1st PET Scan Report

[Mike Cruikshank]

From earlier CT scan:  3.8 X 6.4 cm left upper lobe lung mass extending from the left hilum to the left hemithoracic pleural surfaces. Small left-sided pleural effusion.

 

My 1st PET Scan Report/Impression:

1.) High-level metabolically active left upper lobe lung mass with an SUV max of 8.4, with extension to the left hemithoracic pleura anteriorly and anteroiaterally.

2.) Metabolically active left hilar and mediastinal lymphadenopathy.  The SUV max in the prevascular space is 4.7, and the left hilum 4.5.

3.) Small left-sided pleural effusion potentially malignant in nature.

My Questions:

Has anyone had a similar PET scan report?

I Googled SUV and I understand a number greater than 2.5 typically indicates cancer. What about a number as high as mine... 8.4.?  Any thoughts/advise of what I should expect next?

 

 

[Kleo]

Hi Mike! Welcome!

My initial PET was somewhat similar. I had a 5.6 cm mass in my left lung with an SUV of 16!  I had a subcarinal lymphnode at 4.1 plus  an active left hilar lymphnode at 5.0. The biopsy of the lymphnodes showed adenocarcinoma in the subcarinal one only. Still they treated the other node as if it were cancerous due to the high SUV activity. High SUV numbers can also occasionally be due to inflammation. They couldn't or didn't biopsy the mass itself due to it's location..

The treatment plan following testing for me was initially 6 weeks of chemo and radiation combined, followed by 2 "clean-up" doses of chemo, and then immunotherapy for a year.  They changed my treatment plan a bit due to the surgeon requesting radiation be delayed. 

I'm thinking next for you they will probably want to do a biopsy. I had a bronchoscopy procedure for that. Possibly an MRI. They gotta figure out what it actually is first, then they'll get a good plan together for ya from there. 

More folks will be along soon with lots more info! 

  

[Tom Galli]

Welcome Mike,

Yes, unfortunately I've had high SUV returns on many PET scans.  What are SUV magnitudes to be concerned about? This is a non-scholarly explanation: less than 2.0, likely no concern.  From 2 to 4 suggests watch and wait; it could be metastatic, and could be something else (inflammation).  From 4 to 6 is likely metastatic but still room for doubt.  An SUV of 7 is almost sure to be metastatic with a little room for doubt. Eight and above is metastatic cancer.  So, your mass in the upper left lobe is metastatic disease and given that return, the prevascular and left hilum returns would also likely be judged metastatic.

I agree with Kleo that a biopsy is next. In the lung cancer world, a tissue examination of your mass by a pathologist is the initial diagnostic means.  Your mass is large enough to be sampled by needle or perhaps by a flexible or rigid bronchoscopy.  Interventional radiologist often perform needle biopsy while pulmonologists or thoracic surgeons perform bronchoscopy.  Anesthesia is used for both types of procedures.  Now, with new therapies available to the lung cancer community, biopsy samples are submitted for laboratory testing to test for response to targeted therapy and immunotherapy.

Presuming your biopsy returns lung cancer, you may have further diagnostic scans.  Although you've had a PET scan, you may have a bone scan and a brain scan depending on the type of lung cancer identified.  Lung cancer comes in different flavors.  Here is a short synopsis.  Once all the diagnostic tests are complete your cancer, if cancer, will be staged.  Here is what lung cancer staging means.  Normally a specific type (including subtype) and definitive stage is determined before treatment begins.

Now, what to expect next? If lung cancer, I'd expect successful treatment and extended life.  Keep us in the loop as testing progresses.  You'll likely have more questions and this is the place for answers.

Stay the course.

Tom

[Mike Cruikshank]

3 hours ago, Kleo said:

Hi Mike! Welcome!

My initial PET was somewhat similar. I had a 5.6 cm mass in my left lung with an SUV of 16!  I had a subcarinal lymphnode at 4.1 plus  an active left hilar lymphnode at 5.0. The biopsy of the lymphnodes showed adenocarcinoma in the subcarinal one only. Still they treated the other node as if it were cancerous due to the high SUV activity. High SUV numbers can also occasionally be due to inflammation. They couldn't or didn't biopsy the mass itself due to it's location..

The treatment plan following testing for me was initially 6 weeks of chemo and radiation combined, followed by 2 "clean-up" doses of chemo, and then immunotherapy for a year.  They changed my treatment plan a bit due to the surgeon requesting radiation be delayed. 

I'm thinking next for you they will probably want to do a biopsy. I had a bronchoscopy procedure for that. Possibly an MRI. They gotta figure out what it actually is first, then they'll get a good plan together for ya from there. 

More folks will be along soon with lots more info! 

  

Kleo & Tom, I can't tell you how grateful I am to you both for responding so quickly to my post. The information / advice the two of you have given me is most comforting. 

My primary physician is at the VA in St Cloud, Minnesota.  I am awaiting a call back from the pulmonary department at the VA (they called me earlier today - I missed the call but left them a message to call me back). They want me to come in to see someone in the pulmonary department... I don't know if that's a lung specialist or an oncologist.  Hopefully I will see someone early next week and get more information as to what is going on and what is the recommended Next Step.

[Mike Cruikshank]

1 hour ago, Tom Galli said:

Welcome Mike,

Yes, unfortunately I've had high SUV returns on many PET scans.  What are SUV magnitudes to be concerned about? This is a non-scholarly explanation: less than 2.0, likely no concern.  From 2 to 4 suggests watch and wait; it could be metastatic, and could be something else (inflammation).  From 4 to 6 is likely metastatic but still room for doubt.  An SUV of 7 is almost sure to be metastatic with a little room for doubt. Eight and above is metastatic cancer.  So, your mass in the upper left lobe is metastatic disease and given that return, the prevascular and left hilum returns would also likely be judged metastatic.

I agree with Kleo that a biopsy is next. In the lung cancer world, a tissue examination of your mass by a pathologist is the initial diagnostic means.  Your mass is large enough to be sampled by needle or perhaps by a flexible or rigid bronchoscopy.  Interventional radiologist often perform needle biopsy while pulmonologists or thoracic surgeons perform bronchoscopy.  Anesthesia is used for both types of procedures.  Now, with new therapies available to the lung cancer community, biopsy samples are submitted for laboratory testing to test for response to targeted therapy and immunotherapy.

Presuming your biopsy returns lung cancer, you may have further diagnostic scans.  Although you've had a PET scan, you may have a bone scan and a brain scan depending on the type of lung cancer identified.  Lung cancer comes in different flavors.  Here is a short synopsis.  Once all the diagnostic tests are complete your cancer, if cancer, will be staged.  Here is what lung cancer staging means.  Normally a specific type (including subtype) and definitive stage is determined before treatment begins.

Now, what to expect next? If lung cancer, I'd expect successful treatment and extended life.  Keep us in the loop as testing progresses.  You'll likely have more questions and this is the place for answers.

Stay the course.

Tom

Kleo & Tom, I can't tell you how grateful I am to you both for responding so quickly to my post. The information / advice the two of you have given me is most comforting. 

My primary physician is at the VA in St Cloud, Minnesota.  I am awaiting a call back from the pulmonary department at the VA (they called me earlier today - I missed the call but left them a message to call me back). They want me to come in to see someone in the pulmonary department... I don't know if that's a lung specialist or an oncologist.  Hopefully I will see someone early next week and get more information as to what is going on and what is the recommended Next Step.

[Kleo]

Pulmonary is the lung doc! That's who will probably get you set up for a biopsy. It sounds like your primary physician is right on top of things.

Keep us posted!

 

[Mike Cruikshank]

On 8/24/2018 at 5:40 PM, Kleo said:

Pulmonary is the lung doc! That's who will probably get you set up for a biopsy. It sounds like your primary physician is right on top of things.

Keep us posted!

 

I

On 8/24/2018 at 3:01 PM, Tom Galli said:

Welcome Mike,

Yes, unfortunately I've had high SUV returns on many PET scans.  What are SUV magnitudes to be concerned about? This is a non-scholarly explanation: less than 2.0, likely no concern.  From 2 to 4 suggests watch and wait; it could be metastatic, and could be something else (inflammation).  From 4 to 6 is likely metastatic but still room for doubt.  An SUV of 7 is almost sure to be metastatic with a little room for doubt. Eight and above is metastatic cancer.  So, your mass in the upper left lobe is metastatic disease and given that return, the prevascular and left hilum returns would also likely be judged metastatic.

I agree with Kleo that a biopsy is next. In the lung cancer world, a tissue examination of your mass by a pathologist is the initial diagnostic means.  Your mass is large enough to be sampled by needle or perhaps by a flexible or rigid bronchoscopy.  Interventional radiologist often perform needle biopsy while pulmonologists or thoracic surgeons perform bronchoscopy.  Anesthesia is used for both types of procedures.  Now, with new therapies available to the lung cancer community, biopsy samples are submitted for laboratory testing to test for response to targeted therapy and immunotherapy.

Presuming your biopsy returns lung cancer, you may have further diagnostic scans.  Although you've had a PET scan, you may have a bone scan and a brain scan depending on the type of lung cancer identified.  Lung cancer comes in different flavors.  Here is a short synopsis.  Once all the diagnostic tests are complete your cancer, if cancer, will be staged.  Here is what lung cancer staging means.  Normally a specific type (including subtype) and definitive stage is determined before treatment begins.

Now, what to expect next? If lung cancer, I'd expect successful treatment and extended life.  Keep us in the loop as testing progresses.  You'll likely have more questions and this is the place for answers.

Stay the course.

Tom

Kleo & Tom, I can't tell you how grateful I am to you both for responding so quickly to my post. The information / advice the two of you have given me is most comforting. 

My primary physician is at the VA in St Cloud, Minnesota.  I am awaiting a call back from the pulmonary department at the VA (they called me earlier today - I missed the call but left them a message to call me back). They want me to come in to see someone in the pulmonary department... I don't know if that's a lung specialist or an oncologist.  Hopefully I will see someone early next week and get more information as to what is going on and what is the recommended Next Step.

[Mike Cruikshank]

I did breathing tests and then met with a pulmonary physician yesterday at the VA Health Center in Minneapolis.   The breathing test indicates I have 60% normal capacity.  It is my novice understanding the mass in my upper left lung, has attached to my chest wall and thus my lung is not operating properly which is causing my labored breathing.

My pulmonary physician will be meeting with an oncologist, a radiologist, and a thoracic surgeon tomorrow. The four of them will consult on a recommended plan moving forward. I suspect the next step will be a biopsy.

I am feeling optimistic and grateful!

[LexieCat]

Thanks for the update.   Once they've done more testing and settled on a recommended course of treatment things will begin to be clearer.  Those multidisciplinary teams are in the best position to bring all the necessary perspectives and considerations to the table.  Sounds like you are in good hands!

[Steff]

Mike,

Good to hear that a decision is in the near future and the torturous wait will soon be a thing of the past.  Although we were pretty positive that my mom's original nodules were cancerous, it was still stressful going through all of the tests and waiting for results and then having to wait for surgery/treatment to get going.  My mom had a lobectomy of her right, upper lobe.  Although she did not have any masses per say affecting her lung function, her right upper lobe was full of emphysema which was affecting her lung function.  Once it was removed, she breathed better than she had in years.  I anticipate that whatever type of treatment your docs come up with whether it's surgery or another type of treatment, your lung function will dramatically increase.  Hope you have some sort of a plan of action soon!

Take Care,

Steff

[Kleo]

 Moving along! That's awesome. Your people are moving alot faster than my people did!

 

[Tom Galli]

Mike,

I am also a veteran so don't hesitate to ask about care issues with the VA.  They are improving but sometimes the ball gets dropped.

Stay the course.

Tom

[Gary Bonnas]

On 8/24/2018 at 9:19 AM, Mike Cruikshank said:

From earlier CT scan:  3.8 X 6.4 cm left upper lobe lung mass extending from the left hilum to the left hemithoracic pleural surfaces. Small left-sided pleural effusion.

 

My 1st PET Scan Report/Impression:

1.) High-level metabolically active left upper lobe lung mass with an SUV max of 8.4, with extension to the left hemithoracic pleura anteriorly and anteroiaterally.

2.) Metabolically active left hilar and mediastinal lymphadenopathy.  The SUV max in the prevascular space is 4.7, and the left hilum 4.5.

3.) Small left-sided pleural effusion potentially malignant in nature.

My Questions:

Has anyone had a similar PET scan report?

I Googled SUV and I understand a number greater than 2.5 typically indicates cancer. What about a number as high as mine... 8.4.?  Any thoughts/advise of what I should expect next?

I was very impressed with my PET scan since I was scared having it done, after being told there was no way of knowing where my lung cancer was or if had spread or not. Originally my lung cancer was found by having pneumonia in the hospital when they ran a test, only to be told I had it on both lungs. After being released I was refereed To Buffalo Roswell & a doctor who explained how cancer travels in the body & I wondered about surgery only to be told that doing surgery is like throwing gas into a fire, since cancer could be made worse by air.I confess I was like other people that just found out about cancer the wife & I were scared to dearth, since they have to know where it was located before treatment. Well the PET-scan doctor explained the procedure about injection of the radiation. Well the results of the scan was the best answer to our prayers. To be told that I only had lung cancer in the left lung only. I was half way through chimo when the Roswell doctor wanted radiation as well, to be told by the radiologist claimed that my cancer doctor wanted to stop chimo  use radiation only. When the radiologist told us my lung cancer was stage 3 & I would not not survive with radiation alone so I was put on a 5 days a week radiation with chimo on the week-- end. Well after radiation & chimo I was told that my cancer was in remission, & that I was a survivor of cancer. 

 

 

[Michael305]

New here -

We are just starting the lung journey. Nodules were just found in my (non-smoker) wife's lungs. (I have Kidney cancer - just found this year, so we are not new to the cancer up and downs.) We are not freakout reactionary people, so please be blunt with us. We are on a fact-finding mission. Like with my cancer, we just want to know what we are up against so we can plan accordingly.

Here are CT and PET CT results:

8 nodules found in her lungs from 4 mm to 8 mm

1. Trying to understand the detailed findings of the PET-CT

• 7mm nodule...
• 6 mm noncalcified nodule...
• 6 mm nodule...
• 5 mm subpleural nodule...
• 4 mm noncalcified nodule... 
• 4 mm subpleural nodule...
• 6 mm noncalcified nodule...
• 4 mm noncalcified nodule...

Which ones should we be worried about?  Everything I have read says don't worry about calcified nodules, but none were labelled that way.

 

2. "Nonspecific physiological activity seen in the tonsils/base of tongue. "

Is this a concern?

 

3. "Nonspecific subcentimeter right cervical level 2 lymph nodes demonstrate focal FDG activity measuring up to SUV max 2.7

Worry?

 

4. "A 1 cm left cervical level 2 hypermetabolic lymph node measures SUV max 4.9"

This seems like a problem. True?

 

5. Nonspecific heterogeneous uptake throughout the liver and spleen. Physiological radiotracer activity is present within the gastrointestinal and urinary tracts."

worry?

 

6. "Enlarged uterus with nonspecific, heterogeneous endometrial FDG activity measuring up to SUV max 5.2"

The SUV max 5.2 seems problematic. 

 

Are we heading for surgery? How soon? Other treatments?

We have an appointment with the pulmonologist/oncologist in a week.  Any information ahead of time would be great.

 

We would like to have as much information as possible going into the appointment.

Any thoughts/experience would be greatly appreciated.  

 

 

[Tom Galli]

Michael,

This news on top of your cancer, it seems like things are not going your way.  I'll try and be as specific as I can. First however, read this information from the Cleveland Clinic on pulmonary nodules. As you can see, there are many reasons they form and most are not cancer. I want to emphasize that your wife's nodules are all very small and they may be difficult targets to biopsy. I do note that none of the lung nodules indicated SUV uptake in the PET scan but sometimes small nodules do not reveal uptake. I'm not aware of a calcified -- non calcified discriminator.

SUV uptake, especially with small objects, is not an exact science.  Generally anything reported at less than 2.5 SUV can be classified as not metastatic disease.  Between 2.5 to 5.0 SUV may be a metastatic indicator but my PET scans report uptakes in this range in my thoracic incision plane, inflammation due to my chronic pain condition.  SUVs above 5.0 are generally indications of metastatic disease.  Bear in mind, I am not a doctor, just a long tenured survivor who has had a lot of PET scans.

So you've got some borderline concerns to be mindful of.  The next step would be a biopsy, likely of an area that demonstrates a high SUV return. 

Your wife may have no cancer, lung cancer, or another form of cancer with a presence in the lung.  The uterus find is suggestive of the other form possibility.  At this stage, it is hard to give you precise information ahead of your consultation next week but I would suggest you read into lung cancer to provide you with some background information.  Here is a good source. 

I hope this answers your questions.  This is a good place to ask questions.

Stay the course.

Tom

 

 

[BridgetO]

Hi Michael305 and welcome. Tom's response is good. He is better informed on PET results than many of us on this forum. I wish you and your wife all the best. Keep us posted.

[Michael305]

Thanks Tom and Bridget. 

In a strange way, we both feel blessed; Both my cancer and her nodules - were found very early as part of other concerns (which turned out to be minimal). So in our book the glass is more than half full.

I appreciate the thoughts/insights. 

The report did also note, at Tom you mentioned, these smaller nodules may not react - aka light up - despite being cancerous (if they are in fact are). 

Again, we are not freaking out, just trying to glean as much as we can prior to the appointment so we can speak intelligently about our concerns, options, etc. It served us well in my cancer and I am sure will help with my wife's _______ as well. (The blank to be filled in next week.  )

Thanks again for the quick responses.

 

 

[Andree]

On 8/24/2018 at 12:19 PM, Mike Cruikshank said:

From earlier CT scan:  3.8 X 6.4 cm left upper lobe lung mass extending from the left hilum to the left hemithoracic pleural surfaces. Small left-sided pleural effusion.

 

My 1st PET Scan Report/Impression:

1.) High-level metabolically active left upper lobe lung mass with an SUV max of 8.4, with extension to the left hemithoracic pleura anteriorly and anteroiaterally.

2.) Metabolically active left hilar and mediastinal lymphadenopathy.  The SUV max in the prevascular space is 4.7, and the left hilum 4.5.

3.) Small left-sided pleural effusion potentially malignant in nature.

My Questions:

Has anyone had a similar PET scan report?

I Googled SUV and I understand a number greater than 2.5 typically indicates cancer. What about a number as high as mine... 8.4.?  Any thoughts/advise of what I should expect next?

 

 

biopsy

[Andree]

biopsy