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

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Nordy1
Posts: 30
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: 80
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: 30
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

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LPL
Posts: 586
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

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susie0915
Posts: 904
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: 1046
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 .

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betsydoglover
Posts: 964
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: 30
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: 586
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: 30
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

AppleTree
Posts: 267
Joined: Fri Mar 18, 2016 8:16 am

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

Postby AppleTree » Sun Feb 24, 2019 11:44 pm

6.6 mm met in lung. They tried to talk me into chemo and watching to see how it reacts. No thanks! Had it removed by VATS at Mass General and THEN did the follow up chemo. Since then, my scans are clear. I had no idea how much chemo would affect me. I went from 150 to 103 pounds. I am happy I had the surgery first because I was stronger than.
Diag Feb 5, 2016 Age 45
3 cm tumor 5 cm from verge
Radiation + Xeloda pills - 3000mg 5x week
3/14 - 4/16 - 25 sessions
Shrank just over 50% L nodes 0/13
Remove rectum with temp Ileo 6/17
Reversal 7/20 due to infection
Acute hepatitis August. Chemo cancelled
June to September 2016 - 58 days in hospital

2017
6/16, MRI shadow in lung
Pet - 6.6mm Met in Upper R lobe
7/30 VAT surgery Mass General/Boston
8/24 port
8/30 - 4/28 Folfox. 12 rounds
2018
June CT shows new lung Mets.
July/Oct PETs...CLEAR!

boxhill
Posts: 204
Joined: Fri Apr 06, 2018 11:40 am

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

Postby boxhill » Tue Feb 26, 2019 8:07 pm

I was NED according to CT scans during and immediately after FOLFOX, but my oncologist and I pressed for a liver MRI because I had had a tiny liver met detected and removed by the surgeon during my hemicolectomy. That met did not show on the pre-op CT scan. The MRI showed another tiny liver met and two enlarged nodes in the porta hepatis, so I was clearly not NED after all. The radiologist reviewed the prior CT, and in hindsight was able to find the nodes now that the MRI had revealed their position.

I think that the liver met is 5mm, about the same size as the earlier one that the CT also could not detect.

At this point, my next scan to see if Keytruda is working will be an MRI. More CTs are obviously likely to be useless.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemicolectomy
11 of 25 nodes,5 of 5 mesentery nodes
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28/18
7/9/18 CT no masses or enlarged nodes, 2mm indeterminate lung nodule
11/20/18 CT same, Lung nodule likely calcified granuloma. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met and 2 lymph nodes in porta hepatis, CT review shows progression of nodes on FOLFOX
12/31/18 Keytruda

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Jack&KatiesMommy
Posts: 577
Joined: Wed Dec 21, 2011 1:08 pm
Location: Columbus, OH

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

Postby Jack&KatiesMommy » Wed Feb 27, 2019 11:01 pm

I had "dozens and dozens" of tiny sub centimeter tumors throughout my liver that never showed up on any of my CT scans and were only found when my MD Anderson liver surgeon opened me up to do a liver resection and found them all.

My liver resection was terminated...he told me that there was nothing more he could do. I got a second opinion from Dr, Kemeny at MSK...and the rest is history.
Cynthia
Mommy to Jack (8) now (16) and Katie (4) now (12)
(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
8/13-12/15 (10) RFAs lungs
5/17: Upper Left Lobe of lung resected.
02/18: 3 new mets lymph nodes lung:
05/18: Keytruda (MSS w/Intermediate TMB): CEA: 66.4, 39.2, 23.8, 13, 3.5 1.8, 1.0, 2.8 3.9, 5.0, 5.6, 1.5, .8, .8, 1.1, 1.1, .7
7/18; 9/18; 11/18; 2/19 Clear CT scans

menreeq
Posts: 69
Joined: Fri Jun 30, 2017 10:26 am

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

Postby menreeq » Tue Mar 05, 2019 3:05 am

Generally, a 7-8 mm lesion on CT can be detected on PET. Smaller lesions that are very hypermetabolic can sometimes be seen. But if a lesion is smaller than 8 mm, and it is negative on PET, you can’t be sure that it is truly negative because it may be too small.

Sometimes a person will need all modalities. Each has its advantages and limitations.
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17), 0.8 (2/28/18)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Xeloda monotherapy 8/13/17-1/22/18
PET/CT 3/21/18 NED
CT C/A/P 9/17/18 NED

Brearmstrong
Posts: 75
Joined: Sun Mar 26, 2017 3:24 pm
Location: CT

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

Postby Brearmstrong » Tue Mar 05, 2019 9:49 am

I had nodes that were 1cm on a CT scan but never noted on my report (angry about that) and then my CEA went up slightly and they gave me a PET scan. PET showed high activity in the nodes with suv of 12 which is HIGH! They knew then that they were mets. The next CT scan showed one grew to 1.3 cm. So both CT and PET were able to pick them up at that size. I think PET/CT is your best bet if they agree to it. My opinion only of course but that's been my experience. Best of luck!!

-Brenda
45 F Jan 17 Mom 2 boys
tumor appendix/colon
Muc Adeno 4cm
mod diff G2 T4aN2
nodes 8/50
CEA 4.6 after surgery <.05
KRAS G12D MSS
FOLFOX Apr-sep 17
Clean CT scan Jul 2017 lung nodule 4mm, clean CT oct 17, CEA 3.4, nov 17 8.1. May 18 2.3 Jul 18 1.0 oct 18 1.3 Jan 19 1.3 Mar 19 1.0
Oct 2017 clean CT
Nov 17 PET para aortic nodes Stage IV
Folfori w/avastin Dec 17 CEA 7.1
May 18- surgery to remove nodes- 5 positive xeloda 2000mg/day indefinitely
Aug 18-CT NED Nov 18 CT clear, Feb 19 CT clear


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