Upcoming (3) month interval scan - 1262632

dkm5859
Posts:89

We have been blessed and or simply lucky so far and I hope we every fiber of my being that it continues for my Mom. She had it very rough near the end and after her treatment plan and is still recovering but her scans so far have been very good accoding to her doctors. She might be able to go to six month scan periods. She had/has Stage 3A adeno...the scan is this Monday. I hope all of you are well, will be and or stay well. Please take care and God Bless!!

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Reply # - March 12, 2014, 03:28 PM

dkm5859
Posts: 89

Hello to everyone. I just want to say thanks again to everyone who has helped me/my family out over the past year or so with my Mom's health 'situation' as I sometimes call it. She/we received really good news this past Monday as apparently she has no signs of recurrence and her lungs are continuing to heal after her agressive tri modality approach for Stage 3A adeno. It was a tough road..not one I wish on anyone as most of you know. I do not think I could do it but I guess when presented with no real good/known alternatives one must choose to try these types of cancer treatments.
I can't express how happy I /we are and I also sincerely hope that everyone or at the very least as many people as possible can achieve this status and hopefully keep it.
She does need to go back for a 3 month CT scan per the radiologist's request but not the oncologist..as her oncologist wanted her to go to six month intervals....more of a long term follow-up approach.
Does anyone know why this might be...why might the radioloigist had preferred to stay with another 3 month scan as opposed to moving to a six month interval? Was it likely... a doctor's personal opinion or would most radiologists prefer 3 month scans for a longer duration?
Anyway...I wish all of you, your loved ones and friends the best and hope all of you are in, will become and or will remain in good health. Take care and God bless!

Reply # - March 12, 2014, 03:49 PM

Dr West
Posts: 4735

As I just recounted on another very recent thread, the issue is that there is no evidence or official guidance of the right interval for follow up. Doctors are left to their own best judgment, and there is no clear right or wrong answer, so you end up with a lot of variability as people just make their own guestimate of how to best proceed.

That's not a great answer, but it's the honest one. It's a bit like the question "My medical oncologist's favorite color is blue, but my radiation oncologist says his is red. Who's right, and why don't they agree?". In the absence of actual data to say what people should do, it's all just personal preference/voodoo.

-Dr. West

Reply # - March 13, 2014, 09:29 AM

dkm5859
Posts: 89

Thank you very much, Dr. West for your time. I was wondering if you might have some insight into my following question as it it relates to the CT interval question but then again maybe not given my layman's knowledge level ...why has her last few CT chest scans been done without IV contrast? Is this standard level of care or does too much IV contrast possibly have health risks both short and long term?
Also do interval CT's used as diagnostic/monitoring tools when not using IV contrast provide adequate enough detail for tracing/detecting potential recurrence/metasis(es)? So...should interval CT's be used with contrast or is this also just depend upon a doctor's opinion? Thank you very much in advance.

Reply # - March 13, 2014, 12:11 PM

catdander
Posts:

To a similar questions Dr. Pinder stated, "It depends. If I think the kidney function is elevated because of dehydration, I will usually hydrate the patient, repeat the creatinine and proceed if safe. I also have many patients with chronic kidney problems where the issue is not hydration. In these patients, I usually follow them with non-contrast CTs. A non-contrast CT usually provides sufficient information to make decisions about therapy." http://cancergrace.org/forums/index.php?topic=6666.0

Dr. West added, " I agree that CT scans with contrast are often ideal but not necessarily necessary, especially to follow disease that you've already identified. Chest lesions are often perfectly manageable to follow without contrast. Liver lesions are often easier to follow with contrast, but you can generally get a decent sense of things from a non-contrast CT, or else you could potentially do a PET/CT to get more information without contrast -- though I generally follow metastatic disease with conventional CT scans and not PET scans.

"Of course, as Dr. Pinder said, if the renal function is more reversible, adding hydration and time to improve it is the easiest option.

"Overall, though, I can't recall having a patient in whom I just didn't think I could adequately assess the extent of disease because of a lack of ability to give contrast."

I'm so glad to hear your mom is doing so well and hope she continues to do so.

Janine

Reply # - March 13, 2014, 12:24 PM

catdander
Posts:

dkm, I know you've been on and off again here on Grace so I wanted to remind you that many even most of the questions members have have already been addressed and often many times over. Also we want to keep our faculty fresh, including Dr. West, by not asking them the same questions over and over. For those reasons we ask that members do a search before asking. Note that it may be necessary to log off before using our search function, it depends on what type of browser is on your computer. Or you can use google and start the search, site:cancergrace.org ... example would be, site:cancergrace.org ct with without contrast I learned that from another forum and works beautifully and you wouldn't need to log on and off Grace if you aren't using the magically right browser. Note how I've used spacing.

Please don't hesitate to ask questions and certainly don't take this post as anything but helping improve the site.

Much good luck with your mom moving forward,
Janine

Reply # - March 13, 2014, 02:00 PM

Dr West
Posts: 4735

I would soften my prior comments about the value of contrast in this setting and underscore again that the most accurate answer is that there is really no evidence to say what should be done. Specifically , my own perspective has been evolving as low-dose, non-contrast chest CT scans have become more readily available. Thinking about the rationale for vs. against contrast, I'm moving toward preferring a low-dose, non-contrast chest CT for longer follow-up. It doesn't give the same exact level of precision in evaluating lymph nodes, but it really provides a great amount of information with minimal radiation or risk to the kidneys. In a situation in which we have no evidence at all to say that one type of CT is preferable to another, or even that CT scans improve outcomes at all, I consider a non-contrast chest CT as a very informative tool that is likely to be perfectly good for the job of doing longitudinal surveillance, especially as we recognize that there are potential dangers from overly aggressive scanning.

Good luck.

-Dr. West

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