Initial PET then "wait and see"

Portal Forums Lung/Thoracic Cancer Work-Up/Staging of Lung Cancer Initial PET then "wait and see"

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January 17, 2018 at 7:07 pm  #1293810    
onmyownisland
onmyownisland

My pulmonologist ordered a PET Scan because of 12mm and 8mm nodules that showed on a CAT scan.
He then called and said “PET came back im going to get things together to do a ct guided biopsy ” the next day calls back and said he has decided to wait and do another ct scan in 3 months. The “wait and see” aporoach. Said it could just be an infection or fungus. Ok so I asked are you going to do any type of blood test or proactive treatment while we “wait and see”? His answer was no.
This seems negligent to me. Even with my symptoms of losing weight, and exhaustion. Im waking up short of breath and my extremities tingling. My over all health is not well.
Im at a loss. Im at the mercy of this doctor at The ohio state James Cancer Center.
I live in an old Farm house that I have been remodeling ..perhaps it could be histoplasmosis? And with all that uptook on my PET I am concerned it is spreading . Why would he wait without any bloodwork or treatment to allow such spreading ?
Here is my PET results
Please help
Study Result
Impression
IMPRESSION:
1. Hypermetabolic nodule in the posterior segment of the right lower lobe is
concerning for underlying malignant/metastatic process. However atypical
infectious/inflammatory processes cannot be entirely excluded. Correlation
with direct tissue sampling may be diagnostic. Additional lower lobe nodules
are visualized and continued close attention on follow-up imaging is
recommended.
2. Hypermetabolic subcarinal and bilateral hilar lymph nodes are also
concerning for possible malignant/metastatic involvement but atypical
inflammatory/infectious etiologies are not excluded. Again, direct tissue
sampling may be diagnostic. Indeterminant small mildly FDG avid lymph nodes in
the abdomen and pelvis as noted above. Continued close attention on follow-up
imaging is recommended.

I personally viewed and interpreted these images and I have reviewed and
approved this report.

Electronically Signed By: Chadwick Wright, MD, PhD on 1/5/2018 3

January 17, 2018 at 7:08 pm  #1293811    
onmyownisland
onmyownisland

Narrative

EXAM: NUC PET PULMONARY, 01/05/2018 14:07 PM

CLINICAL INDICATIONS: 43-year-old woman with right lung nodules. The study is
requested for the detection of possible occult malignancy and initial staging.

Initial treatment strategy.

COMPARISON: No prior PET/CT studies are available for comparison. 

CT DOSE:
DLP: 632 mGy x cm 
kVp: 120 

TECHNIQUE: The patient’s fasting blood glucose was 73 mg/dl. Approximately 66
minutes following the injection of 12.1 mCi of F-18 FDG, the patient was
positioned on the Siemens Biograph mCT TOF< PET/CT-64, James Cancer Center
imaging unit. A low resolution non-contrast CT was obtained from the top of
the head through the proximal thighs for use in attenuation correction and
anatomic correlation. PET emission scans of this anatomic region were
acquired shortly thereafter. Axial, sagittal, coronal and maximal intensity
projection reconstruction images were presented for interpretation. Oral
contrast was administered.

FINDINGS: 

Focal radiotracer extravasation is identified within the left antecubital
fossa region which corresponds with the site of intravenous radiotracer
administration.

Head/Neck: Normal, intense physiologic uptake is noted in the cerebral cortex
gray matter and subcortical nuclei without gross hypermetabolic abnormality.
Physiologic FDG uptake is noted in the salivary glands. Symmetric
hypermetabolic activity visualized in the tonsils. Small bilateral
submandibular lymph nodes with minimal FDG activity, presumed reactive. There
is no hypermetabolic supraclavicular lymphadenopathy. 

Diffuse increased FDG uptake observed in the thyroid, likely related to
thyroiditis. 

Chest: Mildly hypermetabolic nodule visualized in the posterior segment of the
right lower lobe, with maximum SUV of 3.2. Another nodule with very minimal
FDG uptake also noted in the superior segment of the right lower lobe.
Subcentimeter nodule visualized in the left lower lobe, too small to
characterize by PET. Hypermetabolic subcarina

January 18, 2018 at 2:44 pm  #1293822    
catdander forum moderator
catdander forum moderator

onmyownisland,

Hello and welcome to Grace. I’m sorry you’re having this scare and I hope it will end soon. We aren’t able to read and interpret labs or scans. If I understand correctly you were seen at a cancer center. If so it makes since the doctor wants to wait and see what happens with the nodules before doing a lung biopsy since they treat cancer not infection and a lung biopsy is not without it’s risks. FDG uptake of 3.2 is well within the range of what you’d expect to see in an infection. A pathologist who reads scans and writes the report include everything they see and often make suggestions about what something is or what could be done about it but they don’t have the expertise to make that determination in part because they never see the patient as a whole.

A pulmonologist would be an appropriate doctor to see about possible infection and have specialized knowledge about taking a wait and see approach or trying some sort of treatment.

I hope you are well soon.
All best,
Janine

January 18, 2018 at 3:54 pm  #1293823    
onmyownisland
onmyownisland

Thank you for your comment. I am still processing all the information. Trying to look at it in a medical point of view rather than emotional. It can be difficult when my health is declining. Most days are spent resting because of exhaustion, nausea and pain. Cooking my family a meal and taking care of my home is an accomplishment not easily done. I am learning to accept that the energy and health I do have is a precious blessing. However sitting back and not doing anything when something can be done to better my health is not ok with me or my family. If this is a fungus growth .. lets fix it. I have read some of the possible infections or fungus that it could be. Some of these could be eliminated with testing/blood cultures while we wait and see.

January 18, 2018 at 6:00 pm  #1293825    
catdander forum moderator
catdander forum moderator

I certainly agree with you. A cancer center isn’t the place to get a non cancer issue resolved that’s why I suggested a pulmonologist. I hope you get your health back soon. The older I get the long it takes to recoup.

January 18, 2018 at 7:16 pm  #1293828    
onmyownisland
onmyownisland

This is a pulmonologist that I am seeing. He is the person who is “waiting to see” without the blood work .

January 19, 2018 at 12:15 pm  #1293836    
catdander forum moderator
catdander forum moderator

Ok, I misunderstood. Grace isn’t equipped to cover diagnosis issues, our focus is on cancer that has already been diagnosed. But as a person talking to a person who is worried about getting the right healthcare, I’d try to talk to the doctor again about why the wait and see instead of more workup to find out if there is infection that needs immediate treatment. He can at least explain the decision making process for this approach. My guess is he will tell you that the findings are possible infection small enough to take care of itself which will show up in your next scan. That the risks involved in further work up procedures outweigh the benefits and blood work won’t show anything more that the possibility of infection. But I really don’t know. A second opinion at another facility or blood work from your primary care doc may help put your mind at ease.

I hope you are feeling better soon.
All best,
Janine

January 22, 2018 at 9:45 pm  #1293857    
onmyownisland
onmyownisland

Thank you again for your reply.
Im asking others what blood work was preformed when there is a question of caner or infection for them?

  • This reply was modified 6 months, 3 weeks ago by onmyownisland onmyownisland.
  • This reply was modified 6 months, 3 weeks ago by onmyownisland onmyownisland.
January 23, 2018 at 7:47 am  #1293862    
JimC Forum Moderator
JimC Forum Moderator

Hi onmyownisland,

A complete blood count (CBC) is the standard blood test to check for the presence of infection. A blood culture may help identify the specific infection. If at some point there is a biopsy, then the tissue collected can be cultured to identify the infection.

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

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