PET Scan Help

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Fluff Bottom
Posts: 61
Joined: Fri Oct 23, 2015 8:13 am

PET Scan Help

Postby Fluff Bottom » Mon Sep 24, 2018 8:23 am

So I found this online. I see my oncologist tomorrow but want to prepare myself. It looks like tumors in my liver, lung and abdomen lit up?

Thanks for any help anyone can give in making sense of this.


COMPARISON EXAMINATION: CT of the chest report dated 05/22/18,
CT of the abdomen and pelvis report dated 09/06/18
INDEX LESION SIZE SUV INTERPRETATION
Right lower posteromedial hemithorax pulmonary parenchyma, right
lower lobe (n=2) 11.6-mm (largest) (frame 200) 5.5 (max)
Fulfills quantitative criteria for viable neoplasm

Right lobe hepatic parenchyma segment VIII 52.8 x 51.9-mm(frame 187) 7.3 ratio > 2.0 Fulfills quantitative criteria
for viable neoplasm

Abdominal retroperitoneum and mesentery, abdominal wall 36.9 x33.1-mm (largest) (Frame 169) 8.5 (max) Fulfills quantitative criteria for viable neoplasm

TECHNIQUE: Following the intravenous administration of 11.4
mCi of F-18 deoxyglucose via the left antecubital fossa,
multiplanar image acquisitions of the neck, chest, abdomen and pelvis to level of mid thigh, obtained at one hour post radiopharmaceutical administration contemporaneously interpretedwith the current CT of the neck, chest, abdomen and pelvis tolevel of mid thigh, dated 09/18/18 via coregistration and CT of
the chest report dated 05/22/18, CT of the abdomen and pelvisreport dated 09/06/18 reveal:
SERUM GLUCOSE LEVEL: 92 mg/dl.

FINDINGS:
1. Focal increased glucose concentration is observed in the right lower posteromedial hemithorax pulmonary parenchyma, rightlower lobe in two separate nodular presentations. The correctedmaximum calculated standard uptake value is 5.5. The maximal
axial diameter of the largest, most conspicuous density on
review of CT of the thorax dated 09/18/18 is 11.6-mm
(transverse).
2. Heterogeneous increased radiotracer uptake is manifest in
the superior aspect of the right lobe of the liver (3.8)
involving segment VIII generating a corrected maximum calculated
standard uptake value of 7.3, with a lesion to liver background
ratio greater than 2.0. The maximal axial diameter of the
corresponding metabolic, morphologic abnormality on review of CT
of the abdomen dated 09/18/18 is 52.8-mm (transverse) x 51.9-mm
(AP).
3. Multifocal increased FDG concentration is defined in the
abdominal retroperitoneum and mesentery, the midline lower
anterior, left mid anterolateral abdominal wall. The corrected
maximum calculated standard uptake value is 8.5. The maximal
axial diameter of the largest individual metabolic, morphologic
abnormality on review of CT of the abdomen and pelvis dated
09/18/18 is 36.9-mm (transverse) x 33.1-mm (AP).
4. Normal physiologic distribution of the radiopharmaceutical
is apparent in the splenic parenchyma, both renal units, bladder
and visualized intestinal tract. The visualized portion of the
cerebral cortex demonstrate symmetric and preserved glucose
metabolism. Diffuse radiopharmaceutical concentration is noted
Notes:
in all four quadrants of the abdomen and pelvis.
Pertinent CT findings are as follows: CHEST: Bilateral
subcentimeter axillary soft tissue densities are non-glucose
avid. There are no parenchymal densities-nodules noted in the
Notes:
right-left hemithorax demonstrating discernible quantitatively
significant increased glucose metabolism. A subcentimeter
non-calcified density noted in the right lower lateral lung
Notes:
field is ametabolic. ABDOMEN AND PELVIS: The gallbladder is
surgically absent. Postsurgical changes are defined in the left
anterior abdominal mesentery without focal increased glucose
metabolism. Subcentimeter bilateral axillary soft tissue
densities are non-glucose avid. Calcifications are defined in
the bilateral lower hemipelvis. SKELETAL: Degenerative
changes are noted in the cervical, thoracic and lumbar spine.
Notes:
ORDER #: 0918-0010 PET/PET CT skull midthigh initial
IMPRESSION:
1. ABNORMAL EXAMINATION INDICATIVE OF MALIGNANT VIABLE
NEOPLASM.
2. Increased glucose concentration demonstrated in the right
lower medial hemithorax pulmonary parenchyma, right lower lobe,
fulfills quantitative criteria for viable neoplasm. (Gould et
al, Annals of Internal Medicine, 138:724, 2003).
3. Viable neoplastic transformation appears evident in the
right lobe of the hepatic parenchyma involving segment VIII.
4. Facilitated radiopharmaceutical concentration noted in the
Notes:
abdominal retroperitoneum and mesentery, the anterior abdominal
wall, fulfills quantitative criteria for viable neoplasm.
10/26/15-Colonoscopy-Mass in Sigmoid Colon
11/17/15 Surgery
Mass is adenocarcinoma with mucinous type components.Lynch Negative
Stage IIIb-T3N1c, 3/13 nodes, High Grade-Poorly Diff to Undiff
12/16/15-Port,began FOLFOX
CEA .8 before surgery
Finished 12 rounds of FOLFOX 5/22/16
5/22/18-Clear CT
9/6/18-CT for possible hernia shows mets
9/18/18 PET confirms mets to lungs, liver peritoneum
10/23/18-Chest CT shows rapid growth of mets

Lee
Posts: 5740
Joined: Sun Apr 16, 2006 4:09 pm

Re: PET Scan Help

Postby Lee » Wed Sep 26, 2018 12:00 pm

So how did it go with the Onc yesterday?

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 - 10 years and counting!

Fluff Bottom
Posts: 61
Joined: Fri Oct 23, 2015 8:13 am

Re: PET Scan Help

Postby Fluff Bottom » Wed Sep 26, 2018 1:50 pm

It went about like I thought. Cancer on lung, liver and in peritoneum. Oncologist now thinks pain is from cancer. Having surgery soon for biopsies.
10/26/15-Colonoscopy-Mass in Sigmoid Colon
11/17/15 Surgery
Mass is adenocarcinoma with mucinous type components.Lynch Negative
Stage IIIb-T3N1c, 3/13 nodes, High Grade-Poorly Diff to Undiff
12/16/15-Port,began FOLFOX
CEA .8 before surgery
Finished 12 rounds of FOLFOX 5/22/16
5/22/18-Clear CT
9/6/18-CT for possible hernia shows mets
9/18/18 PET confirms mets to lungs, liver peritoneum
10/23/18-Chest CT shows rapid growth of mets

hiker
Posts: 84
Joined: Thu Aug 09, 2018 10:15 am

Re: PET Scan Help

Postby hiker » Wed Sep 26, 2018 2:35 pm

I'm really sorry. But I've heard of surgeries to remove cancer from each of those areas so you just need a good plan.

I don't know where you're being treated, but if it's not a major cancer center, please consider getting a second or third opinion from one.

hiker
Colonoscopy 2/17, 5cm tumor descending
Diagnosed stage iv, liver mets 3/17
Colon resection 3/17
Told surgery not an option, get my affairs in order
Meet w/MSK team 5/01/17
Folfox(3rds) 5/17-6/17
Liver resection/implant HAI pump 7/17
HAI pump chemo(5rds) 8/17-2/18
Folfiri+Vectibix(11rds) 8/17-2/18
Spot on chest CT 10/17
Lung biopsy (that was fun) 11/17
Nocardia bacterial infection w/spread to brain (this is serious) 11/17
IV antibiotics 12/17-2/18
Oral antibiotics 3/18-12/18
Clear of cancer since surgery

User avatar
Jack&KatiesMommy
Posts: 521
Joined: Wed Dec 21, 2011 1:08 pm
Location: Columbus, OH

Re: PET Scan Help

Postby Jack&KatiesMommy » Fri Sep 28, 2018 9:56 am

Please, Please, Please have your tumor tested by Foundation One to see if you are MSI High (which is likely to respond to immunotherapy) or MSS (less likely to respond to immunotherapy...unless you have a moderate to high mutation burden in your tumor make up and Foundation One will test for this). Immunotherapy is amazing. Do a search...it is curing/putting people into remission/NED.

Some background on my off-label use of Keytruda (since I am MSS it is not approved for use by me....since it doesn’t generally work for colon cancer patients which microsatellite stable tumors.) Keytruda is only currently approved for use be MSI high patients as it tends to work most for those patients and theya re having some amazing results.

HOWEVER, it looks like it is working for me....and here is the reason why (according to my doctor and the Foundation One reps): it is not whether the tumor is MSS or MSI that is determinative as to whether the immunotherapy will work....it is the THE TUMOR’S MUTATION BURDEN THAT DETERMINES WHETHER KEYTRUDA WILL WORK.

Foundation One is seeing evidence that people whose tumors have a high (or moderately high) mutation burden tend to respond to the immunotherapy treatments. Generally MSI tumors have a high mutation burden and MSS tumors have just one or two mutations if any. In my case (probably dilute to the fact that I’ve had many different courses of treatments over the kart 7 years) my ZMSS tumor has a moderate mutation burden (11 mutations.). So my local oncologist (who has been doing tons of work with immunotherapy over the last 6 years) got permission to treat me with Keytruda off-label.

My CEA (which is super sensitive and very accurate over the last 7 years) was 39.6 before my first Keytruda treatment. Three weeks later, before my second treatment, my CEA had risen to 66.4. Before my third treatment, my CEA was back down to 39.2, and three weeks later before my 4th treatment it was down to 13.0. On Friday, before my 5th treatment my CEA was down to 3.5 and my CT scan showed shrinkage of the only slightly enlarged lymph nodes in my hilar lung area to normal size. My CEA is now 1.0!

This is an amazing breakthrough for MSS patients. If you are MSS, please get Foundation One Testing to see if you have a moderate or high mutation burden. If you do, immunotherapy could work for you.

Please feel free to contact me if you have questions.
Cynthia
Cynthia
Mommy to Jack (8) now (15) and Katie (4) now (11)
(My Most Precious Things)
Dx 8/11 Stage IV CRC (liver mets) CEA 2,600+
9/11 Folfiri 2/12: Failed Liver Resection
5/12 HAI pump/removed primary
4/13 Liver Resection!
8/13; 10/13; 12/13; 3/14; 8/14; 11/14; 2/15; 7/15; 12/15 RFA lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new mets lymph nodes in hilar/lung:
05/18: Started Keytruda (MSS but moderate mutation burden): CEA: 66.4, 39.2, 23.8, 13, 3.5 NOW 1.8
08/18 Clear CT scan

Fluff Bottom
Posts: 61
Joined: Fri Oct 23, 2015 8:13 am

Re: PET Scan Help

Postby Fluff Bottom » Mon Oct 01, 2018 3:23 pm

Thanks so much for the info Cynthia and Hiker!
10/26/15-Colonoscopy-Mass in Sigmoid Colon
11/17/15 Surgery
Mass is adenocarcinoma with mucinous type components.Lynch Negative
Stage IIIb-T3N1c, 3/13 nodes, High Grade-Poorly Diff to Undiff
12/16/15-Port,began FOLFOX
CEA .8 before surgery
Finished 12 rounds of FOLFOX 5/22/16
5/22/18-Clear CT
9/6/18-CT for possible hernia shows mets
9/18/18 PET confirms mets to lungs, liver peritoneum
10/23/18-Chest CT shows rapid growth of mets


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