The Colon Club

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

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.

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.

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

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.

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

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.

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

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.

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

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.

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.