SCAN QUESTIONS

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mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

SCAN QUESTIONS

Postby mpbser » Sun Nov 03, 2019 10:18 am

I really don't like how we get these reports AFTER our oncologist appointment to review the results. I always have questions like this that I cannot possibly ask at the appointment. What do you guys think these passages from the CT report mean? 1) Focal nondistended region of the sigmoid colon is newly noted without discrete mass, probably under distention. 2) Slightly smaller caudate resection zone measuring up to 1.3 cm, previously 1.5 cm, however there is subtle superior marginal 0.7 cm in diameter low-attenuation that is perhaps slightly better perceived but indeterminate. I'm usually pretty good at interpreting medicalese, but these two sentences baffle me. In #1, is a new mass suspected? In #2, are they talking about a spot in addition to the caudate's resected zone? Any ideas? P.S. Neither of these findings appear in the "IMPRESSIONS" section although it is noted that PET scan may be helpful. Going to schedule one for early January.
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: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: SCAN QUESTIONS

Postby mpbser » Sun Nov 03, 2019 12:18 pm

Someone responded elsewhere that this could be a good layperson's interpretation:

1) There is a section of the sigmoid colon that is now visible without distention (enlargement). There is no mass in this section.
2) There is a feature in the caudate resected zone that appears to be on the surface but is not clear enough to determine what it is.

My response: If they were concerned, they would have reiterated the findings in the IMPRESSIONS section, but still -- I don't like these unknowns. Hopefully, the sigmoid is just "adapting" to the sub-total colectomy as we were told would happen by his colon surgeon. The caudate mass was biopsied and found benign so hopefully all that is there is some sort of healing/scarring. The MRI report describes the caudate as follows: Unchanged wedge resection caudate lobe with mild marginal heterogeneity but no discrete suspicious finding. Of note, this region is partially obscured by artifact from hepatic arterial infusion pump, limiting evaluation for focal diffusion restriction.

Both the CT and MRI reports' IMPRESSION sections are silent on these two particular areas. That being said, the radiologists do say that CT/PET scan may be helpful. Going to try to get one scheduled for the first week of January. That way, we can at least enjoy the holidays.
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

zephyr
Posts: 259
Joined: Thu Aug 18, 2016 7:31 am

Re: SCAN QUESTIONS

Postby zephyr » Sun Nov 03, 2019 12:25 pm

I don't know the answer to your questions but having been in your shoes (results & questions AFTER the appointment), I always get my results ahead of time. I'm told that scans are generally read and results available within 24 hours (otherwise they would be hopelessly backed up) so I always call the scanning center the next day and have them leave a copy for me at the front desk. I like having some time to process the information and be ready with questions, if any, when I go in for the appointment.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr/Jul-2019 Xeloda/Avastin, SBRT
Sept-2019 Stable! Continue Xeloda/Avastin

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: SCAN QUESTIONS

Postby mpbser » Sun Nov 03, 2019 12:32 pm

Wish we could do this. However, we have to travel and get the scans within 18 hours of the oncologist consult the following day. The reports never get released until at least 48 hours after the scan and that's when they are on weekdays. Because we come from out of town and my husband's schedule is so tight, the scans get done on Sundays. So, the earliest they would be available would be Wednesdays and then they overnight them to us for arrival on Thursday. Logistically, we just can't get them ahead of time. :(
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

zephyr
Posts: 259
Joined: Thu Aug 18, 2016 7:31 am

Re: SCAN QUESTIONS

Postby zephyr » Sun Nov 03, 2019 7:05 pm

mpbser wrote:Wish we could do this. However, we have to travel and get the scans within 18 hours of the oncologist consult the following day. The reports never get released until at least 48 hours after the scan and that's when they are on weekdays. Because we come from out of town and my husband's schedule is so tight, the scans get done on Sundays. So, the earliest they would be available would be Wednesdays and then they overnight them to us for arrival on Thursday. Logistically, we just can't get them ahead of time. :(


Can you find a local place to do the scans and then just have the results sent to your oncologist? The cancer center where I get treatment often tries to get me to schedule my scans there but I have them done off-site by an imaging company. I just like having all my imaging - X-rays, mammograms, bone density, CT and PET - in one place where all my doctors can easily access anything they want.

No need to reply, just offering a possible alternative in the hopes that it might make your life simpler.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr/Jul-2019 Xeloda/Avastin, SBRT
Sept-2019 Stable! Continue Xeloda/Avastin

Rock_Robster
Posts: 380
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: SCAN QUESTIONS

Postby Rock_Robster » Sun Nov 03, 2019 8:31 pm

Hi mbpser,

I stopped getting my scan results beforehand as I was freaking out about every little comment without the oncologist there to help me interpret it, however my compromise is that he gives me a copy of the report at the consultation and we go through it together (and I can ask questions then). Perhaps this might be a compromise, given he/she must have a copy too?

Also I’ve got to the point where if it isn’t mentioned in the Impressions/Summary, I don’t worry too much about it. Most radiologists are incredibly thorough and will mention every little thing, even if not clinically relevant. If there’s doubt that needs to be addressed they’ll almost always recommend a different scan.

Best of luck,
Rob
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Rock_Robster
Posts: 380
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: SCAN QUESTIONS

Postby Rock_Robster » Sun Nov 03, 2019 8:41 pm

PS: my experience has been that CT is pretty hopeless for imaging both liver and colon. Every time I’ve had these, a subsequent MRI has disagreed with them (in my favour, thankfully). So I’m not surprised they’re only making general comments about these - if they were concerned about either I presume they’d recommend an MRI Liver or a PET/sigmoidoscopy, respectively.
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Cured
Posts: 535
Joined: Thu Nov 27, 2008 10:53 pm
Location: MO

Re: SCAN QUESTIONS

Postby Cured » Sun Nov 03, 2019 9:57 pm

Mbpser, You are correct to make sure you understand everything. Sorry for your travel hassles.
Here they don’t like to give me the Radiologist report until the Onc has interpreted it to me. But I always want to read it myself, as the Onc gives a brief explanation. Especially when they are listing the size of tumors on my lungs; it gives me comfort to see how much they are shrinking or disappearing.
I also ask for a CD of the scans so that we can view them; and have the scans to share with another Dr if we need to.

They schedule my visit with the Onc so that the Onc has time to view them before he sees me. Usually the day after the scan.
A fun note: my wife takes photos of the computer monitor when it is displaying my scans, as the Dr reviews them with us. The pics actually show pretty good on her iPhone.
The Drs. know how to que-up the images to show the previous scan next to the current scan.

My scans are not of the colon as my recurrence has never been there. 10 years after being NED, metastasis was found in my lungs and brain. God is good. I feel great and seem to be well. Do have CT of lungs in 10 days and MRI of brain in January, as Drs want to be sure.

Best wishes for you all.
5-08:Stg 3 Rectal: 6/14 Nodes
Ace Surgeon Remvd 90%Rectum,lots of Colon-Full Incision
Ileo Rev'd 6 Mos.
Radiatn+5fu Pre-Surgery
FOLFOX 8 CyclDone 1-09
Clear Scope 8-17; CEA 2-18
Glory to God! Healed by prayers of many: for 10 years
7-18: tumor pressing against brain Removed
Metastatic to lung. CEA 6.9
Folfiri
CEA to 4.5 after 1 chemo
After 8rds CEA 3
CEA 1.8, 2.3,1.7
12 rds Folfiri
Avastin evy 3 wks
Had Seizure Anti-seizure meds work-no driving for 6 months
Neuro allows me to drive again 0 meds

mpbser
Posts: 934
Joined: Wed Apr 19, 2017 11:52 am

Re: SCAN QUESTIONS

Postby mpbser » Mon Nov 04, 2019 5:20 am

I vacillate between wanting to have an explanation for these statements in question and just letting it be. As some people here already know, I have reviewed images myself from the CDs in the past. My husband always gets liver MRIs (at least since 2017 when his Mass General oncologist dropped the ball and forgot that he was supposed to get them. Now I make sure of it!) and Dr. Kemeny insists on CTs also. I always get copies of them and do have a copy of these recent scans. I just don't have the emotional bandwidth right now to study them especially if it is highly likely that I am worked up about nothing. There is so much going on in our non-cancer-related lives between his work stress and my work stress. I even downloaded my husband's Guardant liquid biopsy report but won't read it. I think I will just wait out until the next appointments which are scheduled for after the New Year. My husband and I really need a break right now.

Interestingly, the same radiologist is listed as the Staff Radiologist on both the CT and MRI. It was the CT scan that contained the statements in the findings section and, in the impressions, recommended close surveillance and suggested and a PET may be helpful. CT was done an hour before the MRI. The MRI IMPRESSION just says: 1. Since August 4, 2019, smaller ablation zones, with lateral geographic signal abnormality abutting segment 5-8 ablation zone with mild enhancement, probably posttreatment related, for which follow-up could be performed. No discrete suspicious lesions. 2. Slightly smaller periportal lymph nodes.

It would be nice if we had an alternative for getting the scans earlier than the consultation with the oncologist so that we could get copies ahead of time. However, my husband goes to MSK and we don't trust the quality of the equipment or the radiologists anywhere else on the East Coast.

Thanks for the input. It really helped me with my decision.
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

kandj
Posts: 263
Joined: Sun Sep 27, 2015 11:29 am

Re: SCAN QUESTIONS

Postby kandj » Tue Nov 05, 2019 11:15 am

mpbser wrote:Wish we could do this. However, we have to travel and get the scans within 18 hours of the oncologist consult the following day. The reports never get released until at least 48 hours after the scan and that's when they are on weekdays. Because we come from out of town and my husband's schedule is so tight, the scans get done on Sundays. So, the earliest they would be available would be Wednesdays and then they overnight them to us for arrival on Thursday. Logistically, we just can't get them ahead of time. :(


You can ask for the reports to be printed off before you leave the floor. We always ask the front desk to print off the reports after seeing Dr. K. We tend to read over them at lunch before his pump is refilled and then fire off any emails to the team if we have questions
wife to DH, dx 8/15 stage IV @36, numerous unresectable liver Mets
resection and HAI placed 12/15
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 4 Liver mets and one possible lung met
Radiation on liver Mets 12/17
Lung met 10/18
VATS on lung met 11/18 started xeloda
Chemo break 6/19-11/19
New spot seen in lungs and adrenal gland 11/2019


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