PET/CT tomorrow

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utahgal7
Posts: 202
Joined: Fri Sep 11, 2020 12:04 pm

Re: PET/CT tomorrow

Postby utahgal7 » Mon Jan 23, 2023 8:53 am

beachsunrise:

Your plan for treatment in Germany sounds like a good one. If the Germany plan doesn't work out, are you open to participating in a clinical trial?

I am sorry your situation is overwhelming. I really admire your ability to persevere through it all.


Paige
02/20 Rectal Cancer dx - 4 cm mass; located 9 cm from AV
03/20 CEA 2.7; 0.9; 1.4; 0.9; 0.9; 1.2; 1.0; 0.8; 1.1; 1.0; 1.1; 1.7; 1.8; 1.8
1.9; 2.4; 2.3; 2.8; 2.2, 2.8, 3.2; 3.0; 1.6; 2.0; 1.2
04/20 ST Radiation; 04/20 LAR surgery w/ileostomy; ypT3N1bM0; MSS, KRAS G12A
05/20 CAPEOX; 08/20 Ileostomy reversal
12/20 CT scan; lung nodules (watch and wait);
11/22 lung nodule biopsy positive for RC met;
1/23 VATS right lower lobe wedge resection
FOLFIRI 10 cycles

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Thu Jan 26, 2023 5:34 pm

I am so
Last edited by beach sunrise on Thu Jan 26, 2023 5:39 pm, edited 1 time in total.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Thu Jan 26, 2023 5:34 pm

I am so frustrated and extremely mad right now. Got a call from Germany to tell me all scans have been reviewed BUT the most recent very important PET/CT scan from Dec 2022 was not with it. I specifically made sure they knew that was the main one I needed and to add all the previous ones. They did not. I hope this wasn't done on purpose. Better not be.
Germany needs to review it before making their decision. I told them I will get it Monday and send asap. Good grief!!!! Does it sound promising so far, don't know.
My hospital wanted me there 3 weeks ago for SBRT saying "you know not everyone is eligible for this procedure" after I told them I can't make a decision until all opinions are in.
I have gotten CEA down to 15.9 from 26.x in two months by really hammering with ADAPT+++ by up dosing on certain supplements and switching back to chronomodulated chemo dosing.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Fri Jan 27, 2023 4:09 pm

After appt today with ND I have decided if not a Rolles candidate I will still wait instead of jumping on SBRT. NLR sits at 7.2 which indicates cancer, inflammation or both. We added All Inclusive Great Tonify to hopefully lower NLR. It is a mix of Dang Gui, peony and Astragulas and should lower IL-6 when paired with Tian Hua Fen. I know its cancer but most markers look good and CEA has come down significantly. I will wait and see what next scan reveals. In the meantime I will hunt more consults.
I have appt Monday with lung surgeon and I know he won't be happy.
Whatever I decide I will have expanded bloodwork before and then 3 weeks after whatever the procedure. Things included will be lymphs, inflammation, CDs, NKs and some others. This is to gauge effects of treatment and a going forward plan.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

rp1954
Posts: 1861
Joined: Mon Jun 13, 2011 1:13 am

Re: PET/CT tomorrow

Postby rp1954 » Sat Jan 28, 2023 5:27 pm

beach sunrise wrote:Lung surgeon wants SBRT asap but onc wants to wait until another scan in March to see if these 5mm nodes have grown.
He mentioned again tapering off xeloda and I said NO NO NO.
He said he's never had a patient so unusual. .

Lungs and Xeloda are, of course, different than my wife's para-aortic LN with UFT (pro-5FU), but I'm sure his head would explode to know we tapered down over the 12 hours before 2nd surgery (a faster clearing chemo, UFT is about 2x faster than xeloda).

Risks of uncontrolled bleeding and later wound healing prey on their careerist minds.
The thing I found out with the first surgery is how far they were behind on wound healing nutrition and chemical support vs the best functional medicine drs recommendations. Life Extension, other sites and papers, prior experience and practice, helped to get more from our surgeons and to maneuver more effectively.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

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beach sunrise
Posts: 1058
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Re: PET/CT tomorrow

Postby beach sunrise » Sat Jan 28, 2023 9:48 pm

Most definiely their heads would spin and explode at yalls success. I am no where near what yall have successfully accomplished and they look at me like I am an alien or something. They only know what they know. I would say 90% of my cancer treatment is what I have done to help myself based on research, not them.
I have all the questions I can think of for Monday and bought a new recorder for the appt.
Some of the questions are the ones I presented that he blew off first time.
Some of the questions and would love feedback on more important questions to ask about SBRT:
% success rate in general and what you have seen with your patients vs growth after procedure or more tumors in same field
Risk/Benefit. Complications (bloodclots, ect) What is the aftercare protocol
Model type, year of machine
Example of bloodwork before and after to monitor effects. I know it causes alot of inflammation and lowers WBCs
Rx requirements/starting or stopping anything I take, chemo gap
How many sessioms
Just the node that lit up or the other suspect node also
Showme the images
What are other options that can be on the table (he knows I am consulting the 4 corners of USA and overseas)
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

roadrunner
Posts: 471
Joined: Sun Jan 12, 2020 8:46 pm

Re: PET/CT tomorrow

Postby roadrunner » Sat Jan 28, 2023 10:34 pm

Beach: A lot of these answers depend on the nature, size, and location of the target you’re trying to treat, and the dose and skill of the rad onc. In my case the treatment itself was a non-event (other than holding my breath for a bit during the treatments). No noticeable side effects. And while you’re correct that pulmonary SBRT initially lowers WBCs (because many pass through the beams, and it takes about 2 Gy to destroy them), it tends to increase levels for six months or so afterward, which was a nice surprise.

One question I have about your case is the following: It’s a little hard for me to tell from the posts if there is a reasonable certainty that the target nodule is in fact a met. If I recall right uptake was on the line, not definitive. I believe I saw also that it’s very small (5mm?). Has your team measured growth rate? Are there other diagnostic factors? The reason I ask is that you won’t be getting material to test, which may be a consideration, both on that basic question and the genetic/treatment front.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Sun Jan 29, 2023 12:06 am

It is reassuring that WBCs could increase later.
Nodes re indeterminate but suspect at this time. Right middle nodule 5mm lit up with SUV 1.3. It has been there a while with no change in size. Not sure how long but around 2 years.
Lower right node stated out 4mm. then 6x4mm and now meaures 5mm.
It was also noted the Right upper lung node that has been sitting there since dx at 5mm is still 5 mm but they suspect it also now.
So, no definite determination of mets but sure looks like it.
CEA is a good marker for me. It rose to 26.x and now 15.9.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

roadrunner
Posts: 471
Joined: Sun Jan 12, 2020 8:46 pm

Re: PET/CT tomorrow

Postby roadrunner » Sun Jan 29, 2023 12:18 pm

Wow, that’s a confusing picture. I understand your frustration.

Sorry if you clarified this before, but they can’t wedge one (perhaps the growing nodule (if it is indeed that, as even the change there appears to be within normal variance))? Or even segmentectomy? Or perhaps a biopsy? (I understand those are challenging in the lungs, especially at those sizes.) I’d be interested in the reason for their reluctance to do a surgical approach, at least in part. I could think of several, e.g., don’t meet growth requirements over time or radiological diagnostic criteria, too small/hard to find, central/difficult location, etc. But you’re saying they suspect they are metastases, and the CEA number is strongly suggestive of disease somewhere. So I’d wonder what the surgeon, in particular, is recommending, and why. Did you get 2/3 opinions there? SBRT/ablation can be very effective, but there is real potential value in knowing what you’re dealing with, if possible.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Sun Jan 29, 2023 3:18 pm

RML nodule is to deep and very close to a bronchial tube. So its difficult. Could take right middle lobe but suggestion is not to, just go for SBRT for now.
RLL nodule is in a valley. So its difficult too.
I had two more consults. Both suggested heavy chemo and see what happens. One of them did say SBRT is an option but still heavy chemo should be used.
I will get PET/CT scan in the mail to Germany tomorrow and await their opinion before I decide anything.
What a mess!!!!
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

roadrunner
Posts: 471
Joined: Sun Jan 12, 2020 8:46 pm

Re: PET/CT tomorrow

Postby roadrunner » Mon Jan 30, 2023 11:54 am

This really is a tough call/“unusual”! If you don’t mind, one more clarification: Are your suspected mets (3 potentially, it seems, all roughly the same size and not growing (or growing very little) over very long periods—top end for CRC Mets is 2x/120 days, though obviously YMMV, and they suspect these, so . . .) confirmed to be lymph nodes? (That’s what it sounds like.) If so, isn’t that also unusual? From what I’ve seen, pulmonary lymphatic involvement does occur in some people, but all the cases I’ve seen have metastases that aren’t lymph nodes as well. If it’s nodes (and just nodes), what does that mean for prognosis? Is that why they’re recommending FOLFIRI (I suppose that’s what you mean by “heavy chemo”)? I understand also that you have been treating it (if I’ve read right, among other things with high(er) dose 5-FU (Xeloda))? While I don’t recall having seen anything in the literature confirming that Xeloda can control pulmonary metastases, FOLFIRI does improve PFS in that context (and occasionally even produces full remission), so the Xeloda certainly could be part of the explanation as well.

Sorry if I’m just late to the party on this. Yours just looks like a fairly unique situation, so I was trying to understand better. It seems like your team is going for a “whack-a-mole” approach due to the CEA, indeterminate radiological findings, and surgical contraindications. That may indeed be optimal under the apparently unusual circumstances presented. You def seem to be on top of it, but fwiw it seems like a situation where it’d be best to make sure all of the “unusual” angles are fully considered.

(I know that’s probably nothing new, and you’ve consulted many different physicians and are sophisticated yourself, so please just see it as me trying to help if this is all redundant. At least I contributed on the “SBRT boosts immune function” point, right? : ) As always, Good Luck!)
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Mon Jan 30, 2023 1:01 pm

They are reported as nodules. So, now I am confused if it means lymphnodes or something different?
You are giving me super great information to digest and have better discussions with consults. Thank you!!!
one of the nodules, 5mm, is not growing but lit up on PET/CT. Second nodule went from 5 mm to 6.6 since Sept I found out today. The third nodule went from 5 mm to 6mmx4mm then back down to 5mm over a 3 month period.
Yes, MSK offered folfiri as first thing and see what happens, Dr. Boyd also said chemo would be best starting out.
These nodules are in such hard places for SOC.
Got the most important scan today (Dec scan) and will send it off to Germany today.
I am going to reachout to Dr. Molena (I think I spelled it right) at MSK also for an opinion.
There is also a Cancer Treatment Center of America someone suggested to me. Never considered them but why not!?!
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

claudine
Posts: 813
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: PET/CT tomorrow

Postby claudine » Mon Jan 30, 2023 1:33 pm

Looks like you’re always on top of things beach sunrise! I just wanted to add that my husband did Folfiri/Avastin for his many small lung nodules (I think the largest one was 5mm), he finished systemic chemo over 3 years ago and his lungs have been clear since, no recurrence there, so there’s something to be said for heavy chemo sometimes :)
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24

roadrunner
Posts: 471
Joined: Sun Jan 12, 2020 8:46 pm

Re: PET/CT tomorrow

Postby roadrunner » Mon Jan 30, 2023 2:53 pm

Happy to be of assistance! Here are a few more general observations based on your last post. Going mostly from memory (I’ll go confirm later and amend if necessary). Pulmonary nodules *can* be lymph nodes, but they can be many other things also. Size, growth rate (usually expressed as “doubling time”), radiological appearance, and clinical context (e.g., primary somewhere else, CEA) are all relevant to diagnostic evaluation. PET uptake is, as you know, another factor. Most generally (there are loads of distinctions “under” this), most *nodes* are “solid.” Many primary lung malignancies are classed as “subsolid,” at least in some respect. CRC mets are usually solid. Another complication in your case is the small size of your nodules: these are just barely beyond being “micronodules” (<3mm). That makes them harder to characterize and very hard to find. It’s a positive factor diagnostically, however. Also, if I recall right, your PET uptake was on the line.

They’ve called these “indeterminate,” which seems to make sense (tiny, stable or slow growing (but with a background of treatment including 5-FU), some uptake but not lots, no other obvious explanation, e.g., infection, smoking, etc.). I would be interested in their view of (1) no (or minimal) growth over such long periods (except maybe for 1/3); (2) any clues from appearance on scans (even at this size there usually are such); (3) are they suggesting chemo to test the nodules through shrinkage/stability, or because of worries about disseminated disease, or both? (4) is there clear lymphatic involvement, no evidence of same, or unknown? and (5) is there urgency to treat now, or can they wait to watch growth? (This last assumes you aren’t considering FOLFIRI. If you are I understand why they’d want to do that right away.) Another interesting question might be whether they consider this to be oligometastatic disease, or evidence thereof, or something else? That would give you more insight into their perspective/rationale than your health, but it might be worth exploring given the complexities of your situation.
7/19: RC: Staged IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.; lung micronodule
8/19-10/19 4 rds.FOLFOX neoadjuvant, 3 w/Oxiplatin (reduced 70-75%)
neoadjuvant chemorad 11/19
4 rounds FOLFOX July-August 2020
ncCR 10/20; biopsies neg
TAE 11/20, tumor cells removed
Chest CT 3/30/21 growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT nodule 1/22
6/20/22 TAE rectal polyp benign)
NED from 3/22 - 3/23
4 cycles FOLFIRI
LUL VATS lobectomy for radio resistant met 7/7/23

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beach sunrise
Posts: 1058
Joined: Thu Mar 05, 2020 7:14 pm

Re: PET/CT tomorrow

Postby beach sunrise » Tue Jan 31, 2023 4:19 pm

CONCLUSION:
1. Stable appearing indeterminate solid nodules within the bilateral lung fields, both
measuring up to 5 mm and exhibiting nonspecific low level radiotracer uptake, however
evaluation is limited due to size. Same for other tiny RUL and LUL nodules. Recommend close
attention on follow-up imaging.
2. No tracer avid local disease recurrence or distant metastatic disease.
CHEST:
ONCOLOGIC FINDINGS: Indeterminate. Stable appearing solid lung nodule within the right lower
lobe that measures approximately 5 mm (CT image 109), previously measured as 6 x 4 mm on recent
CT chest. This nodule demonstrates low level radiotracer activity, however PET evaluation is
limited due to small size of nodule. Additional solid lung nodule within the basal right middle
lobe also demonstrates low level radiotracer activity and measures approximately 5 mm (CT image
104 and max SUV 1.3), previously 5 mm on prior CT chest. This lesion is also too small for
accurate PET characterization. Tiny RUL and LUL nodules on CT images 80 and 79 are also stable
and below the size threshold for PET characterization. No new lung nodule.
This was Sept PET/CT

Dec CT
Multiple thin-walled interparenchymal cyst are perivascular or
demonstrate central vessels. Focal bronchiectasis in the inferior right upper lobe, not
significantly changed. Increased bronchial wall thickening and scattered mucus plugging of the
medial right lower lobe bronchi. Increased atelectasis is noted in the inferior lingula

Stable right upper lobe 5 mm nodule (series 2/image 48). Stable size of the 0.6 x 0.4 cm right
basilar nodule, however now with peripheral lucency (series 2/image 93). Slight interval
increase in size of the subpleural left upper lobe nodule, also with increased surrounding
nodular groundglass densities, now 7 mm (series 2/image 52), previously 5 mm (series 2/image
51). Stable left lower lobe 4 mm nodule adjacent to the major fissure (series 2/image 50).
LYMPH NODES: None enlarged.
Yesterday remeasurement of 7mm nodule was confirmed at 5.9mm not 7mm. Ya, I requested a 2nd review of nodule sizes and if any were doubling time and answer was no.

CONCLUSION:

1. Stable size of the right basilar nodule compared to recent CT from August 2022 (however
which had demonstrated enlargement from November 2021 to August 2022), with new peripheral
lucency/cavitation, indeterminate for metastasis but suspicious and continued close CT
surveillance is recommended. This is likely too small for PET/CT characterization.

2. Slight enlargement of the subpleural LUL nodule, also with nodular groundglass densities
indeterminate for metastasis and also likely too small for PET/CT characterization.

I had the faucci whatever during thanksgiving, knocked me down for 4 days. Had GT scan Dec 20.2022
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test


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