Comparing two scans?

Portal Forums Radiation Oncology General Radiation Oncology Comparing two scans?

This topic contains 4 replies, has 3 voices, and was last updated by Dr West Dr West 3 years, 3 months ago.

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July 31, 2014 at 1:09 pm  #1265200    

skyrain30

My mom has 3b squamous lung cancer. Unresectable. She did 6 weeks of radiation and 2 rounds of cisplatin but was unable to finish the second round do to severe confusion. After 6 weeks she had a ct which her oncologist said was inconclusive due to Scarring and patchy ground glass. PET scan done in March before treatment showed tumor 4x5x6 with left hilar and adenopathy 3.6 The only measurement on the new scan says there is an air filled ovoid cavity measuring 3 cm transverse in mid left thorax either in the oblique fissure or adjacent peripheral lung. Obviously there was a whole lot of other info but I am wondering if that second “air filled ovoid” is either of the tumors mentioned in the first scan or something different. Also what does peripheral lung mean. The original tumor was in left lung, does that mean the right?

With this info her oncologist has recommended another two rounds of carboplatin and rescan in 3 months.

July 31, 2014 at 3:34 pm  #1265202    
JimC Forum Moderator
JimC Forum Moderator

Hi skyrain30,

Welcome to GRACE. Without seeing and comparing the two scans, it’s hard to say whether this air-filled ovoid is what is left of one of the tumors, but there are some clues. First, I would think that if it was a new finding your doctor would have identified it as progression and possibly suggested a change of treatment. Second, being air-filled indicates a lower concentration of cells than a solid nodule. You can read Dr. West’s discussion of the imaging features of nodules here: http://cancergrace.org/lung/2007/11/10/risk-of-ca-among-spns/

“Peripheral” in this context just means that it is near the edge of the lung, not that it’s in the other (right) lung.

You may want to get clarification from your mom’s doctor, but all in all it seems like a good report after radiation and two rounds of chemo. Four cycles is pretty standard if the scan after two rounds shows that the chemo has been effective, so it appears that your doctor feels that she’s on the right track.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 31, 2014 at 4:11 pm  #1265204    

skyrain30

Thank you for your quick response. I did ask her doctor these things but he just told me it was really hard to tell. He said the GGO’s could be new or could be the old tumor. I didn’t really get the impression that the air filled ovoid was the only thing there just the only measurable thing. We had been anxiously waiting for this scan hoping it could definitively tell us that yes she had responded well or no she had not but we just didn’t get that info. I guess we will try to be patient for another few months.

July 31, 2014 at 8:32 pm  #1265205    
JimC Forum Moderator
JimC Forum Moderator

Unfortunately that is the problem with scans soon after radiation…the scarring can make it just impossible to judge the effect of the treatment. The thought I didn’t express too well is that I would think that if what is seen on the scan is something in a completely different area of the lung than what had been seen before, then your doctor would be describing it as progression.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 31, 2014 at 10:59 pm  #1265209    
Dr West
Dr West

Not much to add. After chemo and radiation, we often see a complete mess in the area that is essentially uninterpretable without the assistance of seeing how it changes over time. These changes can absolutely be the detritus that remains after all of the scarring from treatment, but cancer can also look that way. You can do biopsy after biopsy looking for something if you’re impatient, but most experienced oncologists favor watching for long enough to get a better signal of whether things are getting better, remain stable, or are getting worse over time before intervening. Even if things are completely abnormal, if they’re stable or improving a year or more after chemo and radiation are done, you become increasingly hopeful about the prognosis.

In the first few months after chemo/radiation, it’s most often a pretty much uninterpretable mess initially.

-Dr. West

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