1st post chemo cat scn results - 1249952

mamalisab
Posts:5

Hello, My dad was diagnosed with Squamous Cell Lung Cancer in June 2012. He was staged 2b and had a right middle lobe lobectomy. He had one node out of 6 test positive for cancer and no other pet scan activity. He had 8 chemo treatments of cisplatin/gemzar with virtually no side effects except fatigue and thinning hair. He has been finished with his treatments about 3.5 weeks and they had him come in today for his first follow up Cat Scan. They found something new on the right lung in the "fissure" between where the bottom of the middle lobe and the top of the bottom lobe would have met. It measured 2 cm and there was not a post operation cat scan to compare it to. The doctor said it could be scar tissue, a reactive node or cancer. He has scheduled a pet scan for Monday, but as you all know too well, time equals anxiety. Has this happened to anyone else???? Has anyone else had scar tissue from the surgery?? We were told that it was a slow growing cancer so I don't understand how it could have kept growing right through chemo. Any advice would be so geatly appreciated.

Thank You,

Lisa

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Reply # - November 7, 2012, 07:39 PM

Dr West
Posts: 4735

It's very common to have significant post-surgical changes. There's good reason to be wary about drawing any premature conclusions so shortly after surgery. It's worth knowing that you can potentially have some mild to moderate uptake from inflammation after surgery, though I'd be expecting that to subside several months after surgery. Still, if there's a small amount of PET uptake, such as a standard uptake value (SUV) in the low single digits, that could be in a range that might represent cancer or just inflammation.

Good luck.

-Dr. West

Reply # - November 8, 2012, 10:00 AM

mamalisab
Posts: 5

Dr. West,

Thank you so much for you reply. I just want to verify what I think you are saying. There is a possibility in your mind that this could be scar tissue or inflammation. Can you tell me will scar tissue glow with the PET scan? The Onc. said the the nodule is in a hard to reach place and there would be a chance of collapsed lung if they went in for a biopsy. Dad is post surgery 4 months and only almost a month post chemo. This is all so scary, we thought he was doing so great and they were going for a cure. I am just praying that it is nothing to be concerned about.

Thanks again!

Reply # - November 8, 2012, 10:39 AM

catdander
Posts:

Lisa, I hope too that your dad is cured. I don't want to speak for Dr. West but what I read him to say and what I know from my husband's experience is that it is very common to have scar tissue still light up (suv in the single digits) on a pet scan 4 months post surgery.
I'm sorry to say too that I know you will be concerned until he is a year or 2 (five years by most standards but lung cancer usually will show itself sooner) out from all of this and able to say with much more certainty that he's in the clear.
Best of luck,
Janine
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Reply # - November 8, 2012, 04:57 PM

Dr West
Posts: 4735

Yes, I was saying that there could still be low level PET activity even with just inflammatory changes and not active cancer. This should be decreasing over time, so I wouldn't expect much PET activity many months out from surgery, but there could be some low level activity. It should also decrease or, at worst, stay stable over repeated scans over time if it's inflammation. Cancer, on the other hand, will typically become larger and hotter on a PET scan over time.

-Dr. West

Reply # - November 13, 2012, 08:01 PM

mamalisab
Posts: 5

Okay, so pet scan was completed and results were read today. The small "thing" they saw on the cat scan was very very dim on the scan, doc says most likely an infection. However, there was a hilar lymph node that had a suv of 4 that showed up. Doc said he thinks it could be reactive because of the infection, it was not enlarged. He has decided to wait 2 months to do another cat scan to see if the node has grown or has resolved. Does anyone have a different opinion or does anyone agree...

Thank you,
Lisa

Reply # - November 13, 2012, 09:56 PM

Dr West
Posts: 4735

Those findings sound very much like the ambiguous range that could possibly be cancer but is also potentially just infectious/inflammatory. It's very appropriate to repeat a scan and just see whether that improves or not over time, with further interventions only if needed from there. Good luck.

-Dr. West

Reply # - November 16, 2012, 12:13 PM

mamalisab
Posts: 5

Okay, the saga continues.

Yesterday my dads oncologist took the radiology findings to a Tumor Conference to see if the other doctors had any different conclusions. He called us and said the the Pulmonary doctor thought he could biopsy the hilar nodes fairly eaisly so he suggested doing a biopsy. Heres the kicker....He told us by reading the radiology report that not only was the Right Hilar lymph node faintly lighting up but the left one was also. My question is if this is inflamation or infection related like they are hoping for, would nodes on both sides be effected? He said this could possibly be granulomas????? Any advice Please!!!!!!!!

Lisa

Reply # - November 16, 2012, 01:19 PM

catdander
Posts:

It could be infection or granuloma (a non malignant spot).

So that's what we'll hope for. Can't say what the pulmonary doc was thinking except what he said about being able. I'll ask a doctor to comment.

Janine

Reply # - November 16, 2012, 08:59 PM

Dr West
Posts: 4735

I'm afraid that it probably isn't possible for us to say much more than that this is why we do biopsies -- we can't tell the significance of things on a scan, which may represent cancer or inflammation or infection, so a biopsy is the conclusive test. There are some inflammatory conditions that could involve both sides.

Aside from that, I don't think there's much we could say without being directly involved and without seeing the films. Can you ask the doctors actually involved and reviewing the scans for more information?

-Dr. West

Reply # - November 17, 2012, 05:10 AM

dr. weiss
Posts: 206

There are two major ways to deal with an ambiguous spot on a scan. One is to look at it under the microscope; this would mean a biopsy or surgery. The other is to follow it carefully over time. Things that grow are more concerning for cancer. Things that don't grow are less concerning and the longer that you follow them without growing, the less concerning they become. Following ambiguous areas with serial imaging can be a high anxiety approach, but it can frequently spare the patient invasive procedures, which have risks.

Reply # - November 17, 2012, 08:08 AM

drcalvo
Posts: 5

Hi Lisa, it is very common to have "new" findings on post-surgery scans like the one they found on your dad's right lung fissure. It is also extremely common to have "dim" PET-CT uptake in areas that have residual inflammation from either recent surgery, chemotherapy or infections that happen during chemo.
The SUV values you mention and their location suggest inflammation rather than recurrent cancer.
I agree with your oncologist approach to sit back and monitor your dad with serial imaging studies as opposed to actively look for recurrence with biopsies. Tumor board meetings are excellent ways to get another set of eyes on a complex case and usually they have useful recommendations. In my practice I apply this recommendations but individualize them to each patient.
Keep in mind that even if we are dealing with early recurrence, there is no harm in waiting 8-12 weeks to repeat scans and re-evaluate. Something reassuring here is that at no point you mention new or worsening symptoms that may herald a recurrence.

A. Calvo, MD
Medical Oncology
Kettering Cancer Institute

Views expressed here represent my opinion, not those of GRACE or the University of North Carolina. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

Reply # - November 17, 2012, 12:04 PM

catdander
Posts:

Thank you doctors, for the great and gracious responses.

I especially want to thank and welcome Dr. Calvo! (not a very proper intro but as heart felt).

We look forward to hearing more from you. :)

Janine

Reply # - November 17, 2012, 06:01 PM

mamalisab
Posts: 5

I am just reading todays posts and also want to thank everyone for your helpful comments. This has been such a scary and confusing time for my family and your posts have helped ease mine and my dads mind.

We lost my mom 9 years ago to breast cancer and we sooooooo wanted a good result with dads chemo. The biopsy is scheduled for Wednesday so keep your fingers crossed, I will let you know the results.

Have a blessed Thanksgiving!!

Again, thank you to all who have posted

Lisa

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