I just completed my 4th round of Gemzar a first line single agent for Stage IV Adeno with squamous features. I took a CT last week and just obtained the "Impression".
The overall finding was still "Stable". But the "Impression" concludes with something very worrisome and I have been unable to get an explanation. My onc is off till the 17th and the radiologists don' t like to talk to patientes. I know the CancerGrace oncs don't want to interpret CTS and PETS, but could they give me a general idea of what this means or implies? Nothing like this appeared on all my previous CATs and PET/CATS.
"Subtle lucencies suggested in the pelvis and sacrum, nonspecific. No obvious bony erosive change or cortical breakthrough is identified at the time. Clinical correlation recommended."
Reply # - October 4, 2012, 01:11 PM
Reply To: CT SCAN, what does this mean?
Hey Slimer,
The term nonspecific is just that; not specific to anything the radiologist has to offer. It could be many things depending on you specifically.
Clinical correlation means that your oncologist needs to determine what it means in relation to you and your cancer.
And lucencies refers to opaqueness in that area of the scan. So there must be a change in the density in the area. But what?
I'm afraid there isn't anything a doctor online can tell you that you're not already worried about. Meaning it could be something or it could be nothing, but not having all of your information including the scans to look at there just isn't anything to offer that the radiologist who read your scans couldn't.
Is there an oncologist in the group willing to go over this with you so you don't have to wait for specifics as it relates to your case? I would absolutely hate to have this wait. They should not have had you get that scan knowing there would be this wait. I would push for an onc in the group to have a look. But I'm not known as a bull dog to my husband's onc for nothing.
Janine
Reply # - October 4, 2012, 03:11 PM
Reply To: CT SCAN, what does this mean?
slimer, I agree entirely with Janine that a doctor should go through it with you. However, I am going to stick my neck out and say that I wouldn't myself consider such a report very worrying. I would take the overall finding - "stable" - as the headline, and the rest with a pinch of salt. I wouldn't read it as "I have bone metastases", which I suspect is what you are afraid of. I hope I am not being irresponsible in saying this - I'm assuming you are feeling OK and have no new symptoms that have been bothering you.
With my own scan reports I sometimes get the impression that the radiologist is looking for something to say. On one occasion in particular, I was petrified by a reference to something which turned out to be nothing. I suppose it's better that they should record absolutely everything they see than miss something which might turn out to be important. But I feel fortunate that I never see the reports without there being a doctor in the room to explain things.
Dr West wrote a great post, "Did my cancer grow in three minutes?" explaining how if you give two different radiologists the same scan, they can interpret it quite differently. It might reassure you a little:
http://cancergrace.org/lung/2011/08/09/limits-of-ct-scanning/
Reply # - October 4, 2012, 05:19 PM
Reply To: CT SCAN, what does this mean?
Thank you both for your responses. I am taking them both to heart.
I am starting the 5th round of Gemzar tomorrow. I called Oncology/Hematology and asked to talk to an onc, but they were all gone for the day or busy, but the onc nurses, who actually run the place, told me that they would try to round up an onc to talk to me in the infusion room about the "subtle lucencies." tomorrow.
Sometimes an onc will stroll straight through infusion room, looking right and left, I guess to see who is declining and who isn't, so I may be able to snag one myself. But I suspect they will say talk to my onc at our appt in 2 weeks. But we will see. Maybe I can even get one of the nurses to print out the "findings" that may have more detail.
I read Dr. West's interesting article, and although the article is about differences in plane of sectioning and measuring technique among radiologists, I can hope that what this radiologist saw and mentioned, another might not have seen. But realistically, metastasis in Stage IV is kind of inevitable, and clearly Gemzar is not shrinking anything anymore, just keeping me stable, so resistance may have begun and along with it metastasis. But at least I have another round on Gemzar and the normal Q of Life it gives me.
Catdancer, I will be looking for D's next scan result and rooting for him and you.
Reply # - October 4, 2012, 06:05 PM
Reply To: CT SCAN, what does this mean?
I can only corroborate what you've heard from Janine and certain spring, except for adding the perspective that we get these kind of included vague references all the time and don't know what to do with them either. The radiologists do describe just what they see, but saying the significance is very hard, so "clinical correlation is recommended" is passing the buck. It doesn't mean that the oncologist or another doc can provide any more definitive information -- but if a patient has pain in this area, an oncologist would know to take it seriously and perhaps follow up on it. Otherwise, I often make the distinction between questionable progression and clinically significant progression. If there isn't clear, compelling evidence of progression, I would truly consider it stable.
-Dr. West
Reply # - October 4, 2012, 08:16 PM
Reply To: CT SCAN, what does this mean?
Oh good grief I made my post sound negative but didnt mean to. I'm sorry Slimer.
D gets these vague findings sometimes that don't amount to anything down the line. Thanks for the good luck charm. D's scan is in about three weeks.
Reply # - October 4, 2012, 09:25 PM
Reply To: CT SCAN, what does this mean?
Janine,
Don't worry Janine, I didn't find your response negative, just informative and realistic.
Dr. West, thanks for your input. I think my onc must think it not clearly clinically significant at this time or he wouldn't have scheduled me for a 5th Gemzar round . But looking forward to his take on it. He calls me "his best performing patient", but sometimes alters that to "one" of his best performing patients. At this time I have no aches, pains, SOP or anything and wouldn't suspect that I have Stage IV NSCLC cancer if the scans didn't prove it. Even the Gemzar doesn't bother me. So I pass the "clinical correlation" for the time being. All of you have helped settle me down - much appreciated.