The Colon Club

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.

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.

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.

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.

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.

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

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.

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.

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.

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