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can radiation therapy cause hot spots in PET scans?

ranelle65
Posts: 63
Joined: Jul 2010

I am just curious...does anyone know, or ever hear about, radiation therapy causing HOT SPOTS in PET scans? I am 6-weeks out from the end of my radiation therapy and my PET scan results indicated HOT SPOTS...does that mean my cancer has spread, or that the treatment area is just messed up or still healing itself from the radiation therapy??

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mp327
Posts: 3076
Joined: Jan 2010

Hi Ranelle!

Please see my post on the other thread. The hot spots could very well be radiation still working it's magic.

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pjjenkins
Posts: 173
Joined: Mar 2009

I was told the hot spots are bits of inflammation where you are still healing and this is, indeed, evidently what they were for me. Trust yours are, too.

ranelle65
Posts: 63
Joined: Jul 2010

Thanks Priscilla...I was relieved to know that was the case when I saw my onco this past Friday. Also, Martha was a big part of my knowing this despite my close mindedness about the possibility of being cancer free.

Dog Girl
Posts: 100
Joined: Sep 2010

I'm 16 months post treatment and my first post treatment PET scan showed hot spots as well, especially where the tumor had been. My Onc. said that was to be expected as there will still be changes to the cells for several weeks after cessation of radiation. My CT scans since then have been good, so try not to worry about it. (I know; easier said than done.) It is going to be a series of tests that will tell the complete story.

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z810840b
Posts: 212
Joined: Jan 2010

i am 26 months ned.I had hot spots where the tumor was.My doctor said it was most likely the radiation still working.So doctor did a punch biopsey(deep sample) to make sure.All was well!!!

dharma19
Posts: 13
Joined: May 2010

My doc gave me some bad news. My PET (the first since radiation ended, which is about seven months) shows an SUV of 5 hot spot in the area where the tumor was. I was getting pain and discomofort and now bleeding. I am having an EUS Tuesday but pretty much wqas given no hope for what this means. The doc said something about surgery after the EUS. I am in shock, they told me there was an 85% cure rate, and I am in the 15% Also did this come back sooner than most? Thank you all.

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mp327
Posts: 3076
Joined: Jan 2010

I'm very sorry to hear this. I hope the EUS will help your docs determine what is going on. Keep in mind that hot spots can be caused by the radiation still working (which can be for months after treatment) and also inflammation. I just had a PET scan last week, which showed an SUV of 3.56, and I am almost 2 1/2 years out of treatment. The report indicated that it was probably physiologic in nature, which would indicate inflammation. I will know for sure when I see my colorectal doc on 2/17. I sincerely hope in both our cases these hot spots turn out to be nothing. Please let us know what the US shows and where you go from there. My thoughts and prayers are with you.

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lizdeli
Posts: 522
Joined: Jul 2009

You could have inflammation in the area and that could be what is causing the SUV uptick. The EUS will help clarify and so would a biopsy if your docotr is really concernced about it. Just be sure he doesn't jump to surgery without thorough testing and evaluation.

Remember how rare this cancer is. It's rare for us and for the doctors. If you don't feel comfortable with what they come back with, get another opinion.

Wishing you well.
Liz

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z
Posts: 1267
Joined: May 2009

Hi Dharma, Pre tx my suv uptake was 20.1, post tx 3 months after it was 2.7, then 9 months post tx it was 4.3. My oncologist attributed the suv to inflammation due to radiation. I hope everything will turn out good and its just precautionary follow up. I had a biopsy at 9 months also, and it came out fine, even with the suv of 4.3. 2.5 and under is normal, or what they look for. I wish you well Lori.

dharma19
Posts: 13
Joined: May 2010

I wrote a while back when I first received the news that my PET scan came back with a 4-5. My oncologist said that anything in the five range is cancer. I had the EUS and a deep needle biopsy and it came back negative! Also, the surface showed pretty significant inflammation and the doctor called it radiation proctitis. Then the biopsy showed mild inflammation. All I know is that it still hurts a lot but I can live with a hurting rectum rather than cancer. So, I guess you never know. I am pretty confused since they were convinced I had cancer back but right now I am going to try to enjoy it. Thanks for all of your positive energy. I am going to send positive energy your way, I know that some of you are going to the docs soon and hopefully this will bring some comfort. You just never can tell.

duckyann
Posts: 162
Joined: Jun 2009

dharma19 - That is great news! So happy for you that everything is good and it was just radiation proctitis. Thank you for letting us know.

Take care

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mp327
Posts: 3076
Joined: Jan 2010

Your post couldn't have come at a better time for me, as I see my colorectal doc tomorrow, following a PET scan that showed an SUV of 3.56. I am 2 1/2 years post-treatment and have been praying that this is just inflammation, just like it was in your case. Reading about your experience has made me feel more hopeful about mine--I have been on edge for a couple of weeks since the scan. Thank you for sharing this with us--it is encouraging to me. I'm so happy your biopsy came back negative. Here's hoping you heal from that quickly!

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mbh97766
Posts: 39
Joined: Nov 2010

Martha
Sending good Karma your way for your appointment tomarrow.
Darcee

sissy310
Posts: 300
Joined: May 2010

Darhma, I started to read this and what a roller coaster ride that was. I was upset for you and then thank god everything worked out well. Whew. What a relief. I'm very happy for you.

Martha - am sending you positive thoughts and good news for your appointment tomorrow.

Marilyne

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mp327
Posts: 3076
Joined: Jan 2010

Thank you Darcee! I appreciate that so very much!

Thanks you Marilye! As always your words have lifted my spirits!

Hugs,
Martha

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z
Posts: 1267
Joined: May 2009

Dharma, Its so good to hear of your good news, and I know how scary that is. Celebration is in order!

Martha, I'll bet your exam will be just fine and the suv is from the radiation.

Damn radiation, but it has ridden us of the cancer.

I will have you in my thoughts and prayers. Lori

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mp327
Posts: 3076
Joined: Jan 2010

I appreciate that very much and I know you're right. I'm just in drama queen mode right now--this too shall pass!

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mp327
Posts: 3076
Joined: Jan 2010

Hi Everyone--

I didn't want to start a new thread for this, but wanted to let everyone know that I saw my colorectal doctor this morning for DRE and anoscope and everything looks good! Apparently, the activity on the PET scan was due to a little inflammation from the surgical site of last September's wart removal. She did not see anything of concern. I will see her again in 3 months.

Thank you to all of you for the words of support, encouragement and prayers. I appreciate that so much! I have removed the drama queen crown!

Hugs--
Martha

z's picture
z
Posts: 1267
Joined: May 2009

Hi Martha,

This is great news! It is fine to be a drama queen, when we are faced with the uncertainty of this disease. I really don't think your a drama queen though. Its great to be able to express all of our feelings and this is the best place to do it. I wish you well. Lori

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lizdeli
Posts: 522
Joined: Jul 2009

So happy to hear the good news for you both!!!
xoxo
Liz

mp327's picture
mp327
Posts: 3076
Joined: Jan 2010

I so very much appreciate your concern, words of encouragement and support, and congratulations. I am having a very happy day! Thank you, friends!

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sephie
Posts: 543
Joined: Apr 2009

congrats to all that got good news. and hugs to those that are still waiting for results. i am confused and nervous because my docs at MD Anderson will not do a pet scan only CT's. I only had one at the beginning of treatment. i think because of protocol??? or because it will show hot spots that are not cancer???/ i really do not know. i am 18 months post tx. i do still have pain on opposite side from tumor and bleed some times. should i insist on one??? just need an opinion. thanks

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mp327
Posts: 3076
Joined: Jan 2010

Thanks for the congrats. As for PET scans vs CT scans, I think it comes down to a doctor's preference. My med onc just happens to prefer PET scans, so that's what I've been getting. I am not a radiologist, so I'm not real clear on the advantages/disadvantages of either, but I'm sure there are some for each test. It is true that PET scans can show hot spots that are NOT cancer, just as mine have a few times. I guess you would have to put that in the disadvantage column for PET scans. In my case, having the scans is both good and bad--they rule out a return of my cancer, but any activity shown on them always throws me into panic mode, even though it's always come back as "physiologic" or inflammation.

How often are you getting scanned? I would insist on one at least once a year. When was your last one? Also, how often are your follow-ups for DRE's and scopes? I am being seen by my colorectal doc every 3 months. I believe in playing it safe and would certainly mention the pain and bleeding to your doc and ask for an evaluation. Those are just my opinions.

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sephie
Posts: 543
Joined: Apr 2009

thx for the reply. i get CT once per year. next one is march 11 along with DRE and proctoscope. i get DRE and proctoscope every 6 months by surgeon. i also get DRE every 3 months by radiologist until 2 year mark post tx. when getting the CT scan , they place a tube up my bottom to put die in there . it always hurts and last time scratched me so bad i had to put off the proctoscope. i tell them to be careful and use lots of lubricant but..... hugs sephie

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mp327
Posts: 3076
Joined: Jan 2010

Hi Sephie--

It sounds like you are getting good follow-ups. I just want to wish you all the best with your results on March 11th. Please let us know how it goes.

Gulamin
Posts: 132
Joined: Dec 2010

So wonderful to hear all the good news... hopeful for my visit on 3/30!

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lizdeli
Posts: 522
Joined: Jul 2009

Hi Sephie
I'm treated at MDA also and same as you, I only had a PET once in the beginning. It's been CT scans every six months since then. I'm just approaching my 18 months and my next scan is on Monday. Surgeon does protocopy and DRE every six months as well. From what the docs have told me at MDA they do CT scans as their protocol. The CT scan had a 3 dimensional view of the organs, maybe that's why. I almost know tooo much about my body!

Liz

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sephie
Posts: 543
Joined: Apr 2009

what stage were you??? who were your doctors?/ i am just now approaching 18 months and i have not had a ct since feb of last year. i am not afraid to approach my docs if i feel the ct's are too far apart even though it is a little late now. scares me but we will know more on march 11 or 14. thanks

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lizdeli
Posts: 522
Joined: Jul 2009

Sephie
I was stage IIIa. I had two small spots on perirectal lymph nodes. Doctors: Dr. Chang, Surgeon, Dr. Eng, Oncologist and Dr. Crane, Radiologist. My tumor was 2.6 cm. Did you have any lymph node involvement?

I'll PM you my phone number if you have any questions.
Liz

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lizdeli
Posts: 522
Joined: Jul 2009

Sephie
I was stage IIIa. I had two small spots on perirectal lymph nodes. Doctors: Dr. Chang, Surgeon, Dr. Eng, Oncologist and Dr. Crane, Radiologist. My tumor was 2.6 cm. Did you have any lymph node involvement?

I'll PM you my phone number if you have any questions.
Liz

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sephie
Posts: 543
Joined: Apr 2009

liz, i was stage 2 with no lymph nodes, which is truly a blessing since i went for over a year thinking it was a hemmy. and proctologist here in monroe, louisiana did not catch it. at MDA, my oncologist is overman, surgeon is skibber, radiogist is declos but have also seen crane. i am not really sure of size of tumor because surgeon in shreveport tried to remove as much as possible with biopsy but did not get it all so therefore i went to MDA for chemo and radiation with lots of scar tissue from biopsy. i will know more on march 14 after i have the ct on mar. 11 . procto and etc on march 14. since the tx, i have had a problem of inflammation and bump on the left side of anus oposite from where tumor was. they keep watching it. i will let all of you know what they tell me. thanks for your help. sephie

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lizdeli
Posts: 522
Joined: Jul 2009

Sephie
Since you didn't have lymph node involvement that may be why you don't get CT scans as frequently. You have good doctors, ask them in March why you only need the CT once year. I was told I needed to be watched because of the lymph nodes. The tumor was also abutting against the vaginal wall so they want to keep a close eye on it.

But you have the right to understand why your follow up differs, so ask away when there.

Wishing you well.
Liz

duckyann
Posts: 162
Joined: Jun 2009

Sephie,

I was a stage 2 also and I only get scanned once a year. I don't know if that makes you feel better but even in the NCCN guidlines it does not mention scans for Stage 1 & 2 and Stage 3 annual scans. Those are just guidlines though and every doctor is different. Your doctors seem to be following you well and you are from what I hear in one of the best Cancer Centers.

I have an appointment on March 11th too but just for a DRE and anoscope! I will be praying that all goes well with your scan & appt. Please let us know.

Nancy

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sephie
Posts: 543
Joined: Apr 2009

nancy, thankyou. i will be praying for you also on march 11. i will know more on the 14 th after all the exams. i would not be worried except for the continuing problem with inflammation and pain on left side of anus. oh well will know soon. hugs sephie

duckyann
Posts: 162
Joined: Jun 2009

sephie, I had my PET/CT scan in mid Oct. and it showed a hot spot that was not there previously. I was terrified and it was on the left side also opposite of the original tumor. I had a biopsy done and it was negative. It was all due to inflammation and scar tissue. I was 16 months post treatment the time of my scan. How far out of treatments are you? I really think you are going to be fine. This treatments does a number on most of us. Hang in there....hugs back at you...Nancy

lizdeli's picture
lizdeli
Posts: 522
Joined: Jul 2009

I just returned from MDA. Everything is good. Had CT of Lung, Pelvis, Abdomen, flex sigmond something, DRE, blood work. All came out well. Thank God!!!
Liz

sephie's picture
sephie
Posts: 543
Joined: Apr 2009

liz, congrats!!!!!! what a wonderful report. will let you know about mine when i return from MDA in march. one question. do they put the tube with dye( or whatever it is) up your bottom for the CT ???? last time that scratched the Heck out of me and messed me up. sephie

lizdeli's picture
lizdeli
Posts: 522
Joined: Jul 2009

I just returned from MDA. Everything is good. Had CT of Lung, Pelvis, Abdomen, flex sigmond something, DRE, blood work. All came out well. Thank God!!!
Liz

mp327's picture
mp327
Posts: 3076
Joined: Jan 2010

Congratulations on all your good news and thanks for sharing it with us! I'm so very happy for you and hope you are taking some time for celebration. As always, I wish you continued good news. Stay well!

Hugs--
Martha

z's picture
z
Posts: 1267
Joined: May 2009

Hi Liz,

Great News! I just love great news, it gives us all hope. Lori

duckyann
Posts: 162
Joined: Jun 2009

Great News Liz.....I am so happy for you!

Nancy

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nonichol
Posts: 114
Joined: Jul 2010

Congratulations! What a relief it is when we have good test results. Celebrate!!!

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sephie
Posts: 543
Joined: Apr 2009

nancy, i am 18 months post so I hope it is just inflammation due to radiation and i hope that it does not form more of the bad cells. sephie

lizdeli's picture
lizdeli
Posts: 522
Joined: Jul 2009

Thank you everyone. I am so relieved, yet once again humbled by all the people I met during my short visit at MDA. Waiting for the CT scan is endless and of course I wound up talking with many. Their stories were so intense, such hard battles. I learned of cancers that I never knew existed. One woman had such a rare cancer that there are only 100 people world wide that they know of who have it. Chances are 1 in 7.2 million! Makes me thankful even though I had cancer, that it was one that has such a fighting chance.

Sephie, yes they do a barium rectal enema. It's standard protocol at MDA. Not pleasant, but if it helps to insure that they see whatever they need to see then it's worth it.

Also, even though I have no discomfort I do have some inflammation per the surgeon who did the proctoscopy/sigmond thing. I can't keep up with all those terms. I guess that's to be expected considering the doses of radiation we got.

Wishing everyone well and good results on all upcoming scans.
xoxo
Liz

lizdeli's picture
lizdeli
Posts: 522
Joined: Jul 2009

Thank you everyone. I am so relieved, yet once again humbled by all the people I met during my short visit at MDA. Waiting for the CT scan is endless and of course I wound up talking with many. Their stories were so intense, such hard battles. I learned of cancers that I never knew existed. One woman had such a rare cancer that there are only 100 people world wide that they know of who have it. Chances are 1 in 7.2 million! Makes me thankful even though I had cancer, that it was one that has such a fighting chance.

Sephie, yes they do a barium rectal enema. It's standard protocol at MDA. Not pleasant, but if it helps to insure that they see whatever they need to see then it's worth it.

Also, even though I have no discomfort I do have some inflammation per the surgeon who did the proctoscopy/sigmond thing. I can't keep up with all those terms. I guess that's to be expected considering the doses of radiation we got.

Wishing everyone well and good results on all upcoming scans.
xoxo
Liz

Gulamin
Posts: 132
Joined: Dec 2010

to hear your results... just logged on after a while and that made me so happy. I wanted to share that. All the best to you!!!!

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