Adenocarcinoma 3b PET scan help

[Salem]

My dad got back the pet scan result and was diagnosed with 3b adenocarcinoma. Can someone help me understand what this is saying? Is having an SUV this hig bad?

 

FINDINGS:
No FDG avid cervical soft tissue mass or lymph nodes are present.
FDG avid mediastinal adenopathy is demonstrated. Right paratracheal deposit measuring up to 2.9 cm has an SUV max of 18.6
Pretracheal and prevascular deposits measuring up to 2.5 cm with an SUV max of 20.1 are present. FDG avid subcarinal
deposit measuring approximately 4.4 cm with an SUV max of 17.8 is demonstrated. No FDG avid hilar lymph nodes are present.
No FDG avid supraclavicular, axillary, internal mammary or cardiophrenic lymph nodes are present. A small pericardial effusion
is present. No pleural effusion is present.
No FDG avid pulmonary nodule or mass is demonstrated.
Physiologic uptake is demonstrated within the abdominopelvic organs. No FDG avid abdominopelvic adenopathy is present. No
FDG avid body wall lesion is present.
No worrisome FDG avid osseous lesion is demonstrated.
IMPRESSION:
The previously described mediastinal adenopathy has progressed. The lymph nodes are intensely FDG avid typical of malignant
tissue. No definite FDG avid pulmonary mass is present. The mass within the paraesophageal/paratracheal location may be
pulmonary/pleural in origin or represent enlarging lymph node. No FDG avid tissue is present outside of the thorax.

 

[Tom Galli]

Salem,

Is having an SUV this high bad? Yes. Normally, any SUV over 4 is presumed to be metastatic cancer. Your dad's report indicates 3 nodules (2.9, 2.5, and 4.4 cm) with SUVs well above 4. Moreover, the IMPRESSION paragraph indicates the previously described mediastinal adenopathy (swollen lymph node) has progressed. That means a previous scan likely described swollen lymph node or nodes in the mediastinal area and this PET scan indicates the same node or nodes have become further enlarged. This enlargement also points to metastatic cancer.

The PET speaks to finding metastatic disease in the mediastinal region (the area between the lungs containing the heart, trachea and esophagus). Also noted is a small pericardial effusion but that did not yield SUV. SUV means standard uptake value. It is a measurement index that represents the rate of metabolic activity of the body's cells.

Normal metabolic activity yields a SUV of between say 2 and 2.5. From 2.5 to less than 4, the activity may be metastatic or could be explained by an another cause--perhaps inflammation from an infection. SUVs above 4 point to cells containing metastatic cancer. The report uses the term "FDG avid." FDG means fluorodeoxyglucose. This is the very slightly radioactive tagged glucose that was infused into your dad shortly before the test. Avid, in a medical sense, means tissue having an affinity for glucose. Since cancer cells have a metabolic rate far higher than normal cells, they seek glucose. When one fasts before the test and when glucose is introduced intravenously, the cancer cells demand more than normal cells. This concentration of FDG avid cells makes a radioactive tag that is captured by the scan. The scan depicts high SUV as bright spots and the magnitude of brightness is what is measured and reported as a SUV. Radiologists use the unofficial term--light up-- to indicate where SUV is high.

Strangely, there is nothing affected but mediastinal lymph nodes. The test did not show nodules, lesions or a mass in the lungs, other lymph nodes in the chest, or any abdominopelvic (stomach, liver, intestines, and other) organs. The cervical area is also clear. I recall your April post reporting the biopsy of 2 lymph nodes reporting as adenocarcinoma. 

So, in summary, your dad has metastatic non small cell adenocarcinoma lung cancer in three identified areas of his body. I hope this explanation helps. I'm sorry I had to give it.

Stay the course.

Tom

 

[Salem]

Hi @Tom Galli
 

Thank you for the explanation I couldn’t have asked for any more. 
 

We have come to terms with the diagnosis and the doctor said he is hopeful as they are going for a curative treatment of chemo radiation for 6 weeks. 
 

When you say metastatic does that apply to stage 3b as well? The doctor told us it is 3b after this PET scan was done. I noticed some people use metastatic to describe stage 3 but mostly stage 4 on the forum.

[Tom Galli]

Salem,

The term metastatic means your dad's body has multiple areas of cancer. Here is the Wikipedia definition. So yes, Stage IIIB means your dad has cancer that has spread (metastasized) to regional (mediastinal) lymph nodes. But, as I read the report, your dad's cancer is unusual in that a "primary tumor" (the first or initial tumor) was not found or identified in a lung. While unusual, it happens infrequently.

Staging cancer is a one-time event--at diagnosis. The stage is used to indicate or delineate if surgery or cyber surgery (radio surgery) can safely be performed. Since your dad has 3 lymph nodes involved, cancer cells are presumed to be within his lymphatic system. Therefore, surgical removal would not help because a tumor would very likely occur in some other place after surgery. Your dad's chemo radiation is a first line standard of care in the US and Canada. Hopefully, he is "one and done."

Stay the course.

Tom

 

[Salem]

Hi @Tom Galli,

Definitely unusual considering he has been getting ct scans for empheyma twice a year for the last 10 years. Thought that if this was ever happened it would be found earlier but lymph nodes were normal on the scan in august so I assume it’s aggressive. 
 

Thank you for all the information it is a huge aid in understanding what we are dealing with.

 

best,

salem

[hillham]

Salem, I was also diagnosed 3b, and similar to your dad, there was no primary tumor found/identified in the lung. I've always been confused about that, but I guess it happens. I also had chemo/radiation for 6 weeks.  It's been a little over a year and all my scans have been clear so far. Good luck to him!