Help please. Input needed on scan is best for bone.

[some]

So many things all the time. My husband has been in treatment again for a local recurrence and has been on Erbitux & Folfiri. Just had 7th round last week and it's a butt kicker for sure between the stomach issues, fatigue and the cracked feet and fingers.

So the story goes that we are looking for improvement or stability, trying qualify for HIPEC again. Looks like the two spots (at anastomosis and cecum) they were working on did shrink at least a little. One seems to have disappeared on the PET which is good sign. HOWEVER, they noted one NEW spot on the sternum as follows:


Small focus of asymmetrically increased activity is now seen in the left aspect of the sternum body with maximum SUV measuring up to 5.0. No gross underlying CT abnormality is appreciable in the region but the finding is worrisome for an osseous metastasis. There is otherwise physiologic distribution of the radiotracer within the rest of the included osseous structures. There are no suspicious lytic or sclerotic lesions on CT scan.


My husband's oncologist asked if he was injured there. Nothing recent that he can recall and this wasn't there three months ago before he started chemo. It makes me confused since we believe the chemo is working. The oncologist said to take Aleve twice a day for four weeks and we will redo the PET in that area. The surgeon looked at the scans and wanted to make sure we were following up on this. I'm torn bc onc said likely nothing and radiologist that reviewed the CT w/contract taken two days prior to this thought same. I was trying not to worry about this and have faith in their judgment, but it seems that the surgeon is going to want what we hope will be confirmation that it is NOTHING. He's been on Neupogen which I read could have some effects but his last shot was 6 days prior to the scan.

So, is a bone scan better to request than an MRI? I've read around the board and can't seem to get a clear answer. We are also going to UCSF again next week to check in there and see what that onc says.

I'd appreciate your help. as you can imagine, anything that puts surgery in question is pretty upsetting and my 8 year old had a meltdown yesterday about an outpatient procedure my husband had to have. Sigh. All these ups and downs makes it hard to put one foot in front of the other some days.

Thanks.

Serena

[janklo]

The hipec surgeon told us that bone scans are really old technology. But then he ordered one when Lauren had back pain. Didn't show anything so he did an MRI. That was negative too. But her problems were not in the back. Hopefully someone who works in radiology can answer this.

[Maia]

Serena, had not input about what scan is best but just wanted to say I'm sorry to read this! Hopefully, onc is right about not worrying in advance and this is the case of radiologist's overzealousy -they *have* to tend to do that, to cover their asses.
Big hug
m.

[some]

Thanks Janet & Maya. I appreciate it. Nothing feels right in this limbo. Do one thing for info, then wait because you need other info. Sigh. Hoping more people will chime in. Is there anything definitive for scans?

I suppose we may just need to wait for the PET to see if it changes. Anxiety inducing. I don't want any of us to belong at this forum. I just want our normal life back again.

Best,

Serena

[annalexandria]

I know from experience how frustrating the "watch and wait" mode is, Serena...I'm sorry you guys have to go through this. I've had a lot of "hot spots" pop up on the PET that turned out to be nothing in the long run (of course, some were actually "something" too, but not as many).
I hate all the tests, so if it was me, I would probably go with waiting and checking again later to see if anything has changed. That's how I always found out what was, and was not, cancer.
Would it change the course of tx if it turned out to be a met to the bone? If it wouldn't, then probably more reason to wait and see, as hard as that can be, imo.

Hugs and strength to you both~AA

[Georgie]

A bone scan may be useful but I don't know if it would actually add more information from the PET, which is often more sensitive that the bone scan when looking at bone involvement. An MRI may be useful but may be inconclusive... Sorry I can't give you concrete answers. I can tell you that at work we only really see CRC patients for bone scans if they are on a clinical trial (which requires a bone scan as it's cheaper and more available than PET) or they have queries about bone involvement and don't have access to a PET scan.

The only thing that would tell you for sure would be a biopsy... But that has many risks... Especially (if it is cancer) the risk of the biopsy needle causing "seeding" where tiny little cancer cells get deposited up the 'track' of the needle...

Talk to the docs, see what they think. If they recommend wait and rescan that may be the way to go, just makes it difficult for those doing the waiting...

Thinking of you and hoping it's not a bone met.

Georgie