area may be tender to the touch.
Functional impairment: Difficulty using the hand or foot due to pain or swelling.
Ulceration or bleeding: In some cases, the skin over the affected area may ulcerate or bleed.
Palpable mass: A lump or mass may be felt in the affected digit.
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