Hi,
My father was recently diagnosed with cancer of unknown primary. We have had second opinion at University of Washington and both were in agreement. Two strong contenders are esophageal and lung. Both agree to treat like lung. His tumor is in his mediastinal lymph nodes and is 9cm. It is pressing on all of the main organs in his chest, especially his esophagus. He has a feeding tube as swallowing food is a challenge. His cancer is adenocarcinoma NSCLC. We thought cancer was only in the tumor. If I recall correctly the pet scan uptake for the tumor was 47 which they said was very high.
My stepmother told my father' s oncologist to make sure not to be doom or gloom or my dad would wallow. He did mention that another area lit up but did not make a big deal about it. The second opinion made a bigger deal of it, but also said it does not change the treatment plan. Everything with my dad's cancer seems to be unusual. My question is how common is it for a pet scan to light up, but CT shows no mass? The area that lit up is his right adrenal gland. I understand since there is no mass that you can not do radiation. I assume that they are hoping the chemo will kill those cancer cells. He is in his 4th week of chemo and 2nd week of radiation. I believe he is scheduled for around 8 weeks of chemo and 7 weeks of radiation. Originally doc said my dad was 3a, but if the pet scan also lit up his adrenal gland does that make him really a 4? Thanks for answering my questions.
Amanda
Reply # - July 12, 2013, 10:24 PM
Reply To: Pet scan shows cancer, but no mass
Hi Amanda,
I'm very sorry to hear of your father's diagnosis. In order to use radiation, there must be a target, and if nothing is showing up on the scan the radiation can't be directed at a target. In addition, with advanced lung cancer, radiation is not typically used to treat the cancer except to relieve symptoms or the kind of problem your father is having, in which the tumor is pressing on vital organs and that pressure must be relieved.
I'm sorry to say that if the cancer has spread to the adrenal gland then it is stage IV cancer.
I hope the chemo and radiation and very effective for him.
JImC
Forum moderator
Reply # - July 13, 2013, 06:29 AM
Reply To: Pet scan shows cancer, but no mass
I completely agree with Jim. Unfortunately, I think there's reason to be concerned that any adrenal lesion that lights up on PET actually represents cancer and would make this stage IV disease. Even if it's metastatic cancer, radiation is appropriate to shrink a bulky cancer causing compressive symptoms, so I agree it makes sense to pursue it whether the cancer is metastatic or not.
It is uncommon to not be able to see a clear primary tumor, but it happens in a minority of patients.
I think it's always difficult to have an honest discussion about what to expect or make a truly informed decision when the expectation is that a doctor can't be straightforward in discussing potentially challenging information.
-Dr. West