Ct scan as good as pet scan?

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Tdubz
Posts: 152
Joined: Sun May 07, 2017 11:01 am

Ct scan as good as pet scan?

Postby Tdubz » Mon Aug 14, 2017 4:51 pm

First, did 8th treatment today, 2/3rds of the way done!! Yeah!! With that out of the way, here's a brief background about me, had surgery to remove tumor at the beginning of April. Surgeon said he got it all, stage 3b after pathology. Started adjuvant chemo in beginning of May. I had a pet scan before starting chemo. They found two nodes that were what they thought "reactive", and not cancer. 3 months later, I haven't had a cea test or another scan so I asked my onc about it today. He said they would do both after chemo was done, except instead of doing another pet scan, it's going to be a Ct scan. I'm fine with these time frames since i feel like I'm on the home stretch of chemo anyways. But what worries me is the use of the Ct scan over pet scan. I thought the pet scan was better at seeing things on the cellular level. I would have assumed that's what they would have wanted to check since I'm basically on mop up chemo. Will Ct scan be as good? I thought Ct was used to see actual tumors inside you. Thanks

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Robino1
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Location: Florida

Re: Ct scan as good as pet scan?

Postby Robino1 » Mon Aug 14, 2017 5:01 pm

Sometimes the reason for a CT scan over a PET scan has to do with what your insurance will pay for.

I'm lucky that my insurance ok'd my upcoming PET scan.
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

Basil
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Re: Ct scan as good as pet scan?

Postby Basil » Mon Aug 14, 2017 7:10 pm

This has been a mystery to me a bit as well and one of the few things I haven't asked about. My treatment was short - 4.5 months for stage iii - and I never had a PET. Had a ct and MRI at diagnosis and the same right before surgery. I have the utmost confidence in my doctor and am not concerned, but don't understand the diagnostic differences.
40 y/o male, kids 8&11
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear

Lee
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Joined: Sun Apr 16, 2006 4:09 pm

Re: Ct scan as good as pet scan?

Postby Lee » Mon Aug 14, 2017 8:27 pm

This was several years ago, I had to switch Onc (my old Onc was closing her business). Anyway the new Onc wanted to do a PET/CAT scans. My insurance would not cover both, only wanted to pay for CAT scan. I would have been happy with the CAT scan, butt new ONC wanted the PET scan if nothing else and she fought my insurance and got the PET scan approved. At that moment, I knew I wanted her on my team. She told me the PET scan is the best thing out there for finding any new issues, cancer wise. That was when they did baseline PET/CAT scan at diagnoses as part of your staging. It would be the only PET scan I would get. Some people will tell you that PET scans give off to many false positive, thus the reason for a CAT scan to help rule that out. I don't know, like I say I only has the one and there were no issues.

If I were to be diagnosed with a new cancer today, I think I would REALLY PUSH for a baseline PET/CAT scan, unless my Onc can give me a good reason not too.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

Tdubz
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Re: Ct scan as good as pet scan?

Postby Tdubz » Mon Aug 14, 2017 9:00 pm

Can a Ct scan detect cancer in lymph nodes? I'm really curious as to the status of those two lymph nodes they mentioned after the first pet.

Lee
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Joined: Sun Apr 16, 2006 4:09 pm

Re: Ct scan as good as pet scan?

Postby Lee » Mon Aug 14, 2017 9:14 pm

Tdubz wrote:Can a Ct scan detect cancer in lymph nodes? I'm really curious as to the status of those two lymph nodes they mentioned after the first pet.


It can pick up a swollen node per a CAT scan. This happen to me once, 2 nodes were swollen in my stomach area. Six months later they were back to normal per the CAT scan. In my case, my body (nodes) was fighting off some infection. As far as cancer activity, the PET scan might be better.

What does your Onc say?

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 16 years and counting!

JJH
Posts: 290
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Re: Ct scan as good as pet scan?

Postby JJH » Mon Aug 14, 2017 9:40 pm

Tdubz wrote:Can a Ct scan detect cancer in lymph nodes? I'm really curious as to the status of those two lymph nodes they mentioned after the first pet.

I think that a high definition CT scan will allow the radiologist to identify a lymph node cancer based in the shape, size and relative density of the lymph node compared to nearby tissue. A normal lymph node has a characteristic shape like a kidney bean. If it becomes cancerous it loses its shape it is easily identifiable as an abnormal lymph node.That's what I think, but I'm not a professional in this area.

Since they already know where the two suspicious lymph nodes are located, they just need to have another look at them now to see if they have changed size or shape since last time. If they see a problem there, they might then do a followup PET/CT scan. That's just my opinion.

Note: A PET scan already has a CT scan incorporated in it.
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

Tdubz
Posts: 152
Joined: Sun May 07, 2017 11:01 am

Re: Ct scan as good as pet scan?

Postby Tdubz » Mon Aug 14, 2017 10:25 pm

my onc was the one who told me I would be getting a Ct scan. I think he said if it showed anything, we'd do a pet. Honestly, it was early and I was the first patient there so I was really tired still so I wasn't paying 100% attention lol. I'll ask again next Monday. My concern is I think my insurance only pays for these every 3 months. If they do decide to do the pet after the Ct, that would push it into the next year and all my out of pocket maximums reset. I think for my first ct it was around 600 out of pocket and 800 for the pet. I guess out of pocket maximums don't really matter anymore though. Between colonoscopies, Ct scans, pet scans, port removal surgeries, doc visits, etc I'm pretty sure I'll be meeting that maximum every year for years to come lol

Maelleous
Posts: 125
Joined: Tue Nov 01, 2016 8:13 am
Location: FL

Re: Ct scan as good as pet scan?

Postby Maelleous » Tue Aug 15, 2017 4:10 am

During my whole history of cancer (see sig below) I've never had a PET scan. This is going to Cleveland Clinic Florida, a local Oncologist (Stuart Oncology), getting a second opinion from Moffitt, and a 3rd from Duke University. Then doing a clinical trial and getting scanned at University of Pittsburg. None reccomended a PET scan for whatever reason. I asked about it numerous times and they said it used when they have something they see that is questionable on a high resolution CT scan and want to determine what it is.
M 35 yr
DX Rectal Cancer, 10/16 (symptoms Feb 2016)
Dx stage 2 - Surgery Oct 25 201 Loop ileo w/ j-pouch
Close margins within 1mm
9/38 lymph nodes involved on path / Stg IIIc,pT4, pN2 B, p.M0. MSS, K‐ras, NRAS, no mutation
Started Folfox - 3rd Treament, Dec 30th 2016 Cardiac Arrest - Lucky to be part of the 6% to survive!
S-ICD installed / Port Removed
Vaccine Clinical trial at UPMC - last shot June 2017
Reversal 8/1/17 - Praying this is it!
Still NED

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LeonW
Posts: 358
Joined: Sun May 03, 2015 4:59 pm
Location: Amsterdam, Netherlands

Re: Ct scan as good as pet scan?

Postby LeonW » Tue Aug 15, 2017 5:52 am

Maelleous wrote:During my whole history of cancer I've never had a PET scan. [ . . ] they said it used when they have something they see that is questionable on a high resolution CT scan and want to determine what it is.

Same here, and note that over here insurance companies don't have any say; decisions are entirely up to the doctors/hospital. There are no co-pay considerations either, as anything above the first US$ 300 per year, is covered.

I'm sure my docs will use the in-house PET facilities if they consider it worthwhile. Same as anything else they've thrown in so far (see sig below),
L
Last edited by LeonW on Tue Aug 15, 2017 5:58 am, edited 1 time in total.
Dec 2012 - CC 2 unresect liver mets, CEA 41.8 (MM 65yrs)
Jan 2013 - colectomy @ spleen 2/26 nodes IVa T3N1bM1a
Feb-Jul - 1x Xelox-7x Xelox/Avastin, shrinkage from #3
Aug - 2x PV embolization (both failed)
Sep 2013 - R liver resect, 25d hosp (liver failure/delirium, lung emboli, encephalopathy), no living cancer (pCR)
2014/15 - recovery, scopy: 2 polyps
2016 - new town/life
2018, scopy: 2 polyps
2018/20 low (1.0-1.4) CEAs/clean CTs: 4x2014, 6x2015-17, 3x2018-20
next June 2021!

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Ct scan as good as pet scan?

Postby mpbser » Tue Aug 15, 2017 5:56 am

Robino1 wrote:Sometimes the reason for a CT scan over a PET scan has to do with what your insurance will pay for.

I'm lucky that my insurance ok'd my upcoming PET scan.


Yes. I would even say almost all the time insurance drives treatment in the U.S.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

mpbser
Posts: 953
Joined: Wed Apr 19, 2017 11:52 am

Re: Ct scan as good as pet scan?

Postby mpbser » Tue Aug 15, 2017 6:01 am

I'm with Lee on this. If my husband had only had a CT scan, as he did when initially diagnosed, we would never have seen the nearly completely obstructing 6-7cm polyp/tumor on the right side of his colon. It was the follow-up to his left hemicolectomy PET/CT that found that mass and thank god he had it done.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED


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