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Another Cliff Hanger


Bill

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My wife saw her rad onc today. IMO he is the most open-minded of the bunch. However, he can't believe what he is seeing, or more to the point what he doesn't see. " What happened to all the ( active ) bone mets ? ". Spine, pelvis, ribs, scapula ? He states that my wife's improvement not only defies logic, sound reasoning and the laws of medicine but he now admits that he never even expected her to make it out of ICU alive. He's not an expert at reading PET scans but he did take a look at the films and he agrees that he sees no tumor activity anywhere other than the one ( shrunken ) primary tumor in her upper left lung. My wife's recent PET scan was, unfortunately, her first so no means of direct comparison there. But, since she has had several CT scans he says that the best way to confirm these PET results is to order another CT. He wrote the RX order for chest only and requested a comparison report vs. her Jan. ' 05 CT scan results ( which, by the way, were terrible ). He says that CT scans pick up small active nodules better than PET but further states that PET should be able to pick up active lung nodules / tumors as small as ~ 5 mm ~ 10 mm. Do you agree ? I plan to get this chest CT scheduled the first part of next week. This is nerveracking but I have felt all along that a comparative CT of at least the chest would be important for confirmation. Stay tuned !

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Hi Bill:

I may be wrong, but I think PET scans are less reliable for tumors 5 mm to 10 mm. They are more reliable for the bigger ones. I think a 5 mm tumor seen on the CT scan may not show uptake on the PET scan, but still could be malignant. I remember reading somewhere that the reliability is 80% or so for the smaller tumors. I tried to find the document again, but could not find it. You will have to ask a radiologist to make sure.

I feel confident that the follow up CT scan wil verify the good results that your wife has experienced.

Don M

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Hi Bill:

I may be wrong, but I think PET scans are less reliable for tumors 5 mm to 10 mm. They are more reliable for the bigger ones. I think a 5 mm tumor seen on the CT scan may not show uptake on the PET scan, but still could be malignant. I remember reading somewhere that the reliability is 80% or so for the smaller tumors. I tried to find the document again, but could not find it. You will have to ask a radiologist to make sure.

I feel confident that the follow up CT scan wil verify the good results that your wife has experienced.

Don M

Don :

The rad onc offered three possible explanations for my wife's PET scan results :

1. ) Tumor eradication to be classified as a ( Tarceva ) Miracle because there's no credible medical explanation for this.

2. ) Malignant tumors are present but are under the radar ( too small , less than 5 ~ 10 mm. ).

3. ) Tumors / nodules are there but are INactive ( someone please translate this for me. What does it mean medically to have inactive tumors ? Dormant with the potential to become active, dead tumor residue or what ? And, shouldn't the presence of ( numerous ) INactive tumors interfer with resp. function as they take up space ?

He did say that regardless of the CT scan results it's obvious to him by seeing and examining my wife that she has markedly improved. He said that when he saw her in ICU that she was the sickest that he had ever seen a cancer patient that was still alive. Approx. 80% of her lung cpaacity obliterated with mets scattered throughout her bones. Her ALP almost doubled at the end of Feb. This CT scan should nail this down.

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...He's not an expert at reading PET scans but he did take a look at the films and he agrees that he sees no tumor activity anywhere other than the one ( shrunken ) primary tumor in her upper left lung. My wife's recent PET scan was, unfortunately, her first so no means of direct comparison there. But, since she has had several CT scans he says that the best way to confirm these PET results is to order another CT. He wrote the RX order for chest only and requested a comparison report vs. her Jan. ' 05 CT scan results ( which, by the way, were terrible ). He says that CT scans pick up small active nodules better than PET but further states that PET should be able to pick up active lung nodules / tumors as small as ~ 5 mm ~ 10 mm. Do you agree ?...

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Hi, Bill,

The above is exactly why my docs chose CT-PET Fusion for my pre Tarceva and follow up scans. I have a very deformed chest and abdomen because of Polycystic Organ Disease and multiple surgeries. And also because I make both benign and malignant tumors. They need all the help they can get in navigating.

Having said that, all lesions/nodes/nodules-solid, semi-solid-non-solid- that have been suspicious for malignancy via PET imaging have proven to be malignant when excised and examined by a Pathologist.

I have had tumors show up (Lung) on CT that were biopsied and they were benign. They did not show up on PET.

But this is just me, Bill. One thing to consider is that some forms of BAC do not show up on PET Imaging, and for those folks there is another nuke med study called a NEOTECT Scan that is much more sensitive. When I was in the clinical trial for BAC patients using Iressa NEOTECT was the alternated with CT scans for study purposes.

When your Rad Onc was discussing present but inactive cancer he may have been referring to the indolent stage that BAC and Adeno with BAC features sometimes goes through. It's there, but it isn't growing. For some folks it can remain in this indolent stage for many years.

Hope this helps, and Bill, I am tickled silly that she is doing so well. :D

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this is great news to read. I hope she continues to baffle and boggle the minds of those docs and that the mets are indeed gone. Sounds miraculous to me too!

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Hi Bill,

I am like in total shock. :shock: that is incredible news. G-d I pray this is all true and not a mistake.

But, if anything at least your wife is feeling better. :lol:

I will be on pins and needles waiting for that CT test and the results.

INCREDIBLE.....

Fingers, toes, arms and legs all crossed for positive results.

Maryanne

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He says that CT scans pick up small active nodules better than PET but further states that PET should be able to pick up active lung nodules / tumors as small as ~ 5 mm ~ 10 mm

You probably already knows this but I was advised that the differing levels of CT scans determine their ability to pick up smaller things. I think? the average CT is comprised of 5mm slices/pictures. They can however take much smaller slices. “we try and do as little damage as possible” which, to me means that a small slice CT would always pick up nodules where as PET might miss if they are not active.

This flow of information is great, not to mention the outcome.

Bo

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