#41084 04-30-2007 03:11 AM | Joined: Feb 2007 Posts: 1,940 "OCF across the pond" Patient Advocate (1000+ posts) | OP "OCF across the pond" Patient Advocate (1000+ posts) Joined: Feb 2007 Posts: 1,940 | I have noticed over the last few months that just about every one on these boards talks about PET scans.Robin has never had one ,and there has been no mention of him having one since his treatment finished .Is this another UK/USA anomaly?
Liz in the UK
Liz in the UK
Husband Robin aged 44 years Dx 8th Dec 2006 poorly differentiated SCC tongue with met to neck T1N2cM0 Surgery and Radiation.Finished TX April 2007 Recurrence June/07 died July 29th/07.
Never take your eye off the ball, it may just smack you in the mouth.
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#41085 04-30-2007 03:36 AM | Joined: Nov 2006 Posts: 2,671 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Nov 2006 Posts: 2,671 | Liz - I'm glad you asked that. . . Altho' my son had a PET/CT scan before his surgery, there has not been any mention of a PET scan since he completed Rad treatment on 12/19/06. All he had was a chest X-ray on 4/23/07. I don't think it is a UK/USA thing but I've been wondering the same thing. I notice that Robin's stage was T1 and my son's stage is II. Could that be it? All the doctors he's seen since the end of Tx tell him everything is fine.
Anne-Marie CG to son, Paul (age 33, non-smoker) SCC Stage 2, Surgery 9/21/06, 1/6 tongue Rt.side removed, +48 lymph nodes neck. IMRTx28 completed 12/19/06. CT scan 7/8/10 Cancer-free! ("spot" on lung from scar tissue related to Pneumonia.)
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#41086 04-30-2007 03:45 AM | Joined: Feb 2007 Posts: 1,940 "OCF across the pond" Patient Advocate (1000+ posts) | OP "OCF across the pond" Patient Advocate (1000+ posts) Joined: Feb 2007 Posts: 1,940 | Wow what a quick reply. Rob had an upper body CT scan but he didnt have anything injected into him,He just lay down on the bed and was passed through the machine .one thing i found very disturbing was when we were told there was no test post radiotherapy to see if the cancer was all gone. Liz in the UK
Liz in the UK
Husband Robin aged 44 years Dx 8th Dec 2006 poorly differentiated SCC tongue with met to neck T1N2cM0 Surgery and Radiation.Finished TX April 2007 Recurrence June/07 died July 29th/07.
Never take your eye off the ball, it may just smack you in the mouth.
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#41087 04-30-2007 04:46 AM | Joined: Apr 2006 Posts: 794 "Above & Beyond" Member (500+ posts) | "Above & Beyond" Member (500+ posts) Joined: Apr 2006 Posts: 794 | My understanding of the PET/CT combination (usually performed at the same time) is that the PET shows abnormal soft tissue growth with astonishing detail, but it does not show the bony structures well, so location is not always as precisely indicated as is desirable. The CT is very precise about location, but it doesn't show the detail of the soft tissue as well as the PET, so often they are paired to show the growth AND the location in detail.
One reason not to do a PET too soon after treatment is that the PET shows increased metabolic activity within tissues. After treatment, there is usually too much inflammation in the tissues to get a true reading.
Does this jibe with the information that you more knowledgeable people have? What is the follow-up most usually given after treatment?
Colleen--T-2N0M0 SCC dx'd 12/28/05...Hemi-maxillectomy, partial palatectomy, neck dissection 1/4/06....clear margins, neg. nodes....no radiation, no chemo....Cancer-free at 4 years!
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#41088 04-30-2007 05:23 AM | Joined: Feb 2007 Posts: 61 Supporting Member (50+ posts) | Supporting Member (50+ posts) Joined: Feb 2007 Posts: 61 | I was told I would get a CT scan a few months after treatments end. The rest of the follow-up care involves only visual inspections. It wasn't very reassuring and I'm assuming it was because I was Stage I.
SCC, right tonsil, T1N0MO, G3, HPV-33 positive, 7 wks IMRT 2/21/07-4/13/07, 48 year old female when diagnosed, non-smoker, weekend wine drinker, tumor and both tonsils removed. Ethyol for 3 weeks; no peg; only minimal longterm side effects
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#41089 04-30-2007 01:40 PM | Joined: Apr 2005 Posts: 2,219 Patient Advocate (old timer, 2000 posts) | Patient Advocate (old timer, 2000 posts) Joined: Apr 2005 Posts: 2,219 | All,
There are no set protocols for follow-up care and depending on the surgeon, oncolgist, hospital, etc. there are many different approaches taken.
I, for one, have never had a PET/CT scan or any scans, but do get an annual chest x-ray. That is all that my surgeon prescribed as a follow-up. Perhaps this is because I was staged as a T1NOM0.
Someday there may be standard protocols available, but as of now, I'm not aware of any.
Jerry
Jerry
Retired Dentist, 59 years old at diagnosis. SCC of the left lateral border of the tongue (Stage I). Partial glossectomy and 30 nodes removed, 4/6/05. Nodes all clear. No chemo no radiation 18 year survivor.
"Whatever doesn't kill me, makes me stronger"
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#41090 04-30-2007 01:54 PM | Joined: Aug 2006 Posts: 294 Gold Member (200+ posts) | Gold Member (200+ posts) Joined: Aug 2006 Posts: 294 | I had both a PET and CT as part of initial testing prior to Dx but only CT scans post TX so far. I haven't asked why no PET nor have I been told along the way.
Bill D.
Dx 4/27/06, SCC, BOT, Stage III/IV, Tx 5/25/06 through 7/12/06 - 33 IMRT and 4 chemo, radical right side neck dissection 9/20/06.
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#41091 05-01-2007 07:08 AM | Joined: Feb 2007 Posts: 1,940 "OCF across the pond" Patient Advocate (1000+ posts) | OP "OCF across the pond" Patient Advocate (1000+ posts) Joined: Feb 2007 Posts: 1,940 | Mmm varied responses to my question make me think it is down to oncologists preference.I wonder why?
Liz in the UK
Husband Robin aged 44 years Dx 8th Dec 2006 poorly differentiated SCC tongue with met to neck T1N2cM0 Surgery and Radiation.Finished TX April 2007 Recurrence June/07 died July 29th/07.
Never take your eye off the ball, it may just smack you in the mouth.
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#41092 05-01-2007 08:16 AM | Joined: Feb 2004 Posts: 598 "Above & Beyond" Member (500+ posts) | "Above & Beyond" Member (500+ posts) Joined: Feb 2004 Posts: 598 | Here is my understanding, from a layman's perspective.
CT Scan (particularly with contrast) is great for showing structures -- i.e. bony or soft tissue growths -- tumors, lymph nodes, etc. However, by itself, it cannot definitively determine whether a growth is cancerous -- there are certain characteristics that can provide a clue on CT, but nothing diagnostic.
MRI is basically the same in terms of function, though through a different mechanism. Some doctors prefer MRI for clarity in soft tissues, but CT with contrast is close. Again, however, there is nothing definitive in terms of cancer diagnosis.
PET (Positron Emission Tomography) actually visualizes cell activity. You are injected with a radioactive isotope that binds to glucose, which cells use for food. Since cancer cells are "hyperactive", they consume glucose at a much higher rate. This shows up as a "hot spot" on the PET scan. Unfortunately, many types of inflammatory processes also show as areas of increased activity on PET scans, as the immune system cells also consume glucose at a higher rate when battling infection or inflammation.
Thus, most CCCs in the U.S. use a combination of the CT and the PET. If an area of increased uptake coincides with a mass seen on CT, it is highly likely to be malignant. PET is fairly sensitive as well, catching very small cancers.
In terms of the difference between U.K. and U.S., I can only hazard a guess, based upon my travels in the U.K. and Canada. Scanning technology, as a rule, is less prevalent under the nationalized health model than it is here. Friends from Canada routinely come here to Ohio or to Michigan to receive MRI, CT and PET scans, due to the difficulty getting scans in Canada. I have heard the same thing from friends in England.
PET is a newer technology than CT, and even here, the number of machines is much smaller than CT or MRI. It is likely the supply of PET scanners - and the ability to rely on the CT scan + biopsy to achieve the same result. Jeff SCC Right BOT Dx 3/28/2007 T2N2a M0G1,Stage IVa Bilateral Neck Dissection 4/11/2007 39 x IMRT, 8 x Cisplatin Ended 7/11/07 Complete response to treatment so far!!
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#41093 05-08-2007 03:10 PM | Joined: May 2007 Posts: 666 "Above & Beyond" Member (500+ posts) | "Above & Beyond" Member (500+ posts) Joined: May 2007 Posts: 666 | This is my take on it. As already indicated the PET scan looks for metabolic anomalies while the CT scan looks at the morphology (structure). The PET scan also may indicate spread more clearly. Both of these are used for planning IMRT treatments and are performed together (generally ?). You need to know which areas to zap and which to protect, for this a 3D representation is needed which shows where the cancer is or is suspected to be after surgery for instance.
Markus
Partial glossectomy (25%) anterior tongue. 4/6/07/. IMRT start @5/24/07 (3x) Erbitux start/end@ 5/24/07. IMRT wider field (30x) start 6/5/07. Weekly cisplatin (2x30mg/m2), then weekly carbo- (5x180mg/m2). End of Tx 19 July 07.
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