smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

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Nordy1
Posts: 23
Joined: Tue Oct 02, 2018 11:45 pm

smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby Nordy1 » Mon Feb 11, 2019 8:16 am

Hi everyone
I posted on another place here but I dont think my question was clear. Im hoping for people in similar situations to tell me there stories of what was next in terms of testing. If CT scans and ultrasound are inconclusive what did/does your dx do for small indeterminate lesions? I have another CT scan tomorrow and if they once again dont offer any clarity ( Onc on the fence about what they are) what should I ask for? My onc thinks they are too small for PET scan - largest 1.1 or 1.2 cm, sthen 4, 6 and 8 mm.
take care,
Nordy

My earlier post:

When I was first diagnosed with cancer on my colon last year it was noted that I had indeterminate nodes on my liver, lungs and kidney, all smaller - largest being 1.2 cm. I was under the impression that they would be watched for 3 things - growth (potential cancer) shrinkage (potential cancer responding to chemo) or stagnant (potential scarring). Non of these were concrete but loose rule of thumb to watch for as infection was another possibility. On my second scan the nodes had disappeared and there was/is a big question of "were they or weren't they" mets. I was sent to ultrasound on Monday for a different look and low and behold the nodes are all still there. The ultrasound has not been able to clarify anything except they show bigger butt that could apparently be differences in measuring between ultrasound and CT scan. So now I'm back on Tuesday for a 3rd CT scan for yet another look. If that doesn't tell the story then I'm really not sure what the next step usually is or what I should ask for. If they are indeed mets then early intervention is supposed to be key which makes me uncomfortable with the "lets just wait for them to do something" approach. On the other hand I dont know anything....:(

I have learned that when nodes are under 1 cm they can seem to disappear but just not be visible in that particular scan but it sure doesn't help you feel confident in the process of scanning..

Any input from others on what the next step usually is from your experience?
jan 2018 emergency room via ambulance rectal bleeding event
dx Feb 2018 sigmoid adenocarcinoma 2.5 cm, 3 small extranodal foci resected march 2018
stage 3A T1 n1c
multiple indeterminent nodes in liver, lungs and kidney
11 rounds folfox with oxyplatin stopped with full nephropathy of hands and feet
currently waiting next scan in Feb. 2019

martd
Posts: 65
Joined: Tue Nov 21, 2017 3:48 pm
Location: Phoenix, Az

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby martd » Mon Feb 11, 2019 9:22 am

Have they mentioned doing a biopsy? I believe it's an easy procedure, they use a needle. My onc mentioned biopsying my liver mets at my first appt. but he never did saying it wasn't necessary.
49 y/o male dx 11/2017 crc
Stage 4 with 17 liver Mets, cea 490
RAS, BRAF WT
12 rounds folfox , avastin
5/18 cea 2.8 liver resection and pve
7/18 part 2 liver resection, remove right side of liver
Surgical site mrsa infection, wound vac
8/18 cea .9 cCR, rectal tumor is gone
Rectal surgery postponed, watch and wait
10/18 clear scan CEA .7
01/19 clear scan CEA .9

Nordy1
Posts: 23
Joined: Tue Oct 02, 2018 11:45 pm

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby Nordy1 » Mon Feb 11, 2019 10:31 am

Hi martd
Another Onc at the clinic mentioned biopsy in passing but I forgot to ask my own onc about it. I hesitate a bit there because of the chance of needle track seeding should it actually be cancerous, but of course if there is no imaging techniques that can answer then that is probably the next step.

thank you for answering
Nordy
jan 2018 emergency room via ambulance rectal bleeding event
dx Feb 2018 sigmoid adenocarcinoma 2.5 cm, 3 small extranodal foci resected march 2018
stage 3A T1 n1c
multiple indeterminent nodes in liver, lungs and kidney
11 rounds folfox with oxyplatin stopped with full nephropathy of hands and feet
currently waiting next scan in Feb. 2019

User avatar
LPL
Posts: 519
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby LPL » Mon Feb 11, 2019 11:08 am

On my husband’s PET scan they could see 2 nodules in his lung. They were noted as 8mm and 11mm on the CTscan a week earlier.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

User avatar
susie0915
Posts: 899
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby susie0915 » Mon Feb 11, 2019 2:43 pm

I had a 4mm nodule show up on a scan 2 years ago. My oncologist and pulmonologist both said too small for pet scan to pick up or to biopsy. Pulmonologist said it would have to at least double in size. I had 3 repeat scan within the following year with no change in size. The last scan in May, the radiologist attributed it to fibrosis as I have been monitored for lung scarring and inflammation that appeared after chemotherapy. I will have a scan in April which will be a year from the last, and hopefully it will have not changed or maybe even shrunk or disappeared.
58 yrs old Dx @ 55
5/15 DX T3N0MO
6/15 5 wks chemo/rad
7/15 sigmoidoscopy/only scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. surgery,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod
7/17 no change lung nod
10/17 Clear pel/abd CT
11/17 CEA<.5
1/18 CT/Lung no change in 4mm nodule
5/18 CEA<.5, clear CT pel/abd/lung nod no change
11/18 CEA .6

stu
Posts: 994
Joined: Sat Aug 17, 2013 5:46 pm

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby stu » Mon Feb 11, 2019 3:45 pm

Hi ,
My mum had uptake on a 7 mm lung met with a PET scan . Removed by VATs and confirmed to be a met .
Hope you get answers soon .
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

User avatar
betsydoglover
Posts: 946
Joined: Mon Aug 14, 2006 2:31 pm
Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby betsydoglover » Mon Feb 11, 2019 4:37 pm

The size you mention can definitely be detected on PET by a good radiologist. My lung nodule was 9x11mm - uptake only 1.0 on PET, but my wonderful radiologist could see that it was ever so slightly brighter than surrounding tissue (I looked at it with him) - it was very subtle, but detectable and did turn out after VATS to be a met.

Take care,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

Nordy1
Posts: 23
Joined: Tue Oct 02, 2018 11:45 pm

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby Nordy1 » Mon Feb 11, 2019 5:33 pm

Thank you all for the replies!

This gives me confidence to look at another facility if ours wont continue to test with other modes of scanning. CT tomorrow morning so I might possibly have an answer by Friday

thanks again,
Nordy1
jan 2018 emergency room via ambulance rectal bleeding event
dx Feb 2018 sigmoid adenocarcinoma 2.5 cm, 3 small extranodal foci resected march 2018
stage 3A T1 n1c
multiple indeterminent nodes in liver, lungs and kidney
11 rounds folfox with oxyplatin stopped with full nephropathy of hands and feet
currently waiting next scan in Feb. 2019

User avatar
LPL
Posts: 519
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby LPL » Mon Feb 11, 2019 5:42 pm

Nordy1 wrote:Thank you all for the replies!

This gives me confidence to look at another facility if ours wont continue to test with other modes of scanning. CT tomorrow morning so I might possibly have an answer by Friday

thanks again,
Nordy1

Best of Luck tomorrow Nordy1 !!
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

Nordy1
Posts: 23
Joined: Tue Oct 02, 2018 11:45 pm

Re: smallest tumors that turned up on your PET, PET/CT or PET/MRI ??

Postby Nordy1 » Sat Feb 23, 2019 10:23 am

Hi All

Just thought I would update. The scans have shown no growth for the last 3 months so they called it stable. The kidney node is still indeterminate and the liver they think is NAFLD. I see the doctor in a couple weeks but I think they want to take a watch and see approach. Im not sure Im comfortable with this yet, they haven't done a PET or an MRI so i cant help but feel they should try something else first. I also wondered if a second radiologist opinion of the scans would help, not really sure if thats a thing though.

Im struggling....it feels like im giving up if I just agree to wait and see what happens. I know its a legitimate sometimes, but are 2 CT scan and an ultrasound reasonable diligence?


Nordy1
jan 2018 emergency room via ambulance rectal bleeding event
dx Feb 2018 sigmoid adenocarcinoma 2.5 cm, 3 small extranodal foci resected march 2018
stage 3A T1 n1c
multiple indeterminent nodes in liver, lungs and kidney
11 rounds folfox with oxyplatin stopped with full nephropathy of hands and feet
currently waiting next scan in Feb. 2019


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