CT scan results

This topic contains 5 replies, has 4 voices, and was last updated by  iza50 2 years, 3 months ago.

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June 7, 2012 at 1:23 pm  #11162    

iza50

Dear Doctors,
Please help me to understand:
1. Yesterday I had the follow up appointment with my surgeon (lobectomy April 19, 2011, clear X-rays and CT scan till now). This CT scan shows white smokey patches on my right lung. After I told the doctor that I had pneumonia in March he said it may be just this but he wants to repeat CT scan in 6 months. How worried should I be? Can white smokey patches signal recurrence or they are always indication of infection? On one hand my doctor said that cancer does not manifest this way but on the other hand he was worried. I don’t understand.
Thank you

June 7, 2012 at 7:58 pm  #11172    

Dr. Weiss

It sounds like the imaging was not specific for cancer, but also not normal. In these cases, the standard of care is to do serial imaging to makes sure that things get better, and not worse. In my practice, when I’m very concerned, I get the next scan much sooner than 6 months. So, if your surgeon is similar, hopefully that means that he/she isn’t terribly concerned. If you are unsure, you should ask how concerned he/she is. Alternatively, you could consider a second opinion with a good pulmonologist (lung doc).


Jared Weiss, MD
Lead Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or University of North Carolina. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

June 9, 2012 at 9:09 am  #11209    

iza50

Thank you Dr. Weiss. You and other doctors here are God sent here.
I still need some more of your expertise and experience.
Do you think it can be a cancer again? Can cancer look on CTscan like white smokey clouds/patches??? Why my doctor worried but at the same time said that the image on the scan is not how the cancer manifests itself. So what are we looking for? Cancer or infection?

I also have few other questions on my mind:
1.Is it the truth the cancer recurrence is the highest in second year after the treatment?
2. Is it possible to have clear CT scan and have distant metastases at the same time? Is it frequent to see distant recurrence to happen before local/regional? If it can happen, then what is the purpose of repeated x-rays and CT scans? They just show lungs right? Untill now I was under impression that “clean” scans were proof of remaining cancer free.
3. What is the rate of recurrence for my type of cancer: moderately differentiated adenocarcinoma?
Thank you Doctors for your time.
Izabela

June 9, 2012 at 9:47 am  #11211    

certain spring

hi iza50. I’m sorry you’re having this worry about your scan. I hope you are well recovered from the pneumonia.
On your question 1, Dr West wrote a post explaining that the farther you are out from surgery, the less the risk of recurrence:
http://cancergrace.org/lung/2011/08/19/when-do-recurrences-of-lung-cancer-happen-after-surgery/
On question 3, here is a post that deals with recurrence rates:
http://cancergrace.org/lung/2007/10/30/recurrence-and-new-cancers-after-curative-rx/
To make sure that GRACE does not take up too much of the doctors’ time, we ask people to limit the number of questions they ask in any one post, although you can of course come back for another go. You’ll find this in the forum guidelines (no. 6, right down at the bottom of the page):
http://cancergrace.org/grace-discussion-forums#guidelines
In your position, I would ask the oncologist directly why he is worried and what he might be looking out for. I would want to hear that from someone who can see the images on the scans.
Best wishes.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

June 9, 2012 at 4:50 pm  #11223    

Dr West

certain spring has helped provided some helpful information here, such as the time line for recurrence. We really can’t just give a number for a recurrence rate — it is a product of several factors, including the stage but also several variables beyond that that can help us provide a projection of that probability. Your own doctor is in a much better position to do that than we are.

It’s true that haziness (sometimes called consolidation) within the lungs isn’t a typical way for cancer to present — it often looks more solid, with more defined edges. However, some lung cancers, particularly bronchioloalveolar carcinoma (BAC), tends to appear as a hazy infiltrate on an x-ray or CT scan. That said, pneumonia also classically appears this way too.

It’s true that a lung cancer can recur in a distant location, but most commonly, the area covered by a CT scan, which includes not only the lungs but the adrenal glands, much of the liver, and many of the bones in the trunk, does a pretty good job as a high yield test. Additional scans increase radiation exposure and cost, but finding distant metastatic disease a month earlier by a surveillance scan as opposed to detecting the metastasis due to symptoms doesn’t increase the treatment options. Frankly, there isn’t a huge incentive to find metastatic disease a few weeks earlier or later, since we can’t say that earlier detection enables treatment with curative intent. In contrast, if we detect progression within the chest and no place else, it is sometimes still possible to treat for cure if the recurrence is to a very limited extent.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

June 9, 2012 at 5:33 pm  #11229    

iza50

Dr. West, Thank you very much for the response to my questions.

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