If a CT report suddenly omits something…?

Portal Forums Cancer Basics Imaging Issues If a CT report suddenly omits something…?

This topic contains 2 replies, has 2 voices, and was last updated by  huckstep 3 years, 1 month ago.

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May 30, 2015 at 9:49 am  #1270011    


If a CT report suddenly omits mentioning a tumor that’s been noted in the previous bimonthly CT scans for 10 months, would you assume the radiologist just overlooked it, or that it’s no longer visible?

That’s what my oncologist and I are having a friendly disagreement about. He said he would get it re-read, but it’s been a week with no word, and I’m dying of curiosity (as well as cancer). :wink:

In brief, I have ALK+ lung cancer, with a main tumor that started at over 4 cm last summer, was reduced to 2.8 cm by radiation, then has been creeping down approximately 0.2 cm every two months thanks to Xalkori, until it was 2.0 cm on the last CT scan two months ago.

The latest CT scan was taken at the same hospital, and the radiologist noted he was comparing this scan to the last. He didn’t mention the tumor at all this time.

My oncologist says that means it’s “stable,” which I take to mean it’s still at 2.0 cm, which means the Xalkori may no longer be reducing it… not-so-good news as immunity looms. I asked him how he knew the size, and he couldn’t say.

Maybe I’m over-trusting the radiologist, but I took the report to mean the tumor has suddenly shrunk below a detectible size and the Xalkori is actually working overtime. Quite a difference.

Which would be a more typical assumption, or any general comments on the situation? Thanks!

May 30, 2015 at 10:47 am  #1270012    
JimC Forum Moderator
JimC Forum Moderator

Hi huckstep,

It’s unusual for a radiologist to omit mention of what happened to a 2 cm nodule, so I’m thinking it may be an oversight not in the reading of the scan but in the writing or transcription of the report. Given the pace of shrinkage, I would think it unlikely (but certainly not impossible) that the nodule disappeared from view, since very small nodules can be imaged. I would continue to press for a re-reading or review of the report by the radiologist.

If the answer is that the tumor is stable, I would not assume that it is immediately necessary to change treatment. Often patients on targeted therapies have an initial period of shrinkage followed by a more extended period of stability. That is a good result in advanced lung cancer, and it is good to get the maximum benefit from each agent used.

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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

June 2, 2015 at 9:12 am  #1270041    


Thanks for your reply. I still haven’t heard from my oncologist, but am continuing to bug him. :) I’ve got small, asymptomatic brain mets, so the continuing effectiveness of the Xalkori from the neck down may affect decisions on how to approach those, but I definitely don’t want to switch off the Xalkori too soon.

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