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PET Scan 2-7-05 Not So Good

Don M

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I got the report for my PET scan on Wed. 2-11-05, the day before I had my consultation with a fill-in oncologist. My regular oncologist was gone all this week. The following is an excerpt from the radiologist report for the last PET scan:

FINDINGS: Comparison is to a CT scan of the chest and abdomen obtained at Grays Harbor Community Hospital on January 28, 2005. This had shown a slightly larger left upper lung nodule.

On the current PET scan, increased FDG uptake is seen in the left upper lung nodule with a maximal SUV of 2.5. There is uptake anterolaterally in the periphery of the left lung and in the chest wall, corresponding to some pleuroparenchymal opacity. This has a maximal SUV of 3.0.

Mild uptake is seen in the right perihilar region. No definite abnormality is seen there on the chest CT. There is mild uptake in the area of the gastric fundus with a maximal SUV of 2.9. No abnormal uptake is seen in the neck, liver, or pelvis.


1. Borderline increased FDG accumulation in the left upper* lobe lung nodule. Given the patient's history of lung cancer, the findings are suspicious for metastasis.

2. Probable scarring in the anteromedial left lung/ chest wall. The level of uptake could represent malignancy, although the CT appearance suggests some pleuroparenchymal scarring.

3. Mild right perihilar uptake. This may berelated to atelectasis or focal pneumonia that the patient may have developed since the chest CT. No specific abnormality was seen on the chest CT there.

*Impression number one refers to upper lobe. It is actually my lower lobe expanded to take the place of the upper lobe.

Before I had the PET scan and after I had the CT scan, I asked the regular oncologist what the next step would be if the nodule showed uptake. He said that I could do surgery since the nodule growth from 9 mm to 12 mm was the only change that the ct scan showed.

When I saw the fill-in onc last Thursday, he said,

“you are probably not going to like hearing this, but at this point it may be best to treat your cancer as a chronic disease and begin chemo. It is not urgent to start right away, but you could if you want to.”

I replied,

“I am familiar with the concept of lung cancer as a chronic disease, but I still want to explore surgery as an option.”

(I am not eager to join the chronic cancer club.)

The fill in oncologist suggested I go talk to my surgeon to see what he had to say and to determine if I could tolerate the procedure if the rest of my lung were to be removed. The next day, Friday, I saw the surgeon and a pulmomnologist. The pulmonologist determined that I would have plenty of lung capacity after the surgery.

The surgeon said that the uptake in the chest wall represents increased metabolic activity independent of any scarring because the scarring is old and that the next step would be to have an interventional radiologist stick a needle in my chest wall to see if there is cancer there or not. I find out about the appointment next Tuesday. So, I imagine I will have the test sometime the week after next.

If the chest wall test is positive, I will be a full-fledged member of the chronic cancer club. If the test is negative, I can proceed with the surgery. The surgeon will sample lymph nodes in my right perihilar area and at the mediastinal area. If they are clear, out comes the nodule. I have not asked the surgeon yet, but I assume he will test the nodule for malignancy before he takes out the rest of my lung.

I really wonder about impression number one above, using the term "borderline". A SUV uptake equal or greater than 2.5 is supposed to be an indicator for malignancy and it is right at 2.5. Also, I had a benign nodule that was removed at the same site in January of 2004. So, I have a benign history too.

I did not have adjuvant chemo after my surgery a year ago. If I get a second chance, I will definitely do it.

Here’s hoping for a second chance at surgery.

Don M

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I'm sorry to hear that you're needing more tests. I hope this all turns out good for you....the best would be benign, of course, but then the best after that would be removal of the nodule.....keep us posted and I'm hoping for the best.


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Whatever the final decision is Don....I commend you for having all your 'ducks in a row'. You've got everything backed up and you're prepared to make an 'informed decision' when the time comes. I've got to say though...like you...I lean more on the side of surgery for immediate removal of the 'bad stuff'. Although adjuvent chemo...in place of/or in addition to surgery can cover lots of bases too. Here's hoping the news will be good....

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