I wish that your statements were true and PET would be so good.PET scans are imperfect and when considerations are made if to make them or not all these issues need to be weighted.
Itzhak Brook MD

They've been doing PET scans here for over a decade so I can't begin to fathom why Health Canada is still doing clinical trials (not to mention they have recomended there use for H&N cancer since 2005 in BC). Whereas The entire country of Canada has 1 cancer center, we have 3 in California alone. For what it's worth, many Canadians come here for health care.

The NCCN member institutions are a collaboration of the top 21 comprehensive cancer centers in the US. They define the standards of care for cancer diagnosis and treatment and most of the world uses their guidelines. PET (or PET/CT) is definitely on the list of scans to perform as part of the pre-treatment diagnostic workup. Most of the false positives revolve around post Tx issues.

From Don's link:

"Positron Emission Tomography
The use of positron emission tomography (PET) is becoming more widespread worldwide in the management of patients with cancer. Numerous studies have demonstrated that squamous cell carcinomas of the head and neck region are well imaged by PET and there is accumulating evidence supporting its use for a number of indications in head and neck cancers.

Effective August 16, 2005, the Functional Imaging Department has expanded the clinical indications for referral within the framework of the evidence-based BCCA guidelines for FDG-PET. PET/CT scan referrals will now be accepted at our facility for certain indications in adult oncology patients. To view the referral guideline, please go to the Functional Imaging page.

There is support in the literature for the use of PET in three main areas:

1. In the initial staging of head and neck tumours where there is some uncertainty as to how extensive initial surgery or radiotherapy should be.

2. As an additional procedure in the diagnosis of carcinoma of unknown primary presenting as a nodal neck mass.

3. In the detection of recurrent disease post therapy where standard investigations are equivocal and further salvage therapy is feasible."

Contrast agents are typically used with MRI. I am unaware of contrast agents being used with PET scans. See:

http://radiology.rsna.org/content/227/3/817.full

Way to go Doc. At least for tongue cancer, other doctors have not come to terms with the fundamental disconnect between the underlaying premise of PETscans (the cancer tumors take in more sugar than normal or healing tissue) and the reality that healing tongue tissue takes in more sugar than cancer tumors.
I surfed the major PETscan manufacturer sites and at least they almost uniformly had this summary.
[quote]Positron Emission Tomography (PET)

PET Scan for Cancer, Alzheimer's, Heart Disease A PET scan allows physicians to measure the body's abnormal molecular cell activity to detect

* Cancer (such as breast cancer, lung cancer, colorectal cancer, lymphoma, melanoma and other skin cancers),
* Brain Disorders (such as Alzheimer's Disease, Parkinson's Disease, and epilepsy), and
* Heart Disease (such as coronary artery disease).[/quote]

I expect to see more and more studies like the British one I linked to as the facts surface.
Thanks for posting
Charm

Canada has a Comprehensive Cancer Center in almost every Province. Not just 3 in the entire country!!! Furthermore, there are more people in California than there are in Canada. FYI

Donna

I live in Northern Ontario,Canada. Pet scan's are used primarily
for clinical trials & are available if you qualify. It is a very sad situation & I am living it. My oncologist advised me to travel to Montreal Quebec to have a combined Pet/Ct scan done at my cost. I am fortunate to be able to afford it however, there are other's that cannot. We have the cancer centre's yes but the available equipment not!

Well - I do know we have a lot of cancer centers here in Canada - 4 in my direct vicinity - I could have - and would have - been referred to one - 3 mms from my home - however - I wanted to go to PMH - it it one of the top two in - Canada - and close enough (20 minutes in moderate traffic) that I didn't think twice about asking for a referral. Also the top Dr. In surgical oncology/ENT dude is the man I wanted to treat me - and he works out of PMH. I managed to get in with him - have 2 CTs and 1 MRI - have my appointments - and be slated for surgery within 6 weeks. ( the date of my surgery will be almost the 6 week mark - actually 5.5 weeks.) So I'm not complaining about health care here in Canada. There is a private center with a PET scan five minutes from my home - if I want to pay $2300 to get it done. I understand your frustration Donna -with the system especially if you live up north - but I think it's like any rural location in Canada or the US for that matter. Services are not all close - at least from what I have been reading from some people here who have to travel hours - to get to a treatment center. It's a pain that a certain diagnostic tool still hasn't been completely approved for use - and/or isn't widely accepted for use here in Canada - but our government has always been stodgy that way! For the most part I am grateful that I don't have to be dependant on the comprehensiveness of my insurance - or the insurance company to determine where I can go for treatment and what they will and will not pay for. At least I know for the most part that my illness - diagnostics - treatment and hospital stay and follow ups will cost me nothing. I know the private vs social medicine is a hot debate ( and off topic for this post) but I have to say I am relieved that I can seek out the best doctor - go to a top cancer center - and not have that decision be made for me by someone working at a private insurance company. As in - no you can't go to that hospital - because it's not part of your coverage. Unless you want to pay out of pocket. (even though the insurance itself is something you have to already pay handsomely for) I am lucky that I too can afford to pay for an independent PET - I just wasn't sure if it was worth it - since my dr. Didn't suggest it. I know there is some ambivalence towards it here in the medical industry - perhaps a lack of trust - which is also why I was wondering if it was worth it to pay for an independent test - if the dr. Is going to disregard it. That's why I will ask him when I see him... Just out of curiosity. Thanks for all the info!

Hi Everyone
Well I just wanted to let everyone know that we had the PET/CT scan this morning and I was concerned after reading everything here what the results would be. We got excellent news! No sign of reoccurance cancer. Emmett finished TX just 6 weeks ago so I was worried about the false positives I was reading about but his test was clear. With this test result and the physical exam he got we are breathing a sigh of relief and we will keep our appt for another PET/CT scan March 21st too. See my original post for results of our concerns. In this case the PET/CT gave us a sense of peace. Talk to you later.

Amazing Karen...that's awesome. I'm so glad that you have peace of mind tonight.

Eric

Karen..so glad you got good news. I know that drive was a pain but now you know why you did it.

With all the PET/CT controvery, it does make you question things, but I think a big difference comes when those reading the scans do it all day every day and can differenciate the results. Bill has had several ordered(at a CCC)since the end of treatment which are read immediately by the docs and then later by the radiologists and he has never had a report of a false positive..not even a mention of what it might be. So, we have a peace about it as well.

Wonderful news for you...just wonderful.

Deb

God bless and that's fantastic news.