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Mom's PET Scan Results


Sandy Parker1950

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Hi all, my mother's cancer diagnosis came about with what we thought was pneumonia in early October. When the antibiotics didn't work to clear up the pleural effusion, we knew it was more serious. Her lungs tested positive for adenocarcinoma neoplasms. She had a biopsy on the left supraclavicular  node on Friday, so we're awaiting the results to diagnose her primary cancer source. In speaking with her Radiologist, he mentioned that he believes this is non-small cell lung cancer. Despite the fact that no nodules were found in the lungs, as noted below in her PET. We are meeting with an oncologist on Monday. Her issues were complicated by a pulmonary embolism, which prolonged her hospital stay and prevented her from getting a PET until she could be discharged. 

I would be so grateful if anyone had any advice or thoughts on my mom's scan. I've been reading all of the posts by the moderates here and I'm blow away by your knowledge of the disease just being a patient alone. Thank you again, Sandy

 

CLINICAL INDICATION:  J90 PLEURAL EFFUSION, NOT ELSEWHERE CLASSIFIED

PET/CT is performed for initial staging of disease.

TECHNIQUE:

Scan Region: Whole Body Skull Base to Hips

CT: Low Dose, Non Breath-hold, Non-contrast

Administered Activity:  10.5 mCi F18-FDG, Intravenous

Delay Before Imaging: 60 minutes

Blood Glucose: 114 mg/dL

COMPARISON:  None.

 

PET/CT Findings:

Head Base and Neck:  Base of the brain within normal limits.  There is a left supraclavicular node with an SUV of 12.5

There is a cluster of nodes seen at the base of the left neck posterior to the thyroid gland with an SUV of 10.7.

There is a node with low level uptake posterior to the clavicle series 3 image 52 SUV of 4.8

There is a focus of increased uptake in the right brachiocephalic vasculature within SUV of 8.6.  The discrete note is identified.

Chest:  There is a focus of increased uptake in the left internal mammary chain series 3 image 69 SUV is 5.7.

There is a bandlike area of increased uptake seen to the left of the mediastinum with an SUV of 11.3

A small soft tissue mass is seen at the border of the right aspect of the left atrium with an SUV of 6.4.  It is some mild uptake in the left posterior pericardium and SUV of 4.9.  Foci of increased uptake seen associated with the left chest wall.  There is a large left effusion.  This demonstrates some mild diffuse uptake.

No definite pulmonary nodules are identified.

 

Abdomen: There is a focus of mildly increased uptake to the right of the aorta measuring SUV of 5.7 which may represent a node.  There are number of tiny foci adjacent to the left aspect of T11.

Pelvis: There appears to be increased uptake in the cecum which appears thickened and demonstrates FDG avidity with an SUV of 12.7

Bone/Musculoskeletal: Diverticulosis.  Bilateral cystic changes seen just superior to the bladder.  Possibility of ovarian cysts are raised.  No increased FDG avidity.

Other: Multiple bony foci are seen:

There is a focus in the proximal left femur with an SUV of 10.  There is a focus in the right pubic bone with an SUV of 12.4.  There is a second focus in the right superior pubic ramus with an SUV of 17.  There is a focus in the right femoral head with an SUV of 16.  There is a left posterior ischial focus with an SUV of 12 there is a left there are left and right iliac foci seen.  Increased uptake in L2 and 3, T9 T5 of C3 and C4.

LOW DOSE FUSION CT Findings:

Loculated left effusion consolidation at the left base.  Multiple findings as described above.  Diverticulosis of the colon.

2 cysts seen in the pelvis measuring 5 and 4 cm which may represent ovarian cysts.  Further evaluation advised.

IMPRESSION:

Large loculated left effusion with some surrounding pleural and chest wall activity.  FDG avid adenopathy as described above.  Bandlike area of increased uptake adjacent to the left mediastinum.  Possibility of a malignant left pleural effusion raised.

Focus of increased FDG avidity in the region of the cecum.  SUV is 12.7.  However, the patient had a CT of the abdomen and pelvis on October 25, 2018 that demonstrated no definite abnormal pathology in this location.

Multiple bony foci, some of which demonstrate bony erosion.  Presumably metastasis.

Findings consistent with metastatic disease.

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Sandy,

Welcome here.

My thoughts on your mom's PET scan? It appears she has stage IV cancer. Relying on the first biopsy, one might conclude adenocarcinoma as a subtype of NSCLC.  The left supraclavicular node, thyroid and band of increased uptake to the left of the mediastinum may suggest her primary cancer is in the tissue between the lung and interior chest wall (my guess). She also has numerous mets to the bone (pelvis and leg), all of which are of concern, but note the potential involvement of the spine with proximity to L2 and L3, T5 and T9 and C3 and C4. But, I'm not a doctor so don't rely on my opinion.

Advice? Although pretty standard, I'd inquire if biopsy tissue was sent for lab analysis to determine suitability for targeted therapy and or immunotherapy.  You've not reported your mom's age or complicating medical problems, heart disease or diabetes for example.  Your mom's overall health and biopsy results will dictate how aggressive her treatment might be.  Very aggressive would be precision radiation to mets in the leg, pelvis and spinal chord along with combination chemotherapy, perhaps administered with concurrent immunotherapy.  Less aggressive might be just chemotherapy alone.  Palliative radiation may be given if bone mets start to produce pain. 

To be honest, there is no good news in the PET scan.  You'll need to steel yourself to help your mother make choices about how to treat her cancer.  These will be hard decisions.

Stay the course.

Tom 

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Hi Tom and all,

The other issue is that my moms right leg is very swollen lately, she said it feels like she’s carrying bricks in her legs. This is preventing her from walking around very much. Her general oncologist said that her current state is borderline stable at best, and he would recommend chemo only. Her heart rate is also high recently, about 110 at rest while at home. During the appt yesterday it was up to 123. How can we get my mom stable enough for the targeted therapy?

thank you!

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Hi Tom,

We should have my moms biopsy results back today or tomorrow (fingers crossed). Once the diagnosis is confirmed, they will send her biopsy tissue for molecular testing, as you mentioned. We need to get the swelling in her legs and her hear rate under control so that she's considered 'stable'. She is currently taking Cardizam 120mg once daily for her heart. We're going to see if this can be increased, but my only worry is that this is also causing her legs to swell (I read it's a side effect). Again, she never had any issues with her heart until this fiasco began about 5 weeks ago. The journey continues...

Sandy

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