whole body PET scan - 1262615

gigy
Posts:27

i ask my Onc to order a whole body pet scan to confirm some suspicions and to check into details. He said it is good enough to scan from scalp to knee. NSCLC usually do not go below knee. but i would like to have a whole body scan. Any benefit? is it necessary to have a whole body?
Thanks.
Gigy
Adenocarcinoma 2 years ago, suspicion of spread to adrenal gland and vicinity.

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Reply # - March 5, 2014, 02:22 PM

JimC
Posts: 2753

There wouldn't really be much value in scanning any greater an area than that suggested by your oncologist. NSCLC doesn't often spread below the knee, and in general bone mets are not treated unless they are causing pain or threatening the structural stability of a bone.

As Dr. Pinder has said:

"It is VERY unusual to see metastases in lung cancer below the knee or elbow. However, I recently had a patient with a biopsy-proven metastasis to his ankle. Still, it is so unusual that the value of scanning all patients in these areas is questionable." - http://cancergrace.org/forums/index.php?topic=6576.msg46134#msg46134

Good luck with the results of your scan.

JimC
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Reply # - March 5, 2014, 02:39 PM

Dr West
Posts: 4735

It's so unusual that I don't think that's really necessary and really wouldn't consider it appropriate based on a 1 in 1000 or 1 in 10000 possibility, especially in the absence of something to suggest cancer beyond the areas that will be well covered by a PET scan, which is already a conservative test that casts a very wide net. If you have some findings highly suggestive of/worrisome for cancer below the knee, that's different, though an MRI would probably be the right test for some unusual finding in an extremity. Otherwise, I think it's more likely that a whole body PET scan would identify an unrelated and irrelevant area of inflammation as a question, rather than finding something you're really looking for.

-Dr. West

Reply # - March 7, 2014, 07:06 PM

gigy
Posts: 27

Had a PET done today, from eye to mid thigh.
The outcome is worse than i expected, it has gone to:

upper left lung (i only have one lobe) 6mm nodule
Left Hilar region lymph node 2.2 cm
Adrenal gland 2.4x3
Left periaortic region 6mm
Sclerosis in right scapular, highly suspicious

My Onc order EGFR to decide how to treat, in the mean time, suggested to radiate the scapular area to
minimize pain.
I have cancelled the biopsy set for next week, i don't think it will do any help.

i think i am at the group of high risk, i was only clear for 18 months. It was a great time in my life.
during the 18 months, i have 3 CT scan but NO PET done, is it normal?
May be i can find out early if at least have it done on a yearly basis. Any comments?
Thank you for your time.
Gigy

Reply # - March 8, 2014, 05:46 AM

JimC
Posts: 2753

Hi Gigy,

I'm sorry to hear about the finding from your PET scan. As far as whether you should have had a PET scan earlier rather than CTs, many oncologists favor followup with CT. As Dr. West has said in his post on the use of PET scans for surveillance:

"Chest CT scans provide a lot of detail, so if there isn’t anything suspicious that has emerged from one CT to the next, I’m quite reassured that anything you might find on a PET scan would have a high chance of being a false positive." - http://cancergrace.org/lung/2007/11/03/pet-scans-for-surveillance/

In addition, it seems that much of what showed up on your PET scan would have appeared on a chest CT as well. The faculty here have often said that discovered new metastases a few months earlier does not lead to better outcomes. As Dr. West said in the same post:

"The concept that PET scans will improve our ability to detect curable recurrences or new cancers hasn’t yet been supported by any evidence of better survival or quality of life in patients."

JimC
Forum moderator

Reply # - March 8, 2014, 03:18 PM

Dr West
Posts: 4735

I'm sorry to hear of your recurrence.

Jim is exactly right. The current standard of care after surgery is CT scans, and there is no evidence that people do any better getting PET scans. Over time, the movement is only away from doing PET scans of remarkably greater expense but no demonstrated benefit for surveillance after initial staging. That includes yearly surveillance. There is no evidence that people do better with ongoing PET scans vs. CT scans, and there is a growing consensus among experts that PET scans are over-ordered, largely due to financial incentives.

Good luck with subsequent treatment.

-Dr. West

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