Hello all,
I am just past a year out from the completion of my treatment for SCC of the tongue - Chemo/IMRT. I was stage 2 with no metastisis. Everything to date has been right on target for healing and no signs of recurrence. I'd had two PET scans following treatment which showed no metastisis whatsoever. I just had my third follow up PET/CT last week, and really felt positive about the outcome.

I got the results. The findings go like this: "Moderately increased FDG accumulation within and enlarging infrahyoid right internal jugular vein lymph node. This has developed since the prior examination October 2006 and is concerning for metastatic spread of the patient's primary tumor. No evidence of recurrence of the primary tumor on this examination."

I could clearly see the white spot on the PET images - where there was never any white before and way down at the base of my neck, where I'd never had any other issues during or after treatment.

So...I'm not a doctor and I guess I'm not supposed to be able to interpret that but it seems pretty obvious. I'll be at my primary doctor on Monday and I guess I'll find out what he thinks I should do.

Is surgery probably the most likely outcome? I'm trying to study up on other cases where people have had lymph node metastisis after the primary tumor has cleared up, and get a feel for what I'm going to be looking at.

thanks,
Steve

Steve,

Sorry to hear that you may have a met to your lymphnode. Remember it's not for sure until you get a biopsy. I hope and pray that this is a false positive for you.

Not sure about most likeley course of treatment for you, what were your prior treatments?

Tim

Dear steve
what a worrying time for you.I know when Robin had his neck dissection they removed his internal jugular because it is very susceptible to spread.Did you have surgery?From my anatomy lessons i guess infra hyoid is somewhere near the hyoid bone at the front of the throat,what a worry,but dont get to alarmed until you have a differential diagnosis.Let us know how you get on.

I did not have surgery - 3 rounds of Cisplatin chemo and IMRT x 35.

Would they do a biopsy of such a lymph node and not just take it out? The corresponding CT scan also indicated slight enlargement of the lymph node. I know when I was healing from radiation, they explained to me that healing, scarred tissue could show false positive on PET. It just seems to me where there's no chance that this location is just healing scar tissue (it's not within my original treatment area), the PET/CT would be a pretty strong indication.

I guess if they want to just biopsy that's ok but the idea of leaving it in there makes me nervous. Seems like they'd want to just get it out to be safe.

thanks
Steve

Steve,
"Salvage" surgery would be one option but since it is in a different location you could conceivably get IMRT again. We're getting ahead of ourselves here though - you still need a pathology report, either from a biopsy or FNA and possibly an MRI as well.

Remember that the reading radiologist has to notate every anomaly and it is only a part of the full diagnostic workup. False positives happen more commonly then false negatives on a PET ot PET/CT.

Hang in there.