Are CTscans alone enough or Pet Scans needed too?

maryaz

I have a question about Pet Scans. I knew nothing about cancer treatment until my husband's journey this year. I thought the real test to know just what is there in the way of cancer was a Pet Scan. Even now my husband has had 2 CTscans since his surgery and shows no cancer. Yet there is going to ultimately be a Pet Scan according to our understanding.

I am asking this because now I am thinking that I am thinking that may not be right. I don't want to ever tell anyone anything wrong.

My husband had CTscans. He had an inclusive Bronchoscope and so had to have a needle biopsy to determine for sure it was cancer. After that the Pet Scan really showed where the cancer was.

Onecoyote's husband had a CTscan. Is it due to the way the cancer shows. I just want to understand right.
_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1262

Hi Mary,

Thanks! The only conclusive way of making a diagnosis is by having a biopsy of some type of another. Tumor tissue samples are the key. Often broncoscopies cannot get far enough into the lungs to grab a sample. Needle biopsies or wedge sections are often needed.

Beyond that, PET scans are the state of the art in determining location and how active the tumors are. CT scans are good too. PET's sometimes light up things that may go unnoticed on a CT scan. The reason why PET scans are not always used is that they are fairly expensive and most insurance companies balk at using them. Often they are used and allowed initially, but not repeated because of the cost. If the doctor writes out the script in the correct way as "restaging of Stage IV lung cancer," I know Medicare picks up a portion of the tab. It's a game with insurance companies and the docs have to know how to play the game. If you already have a conclusive diagnosis, the docs may wait until some treatment is given to utilize the PET scan. They already know most of the locations of the tumors from a CT, so the PET is an excellent tool to use to see if the treatment is working. CT's can pick up a dead tumor, but a PET will show it is dead by not lighting up.

That's our experience on the whole PET scan issue. My husband routinely had both a CT and a PET every three months. I've also noticed they don't utilize PET scans as much for SCLC as they do for NSCLC. I have no clue why.

Hope this helps and anyone with different experiences please feel free to jump right into this discussion.

Hope your Hubby is doing okay Mary.

Hugs,
PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

simplyklb

My parents have not had a PET scan since their initial diagnoses in May.

Kristi
_________________
Dad - Andy, 70, diagnosed with SCLC in May 2008
2/20/38 - 10/15/08 Fly high, Dad!
Mom - Jackie, 67, diagnosed with NSCLC in May 2008

brainman

Mary, PET Scans are most often used in the staging process following the biopsy. However, not everyone needs a PET Scan. Sometimes it can detect smaller tumors than a CAT Scan. However, if it can be seen on a CAT Scan, it is likely that the doctors will continue to use it rather than do a PET Scan.

This is a good question for you to ask your husband's medical team.

Mary, you and your husband continue in my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

onecoyote · Experienced user Joined: 15 Jul 2008 Posts: 66

Hi Mary,
Thanks for getting back to me. I just wanted to let you know that my husband's doctor felt it wasn't necessary yet to do a PET scan, nothing to do with money since he is at the VA.
My husband has had a regular CAT scan, a biopsy during his bronchoscopy, and a contrast dye CAT scan. The bronchoscopy revealed a less than 3 cm. tumor in his right middle lobe which had collapsed on top of it(maybe this kept the cancer at bay?). The biopsy revealed squamous cell, poorly differentiated carcinoma. The contrast dye CAT scan showed no lymph node enlargement or lighting up. All of this information was used to determine his surgical candidacy. Tomorrow we go to see the surgeon to find out the details as well as what stage they consider my husband to be at. The pulmonologist did make it clear to us that surgery had to take place this month and for us to place this at the top of our list ahead of everything else.

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1262

Hi Mary,

Well -- I feel like a dope! I didn't realize you were answering a question in the other thread. Rolling Eyes

I'm sorry. Thanks for posting this in a new thread -- it's probably worth it, but I acknowledge my faux pas. Chalk it off to shrinking brain cells. Wink

PET scans fall under a "preference" for each oncologist. You may not have to do them, but they are a useful component in the whole picture. How often either scan is done is also the choice of each doctor and they do vary. Generally speaking, if a patient is doing well, breathing better, and gaining weight that points to a response to chemotherapy. I can only go by my husband's experience with our particular oncologist.

PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

maryaz

PBJ, We are fine. No problem. It was not clear to you. I debated where to put it. Onecoyote and I sort of talked behind your back in a PM. Actually, it is good on its own topic.

I didn't understand about the Pet Scan. I probably cannot explain it, but I think I can understand why my husband was having them. He was so borderline too for surgery.

I like the response you all posted. Two CTscans have indicated no cancer for my husband since surgery. I have had some anxiety about the Pet Scan one day. None set yet. Had been mentioned.

I sure hope the surgery for onecoyote's husband works. Sounds like that is the reason so soon. Let us know when you have a date. Take care,
_________________
Mary

Husband is 67 year old Male
NSCLC - Squamous Cell Carcinoma
Chemo and Radiation Treatments together
Allergic reactions to Taxol and Taxotere.
The Story: http://www.cancerforums.net/about9079.html

karibrenmom · Regular Joined: 23 Oct 2007 Posts: 36

I have wondered on this same question too, but for after surgery. My mom had her surgery in November and has had two lung CT's since. I worry because her tumor had invaded the visceral plura and still they are only scanning her lungs. It seems they should check the rest of her as well to make sure no mets as on the PET it didn't show the tumor crossing the lung lining. I know it is all 'what if'....
_________________
My mom was diagnosed with NSCLC Squamous Carcinoma 10/23/2007. Wedge resection 11/20/2007. Final pathology showed poorly differiniated large cell carcinomawith invasion of visceral pluera, T2NxM0/stage 1B. 12/14/2007. No chemo elected.

dano

This was a good question, with good information back. I had my initial Pet scan after my biopsy to help determine the extent of the Cancer, then that was followed with an MRI to determine if mets had sped to the brain, which they had. Normally brain mets are a high priority to work on first, however mine were small (largest was 6mm at the time) and my coughing and breathing was bad that they chose to use chemo first. I do remember that the Pet scan was very expensive, and I was wondering when they may do it again. But listening here I realize that I may not get one again until at least a year after the first at best, but I have had several CT scans and some have been lower than my chest just to double check other organs than my oncologist and I had talked about. It was a help to talk about things that I'm feeling so the doctor could have questions answered with the right CT scan while we are doing it.
God Bless
Dan
_________________
54 year old male in Hawaii
Diagnosed Nov. 9,2007 with NSCLC IV
with Mets to the lymphs and brain
Had full brain radiation treatment in Jan 08
Currently on chemo treatments every 3 weeks
with Alimta
and taking Lovenox for blood clots
Now back to work full time
http://cancerforums.net/viewtopic.php?t=9993

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1262

Typically PET scans cover the area from the bottom of the head (which means nothing, because PET's don't work on brains) to the thighs. Usually they will do the initial scan, then rescan the liver area to make sure there are no further uptakes in that area.

CT's and MRI's are the way to go for the brain. MRI's are better and also best for bone mets. Oddly, my husband only had two CT's of his brain the entire time. His cancer liked his lungs -- a lot and his only caused two bone mets that were picked up by the CT/PET combo.

Random thoughts... Wink

_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

brainman · Last edited by brainman on Tue Aug 26, 2008 10:49 pm; edited 2 times in total

The benefit of an MRI or CT over a PET scan is that they are better ways to image the tumor, its specific location, and if there are any other parts of the organs involved in the tumor.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

dano

Hi Mary;
Sorry if I've missed something, but I'd like to know what is happening with your husband, I'm hoping for good news which is hard to find. After reading your husbands medical history, I'm a bit worn out. So many doctors involved, so much confusion. It sounded like they were were really well intentioned but in part by the numerous complications your husband had put you both in a continual tail spin. Something was keeping you from attending your husbands visits, I didn't hear why. At the start I had someone with me for the first three months with a note book to take info, it was a help. A lot of times after the doctor visits my wife and I would talk and clarify what we just heard. I laugh now, but we would line up questions for my Onc and ask them, then after the appointment realize the questions never really got answered. What we believe the reason was we were asking opinions relating to the future, and she had no way to give a truthful answer without sounding bleak. She was too up beat to do it, what I found was her associate Oncologists could answer questions better. I had previous heart problems and still have a blocked artery in my heart but I can manage normal life without problems, once I started on cancer treatment, the cardiologist stayed out of the way, he was posted if and hearts meds were altered and was notified when I had some chest pains that the Onc followed up with an EKG and Ultra sound, sending the info to my cardiologist, which used it on my 6 month check up right afterwards. My Oncs clinic was part of the Queens medical system, all my doctors were a part of it, and all testing procedures. I had reactions to meds and chemo and didn't know which end was up sometimes, I went to the Emergency room once because of the way I was feeling early on with my Oncs advice, just to be disappointed which going there, it seemed unfair to put a doctor in that position when my regular Docs scratch their heads enough on their understanding of what I have and what is next. So I stopped going to emergency rooms for cancer related problems, I learned to calm down and not be so anxious, and help my lovely wife do the same. I learned that my wife could handle certain things and some things not so good. So I had to relate to her in ways to reduce stress as much as possible and laugh about it as much as I can. It seems to help.
Again I am amazed at what you and your hubby have gone through and still holding it together.
God Bless
Dan

Hoping you get this Mary!
_________________
54 year old male in Hawaii
Diagnosed Nov. 9,2007 with NSCLC IV
with Mets to the lymphs and brain
Had full brain radiation treatment in Jan 08
Currently on chemo treatments every 3 weeks
with Alimta
and taking Lovenox for blood clots
Now back to work full time
http://cancerforums.net/viewtopic.php?t=9993

UneasyRider · Regular Joined: 21 Aug 2008 Posts: 16

After my initial x-ray, the VA used a dye contrast CT scan on me. I had surgery, then just another x-ray 3 months after surgery, then a dye contrast CT scan at 6 months after surgery. It sounds like the VA likes the dye contrast CT scans for lungs.
_________________
57 year old male in Texas diagnosed with Stage II NSCLC in November, 2007
Treated with upper left lobectomy and 3 rounds of adjuvant chemotherapy
6 month CT scan shows lungs clear
My story is in this thread: http://cancerforums.net/viewtopic.php?p=39609#39609

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1262

Uneasy,

I'm suspecting that a lot of places use CT's over PETs because the PET scan is a lot more expensive.

Sometimes it depends on insurance coverage and the particular oncologist. Ours was a nut for both -- a good nut though! Very Happy

I would have suspected that he was a little more insistent with a PET because of the amount of cancer my husband had, but I heard many patients making appointments for PET scans while we would be at the office. Go figure. They all have their own way of doing things and some have more constraints because of policies, like the VA. Our doc was a solo-practice, so he did what he wanted.

I see far less people getting PET scans as follow-ups than I do getting CT scans. Keep pushing for the best Uneasy. Make sure they utilize CT's and not just x-rays.

More random thoughts.

PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

onecoyote · Experienced user Joined: 15 Jul 2008 Posts: 66

Uneasy,
My husband had an initial xray, a catscan, a contrast dye cat, two more xrays, two bronchoscopies, a mediastinoscopy, a mobile xray after the mediastinoscopy and next up is surgery. He goes to the VA also and they don't seem to skimp on anything. The surgeon asked us if we wanted a PET scan but we would have to go to a non VA hospital for that.
I am sure if you requested it, they would oblige.
Take care,
Onecoyote

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