Question about PET scans

[recce101]

Please see below for my background and status.

Currently awaiting additional consultations and healing of incision before starting chemo about the end of September. I've had a CT scan, but the subject of PET scans has not come up, and I did not ask about it during my 9/12 meeting with the medical oncologist since I was not aware of the device at the time. I now know there is a PET machine at the Queens Medical Center in downtown Honolulu and possibly a mobile van which travels to other facilities on Oahu.

I see frequent reference to PET scans on the discussion board, generally in connection with checking the progress of treatment. Before pursuing this with my oncologist, I'm interested in knowing if anyone considers a PET scan highly desirable or a "must" BEFORE beginning the first chemo cycle. Would it be covered by Medicare for this purpose? And would the initial "systemic" chemo treatment likely be the same whether or not a PET scan had been done?

[john]

PETs are pretty good for non-invasive staging.

They are only about 85% accurate and can miss malignant lymph nodes

Since you had the surgery to look for the cancer, there must have been cancer in different lobes to make you M1 or Stage VI.

Staging is based on the TNM system. (Google "TMN staging")

T = size

N = lymph nodes

M = metastasis

Since I imagine the surgery was only around the lungs the only way you can be stage VI is if multiple lobes are involved or you have a malignant pleural effusion.

So a PET is not necessary if you are have multiple lobes involved because that classifies you as Stage VI.

One thing to find out for sure is that your are stage IV. Then the pet would not matter really except it would give the Drs more info about any other metastasis (if any exist). The treatment would not change and still be systemic.

Another thing to ask is do you have pulmonary metastasis or multiple primary lung cancers (MPLC). They are different

If you have multiple primaries then surgery might be possible (I think)

I am sure there are a few PET scanners in Hawaii and there likely is a combined CT/PET scanner there.

[recce101]

Thanks for the info, John. My path report has this in the comments section:

"The material, in aggregate, is consistent with a primary pulmonary adenocarcinoma with direct invasion into the parietal pleura/chest wall and several areas of parietal pleura metastases."

It continues with "T4 (clinically separate tumor nodules in the same lobe)" then the code "Nx" which my Googling says means the lymph nodes cannot be assessed. I don't see an "M" code.

If I read your post correctly, there's no need for use of PET for staging since we're already maxed out, so to speak, and the systemic chemo would not change even if a PET detected something else suspicious elsewhere. Rather, in my case the PET would likely be used for monitoring later.

Am I on the right track?

[john]

Yes the pleural metastasis makes it M1, though from what I have read there are questions whether it should be a lower stage in some articles.

Sometimes resections are done even when there is a chest wall invasion by the tumor. I would ask why you are not a candidate for surgery?

Is it the lymph nodes? Nx seems strange to me since they opened you up. I guess once they saw the tumor, it was staged IV and there was no need to check the lymph nodes.

Is it the malignant effusion?

I believe multiple tumors in one lobe can be resected, though I am sure there are always exceptions

The best bet is to make sure you are not a candidate for surgery before the chemo. Or is the chemo planned as neo-adjuvant and resection planned later?

Ask some questions and get 2nd opinions if necessary.

I think even if someone is going to Sloan-Kettering 2nd opinions are good.

But overall, a PET is not necessary if there are multiple nodules in different lobes or plural effusion because it makes it M1 which is Stage IV and that means systemic treatment not local treatment

I'm not a Dr not in the medical profression so don't rely on this info. Talk to your Drs.

Hope you nickname does become NED

[recce101]

John, thanks. I appreciate the suggestions. Anyone have something to add?

[kamataca]

Hey Ned!

Mom is on Medicare, with Option B maybe (Secure Horizons, or something?) She is in a cycle of X-Ray one month, CT scan the next (better imaging), and a PET scan every few months (4 maybe?). My understanding is that the cancer 'lights up' better on the PET scan, but what do I know? Mom has no out of pocket expenses for these tests with her Medicare / Secure Horizons.

Sorry to have so little 'real' info for you. It seems to be like Xrays are good, CT scans are better, and PET scans are the best in profiling certain types of cancers (not in the brain, etc.)

Hope this helps a little.

Kelly

[Don M]

I think John covered it pretty well. It is hard to find a surgeon, as far as I know, who will do removal of tumors from the chest wall and chest wall reconstruction. Here is a link to a website of one lung cancer center that features chest wall tumor removal and reconstruction. Maybe some of the major cancer centers do it too. You may be able to send them cds of your scans and fax them your reports to see what they think about the feasibility of surgery.

http://www.winthrop.org/departments/cli ... ungCancer/

Don M

[Welthy]

In our opinion, further down the treatment road, PETs are a must and have been very comforting to discern between old dead tumors and active ones. Our Doctor is a firm believer in Tony having PET's every three months combined with CT's. We have Medicare Parts A & B with supplemental and it is ALWAYS covered. The PET test has been a Godsend to accurately follow Tony's progress with different treatments, response, spread, etc. Just our opinion (and our Doc's!).

Regards and best wishes on your treatment,

Welthy

[karen335]

Ned,

You may want to check with DR. McKenna at Cedars Siani (sp) in Los Angeles. He is one of the best thorasic Surgeons. Also you can try Cyberknife Radiosurgery. It is is a non invasive sergery and kills the tumor. Here is a website for Cyberknife...www.cyberknifesupport.org/forum. They are real CK doctors snd will answer your questions very promptly. Navigation is very easy, it is user friendly...

Blessings and prayers,

Karen

[Linda661]

Can't add much more to what the others have said other than your planned systemic chemo. is standard for your cancer dx (i.e. the type of cancer you have) -- an initial PET will not change that -- taxol/carbo. is usual first line chemo for your dx.

Medicare will cover PET scans as others have already stated. I would agree that it should definitely be desireable in the future to find out what remains as active sites versus what has turned into scar tissue (not active).

Linda