MRI Question; Avastin effects on Pituitary gland (NSCLC Stage IV) - 1265620

rdcrew
Posts:16

Hi All,

I am on Avastin maintenance for stage IV NSCLC. On my last visit I diligently reported some odd vision issues that I had (one time only "seeing trails) and some mild balance issues (also isolated incident). My doctor cancelled my infusion until I got an MRI, which I did. I always get my report as soon as possible because I like to do my research. I do have a call into my doctor to go over the results but have not received a call back yet.

The MRI results are pretty good but confusing. No evidence of metastatic disease thankfully but it is noted that I have a

"6.5 mm right paramedian pituitary lesion subtle region of slightly hyperintense T1 signal with associated T2 hyperintensity likely related to a small focus of nonacute hemorrhage or protein within the lesion. Overall size to the pituitary remains normal. No impingement on the optic chiasm. Flow is present in the anterior and posterior circulation vessels and major dural sinuses."

Also "Nonspecific pathologic foci in the cerebral white matter without significant change. Findings may be related to mild chronic small vessel disease or other less common causes of chronic white matter signal abnormality / demyelination"

My concern is related to the lesion noted. This lesion has been present since at least 2012 and has not changed in size but this is the first time hemorrhage is mentioned.

I'm looking for input on how concerned I should be with these results. Since my doctor hasn't called back I am assuming its nothing too terribly urgent but could possibly halt the Avastin. Any input that can ease my mind would be greatly apprecaited.

Thanks so much,
Ronda

History:

Was diagnosed Sept. 2011, have been through many rounds of chemo, radiation, a couple bouts with Cyberknife to my rib and sub pectoral muscle. I have posted here before and got wonderful advice. I lost my password so just created a new account.

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Reply # - August 29, 2014, 10:46 AM

JimC
Posts: 2753

HI Ronda,

Most GRACE members understand "scanxiety" very well, and I can tell you from personal experience that obtaining scan reports prior to discussing them with your oncologist is a double-edged sword. If the report clearly indicates shrinkage or stability, the anxiety is alleviated sooner. But when the report appears to indicate bad or at least concerning news, reading that report in advance can create even more tension and worry. Please understand I'm not criticizing you for looking at those reports; I did the same for my wife (in addition to getting a CD of the scan images and looking at them). I'm just pointing out the hazards of doing so.

I think it's good to remember that radiologists often have only two or three pieces of information at their disposal when they write a report - the current scan, the previous scan and perhaps a very short description of your history (e.g., "lung cancer"). So they may have no idea that this lesion is unchanged since 2012 or what it looked like then. Often they make an educated guess as to the cause of a finding, but it's based on the appearance and not your medical history. Those guesses are quite often wrong, which is why it is best to talk to your oncologist, who has experience in knowing which parts of a report are important, and which are not. On more than one occasion we discovered that the language in a report was really nothing to worry about.

I hope you have a good, anxiety-relieving discussion with your oncologist.

JimC
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Reply # - August 29, 2014, 05:15 PM

Dr West
Posts: 4735

I must confess that I am really NOT a fan of giving scan reports without discussion of them first, which I think puts everyone in an awful position. I'm even less a fan of fielding all of the questions from people who really need to be talking with their doctor about these findings.

The "how worried should I be?" question is one we just can't and don't want to answer -- I would say that your own doctor needs to put it into context. This is NOT a code for "be very afraid -- this is awful"... I would just like to follow a clear general policy that we have tried to follow over the years that we can't and won't interpret scan reports for people that are part of the job of their own doctors, and it would be malpractice lawsuit-inducing for us to try to answer a question of "how worried should I be about _________?".

Good luck.
-Dr. West

Reply # - August 30, 2014, 06:19 AM

rdcrew
Posts: 16

Thank you for the responses. I am aware that reports can be scary to an untrained eye, proof above.

My doctor did call back but due to my luck I was away from the phone and got a message (after hours) saying all good, I will get your infusion scheduled.

I'm okay with that for now but will get some real answers to my questions when I go in.

I am still concerned about pituitary issues. An oncologist might not see it as an issue but I think I will take the MRI results to my GP to see if she feels anything is worth looking into.

Thanks again,
Ronda

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