Radiologist vs Oncologist

Portal Forums Cancer Basics Imaging Issues Radiologist vs Oncologist

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

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October 13, 2015 at 2:41 pm  #1271459    

jshurt

Thanks so much for this forum to give we worriers a place to ask questions. So I’ll jump right in:

In Feb. 2014 I had a partial LUL lobectomy and was dx’d with adenocarcinoma. Surgery ‘cured’ the cancer and no other treatment was required. I’ve been having regular follow-up CTs, on 4-6 month intervals. The last one, last week, mentions a previously seen 1.3 cm spiculated nodule in my RLL, that has not changed in size. However, the radiologist recommends a PET scan for further evaluation.

My current Oncologist (new to me – my previous doctor moved to TX – but same office) has ignored the recommendation and has scheduled the next CT in 3 months. My concern is mostly about his ignoring the radiologist’s recommendation. Am I being unreasonable in questioning that and worrying needlessly? Thank you again for your response.

October 14, 2015 at 8:43 am  #1271460    
JimC Forum Moderator
JimC Forum Moderator

Hi Josie,

I think the differing answers you’re getting in part reflect that there is an art to medicine as well as the science; doctors can have equally valid approaches to the same situation. The fact that the nodule has not changed in size for at least 4-6 months (dating back at least to your previous scan, and perhaps further) is highly suggestive that it is not cancer. On the other hand, the spiculated nature of the nodule is a factor which can suggest cancer. Often such a small nodule is watched over time to see if it grows, and it sounds as though that has already been the plan since at least the previous scan.

I’d also mention that a radiologist specializes in reading and interpreting scans of many types, which can reveal a variety of medical conditions, while an oncologist focuses on cancer. Also, a radiologist has access to your previous scans, but not does not see your full medical record, while your oncologist looks at all your results and history.

In addition, though a PET scan might provide additional information about how active that nodule may be, one scan won’t necessarily give you the answer, especially if the SUV from the nodule is relatively low.

Finally, a three month interval between scans is pretty short (although I understand it may not seem that way to you), but enough time to see growth, if any. Anything shorter may have everyone squinting at the scan images to try to detect a change.

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

October 14, 2015 at 1:31 pm  #1271463    

cards7up

If you’re concerned about this nodule, I’d suggest getting a second opinion from another oncologist. Were both of these sans done in the same place?
Take care, Judy
I am not a medical professional nor a moderator. I am a LC patient and survivor.


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

October 16, 2015 at 11:09 am  #1271491    

jshurt

Thank you, JimC and Judy for your replies. Because of them, I’ve decided to dial back the anxiety.

But to answer your question, Judy, yes, both scans were at the same facility. The only thing different was the Oncologist.

I would add, too, that I was also dx’d with CLL at the same time as the lung CA. I am symptomless from that. Some labs are changing but not enough so to suggest the need to treat yet. I have a family history of cancer, as well. I guess that when I lumped it all together, I panicked.

I can wait for the next CT scan, I think. But again, thank you for taking the time to reply.

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