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What do you think this might mean?


jack14

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I had a CT scan done on the 18th after four rounds of Keytruda for Stage four NSCLC. It was compared to a CT scan that was done in July. 

The primary site, a right lung nodule, has remained stable at 9mm in size. The left subpectoral lymph node is slightly larger at 1.8 cm (from 1.4 cm). The left supraclavicular node has went from 1.0 cm to "Asymmetric nodular soft tissue in the left supraclavicular region, extending into the high left subpectoral region, appears more prominent than on 07/30/2020". 

My CA 19-9 marker has been dropping from 76 originally to 54 when this CT scan was done, and all labs are unremarkable. My Oncologist has advised that we continue this line of treatment, I agreed and had my 11th infusion.

Anyway, I just accessed my report through the portal and  I was wondering what the radiologist means regarding the supraclavicular change from a 1.0 cm lymph node to "Asymmetric nodular soft tissue in the left supraclavicular region, extending into the high left subpectoral region"?

PS I am hoping that maybe the enlarged node is pseudo-progression and the other one has dissolved and left an area of inflammation?

Thank you

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Hi Jack: If it were me I will call the oncologist and ask for an explanation in plain English. I discovered that an oncologist and radiologist do not necessarily interpret the CT scan  the same way. As a matter of fact I am having a similar situation to yours and on Monday I am calling my oncologist.

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Well, my Onc was trying to pull up my previous CT scan on the computer in the exam room to see for herself, but it wouldn't come up. She said that the IT people had been working on the system and had apparently not fixed it. I have copies of the scans myself and might look at them. I have learned something about them during the ten years I have been getting them. A dozen for an abdominal aneurysm as well as a few for renal stones. And now for cancer....sigh I should be glowing, I bet I have had a couple dozen all told.

Thanks, I will see the PA in three weeks and my wonderful Onc again three weeks after that. I don't bother them unless it is really necessary because they are overloaded. There are only two Oncologists in the Center. I asked the tech that did my CT at four pm if they had done many scans that day and he said fifty two! I said wow, and he said we did 85 the other day.

Too much cancer going around these days....

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Agree with Gary - scan results seem to be very subjective, especially when multiple radiologists are involved.  For instance, I had one when I was hospitalized at the end of September that sounded like significant improvement;  next one on Oct 19 would have been concerning as it described increases in size of primary tumor, etc.  BUT when you looked back at the ones before the hospitalization, all the measurements were the same, so no growth after all.  They only compare to previous, whereas your onc looks at the overall picture.  
Susan

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  • 4 weeks later...
On 12/19/2020 at 6:36 PM, Sabacat said:

Hey Jack, did you ever get an explanation of the changed language on your CT report?

Susan

Hi Susan

No, I haven't seen my Onc yet to ask if she can review thosed images with me. I met with the PA last time I had my infusion and she isn't as up on reading those scans so i decided to wait until I see the Dr. That will be next Friday. I will let you know what she says if you are still interested.

Sorry I took so long to reply, but I just saw your question a few minutes ago. I also saw your issue with the ortho and rad in regards to the clavicle fracture. All I can say is, heaven help us all. I suspect that things are likely going to worsen as more and more burdens are put on the healthcare system.This covid business as well as the influx of immigrants with health issues....

Sure hope that we are all able to stay on top of things.

Jack

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On 12/25/2020 at 1:10 AM, jack14 said:

Hi Susan

No, I haven't seen my Onc yet to ask if she can review thosed images with me. I met with the PA last time I had my infusion and she isn't as up on reading those scans so i decided to wait until I see the Dr. That will be next Friday. I will let you know what she says if you are still interested.

Sorry I took so long to reply, but I just saw your question a few minutes ago. I also saw your issue with the ortho and rad in regards to the clavicle fracture. All I can say is, heaven help us all. I suspect that things are likely going to worsen as more and more burdens are put on the healthcare system.This covid business as well as the influx of immigrants with health issues....

Sure hope that we are all able to stay on top of things.

Jack

Update! They had me scheduled today instead of Friday because of the holiday. Anyway, it was my PA again, as the Dr was taking the other Oncs patients for him as he was out.  So, I asked her if the Dr had remembered to check on the disparity of the CT radiologists in my last scan. She went out of the room to see if the Dr had noted it in her notes and returned shortly, and said, that "the mass" appeared to a bit larger maybe 1.4 to 1.8, but all else was stable and no metastises, so we are staying the course. 

PS excuse me for not being more pithy

 

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Hi Jack: It seems that your Oncologist is not concerned about the mass growth and maybe he is waiting for the next scan to make a decision. I wonder what parameters they use for 'Stable'.  I guess we will find out. In any event I am glad things are not as bad as feared so enjoy the new year and hopefully 2021 will be a better one for all of us.

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On 12/31/2020 at 6:12 AM, GaryG said:

Hi Jack: It seems that your Oncologist is not concerned about the mass growth and maybe he is waiting for the next scan to make a decision. I wonder what parameters they use for 'Stable'.  I guess we will find out. In any event I am glad things are not as bad as feared so enjoy the new year and hopefully 2021 will be a better one for all of us.

 

Hi Gary

I didn't have the opportunity to discuss it with the Oncologist, who I was originally scheduled to see. Anyway, the PA went and read the Oncs notes after I asked her if the Onc had reviewed the scan herself and clarified what was stated. I hope it's not really an increase in growth, but a difference in opinion between the two radiologists,  But, if it is, I am hoping, of course, that it is pseudo-progression. I am also  hoping that the PA is just repeating what the radiologist said, which was somewhat ambiguous, or supposed, ("Asymmetric nodular soft tissue in the left supraclavicular region, extending into the high left subpectoral region, appears more prominent than on 07/30/2020") . "Appears" implies some doubt IMO.

The fact that all else is stable, meaning that there hasn't been an increase in the size of the primary site on the right lung apex nor in the other lymph node on the right and no new sites (metastisis), is encouraging, and I agree, in waiting for the next scan, before going chemo. I believe I have another round to go before the next scan which will be on the 25th of January. I appreciate any prayers.

jack

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Say, has anyone ever heard of Keytruda shrinking a tumor after an administration, and then a bit of growth after another admin and then stasis or more shrinkage? In other words, can immunotherapy work intermittently?

 

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My CA-19 marker came in from the labs the other day. It is down to 49. I think that is a good sign. It started at 76 back in April.

CA 19-9 cancer marker Record:

Dec 30, 2020
49 U/mL 
0-35 U/mL    H

Nov 20, 2020
54 U/mL 
0-35 U/mL    H    

Oct 09, 2020
60 U/mL 
0-35 U/mL    H    

Jul 13, 2020
59 U/mL 
0-35 U/mL    H    

Apr 06, 2020
76 U/mL 
0-35 U/mL    H








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