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GKH
Posts: 292
Joined: Jul 2012

Can anyone tell me how good the PET scansarre at finding indolent lymphomas? I am convinced I have something going on in my left leg. Nothing showed on a PET in March or a Ct in April. I am wondering about the skill of the radiologist as a factor. My onc said PET is not always good at finding small indolent lymphomas, especially in bones or joints. In my first PET, the brighter spot was only 2.8 and it took a biopsy to confirm NHFL stage IV with bone marrow involvement. Any ideas about how best to tell if I have a lymphoma in my left thigh bone? I do also have infrequent night sweats but only from the shoulders up. I feel generally pretty good but with days when I can hardly function. Left leg pain is constant.

Garry
Nhfl stage IV

po18guy
Posts: 237
Joined: Nov 2011

To me, it sounds like a CT would be far better in your case. PETs are great for revealing hyper-matabolism, and in the case of aggressive cancers, they light up like a Christmas tree. Yet, a slow growing cancer does not display this trait, and so a PET might be less useful. As well, PETs are $$$ and do expose you to some rads (so do CTs, though). CTs reveal masses, whether fast or slow growing. I do not know about MRIs, but that may also be a diagnostic tool. Only an actual tissue sample will give a final diagnosis. As to radiologists, they tend to point out each and every tiny imperfection in the scans - not only as a CYA, but because they simply cannot tell from an image, what exactly is going on. They make suggestions based on the images, and things can certainly be misinterpreted or overlooked.

GKH
Posts: 292
Joined: Jul 2012

Thanks. My two PET scans were done with accompanying CT scns.

anliperez915's picture
anliperez915
Posts: 748
Joined: Sep 2011

Hi Garry,
I have also wondered the same about CT and Pet scans, I'm also having lots of pain in my sacrum area on my right side. I have been having this pain since last year but it is getting worse now with pain on my right foot but only on the right edge. I've talked to my docs one saying is a disc and sending me to therapy which didn't do anything for me. I'm also thinking that it could be something else (cancer) when I was diagnosed I had bone marrow involvement with tumors in spleen and liver and have only had Rituxan for treatment. Last time I saw my Onc he ordered another BMB and a Pet scan which will be done next week, I just hope that my pain is nothing bad and its all in my head! I wonder if the Pet scan will catch anything out or the ordinary? Take care and if you find any answers please share.

Sincerely,
Liz

po18guy
Posts: 237
Joined: Nov 2011

Disc impingement on the sciatic nerve can cause pain at virtually any point on your leg. For example, if I kneel too long, I get a stabbing pain in my left calf - yet there is nothing wrong at there - rather, it is the nerve that serves that area that is being pinched by a herniated disc in my lumbar spine. Have you asked for a scan of your spine? Thatr might alleviate worries about something more serious.

How about peripheral neuropathy? It can be anything from slight numbness to sharp pain. As well, arthritis can be a side effect of some chemotherapy drugs. From the Univ of Penn Abramson Cancer Center site: "Arthritis can be observed during or after cytotoxic chemotherapy, such as ABVD doxorubicin, bleomycin, vinblastine, and dacarbazine. This usually has a self-limited course (meaning it resolves on its own) but may last several months before (usually) resolving spontaneously. It can involve several joints in sequence, but is usually non-inflammatory, i.e. joints are NOT red, swollen, or hot. If any of these symptoms develop, then a workup should be performed for an inflammatory arthritis, such as rheumatoid arthritis. These other conditions, however, are very rare in this patient population."

GKH
Posts: 292
Joined: Jul 2012

Actually I saw a neurologist yesterday. I had back pains for years along with the leg pains. Also I have experienced some problems with double vision. This neurologist suspects that lymphoma cells have infiltrated nerve endings either in my lower spine or brain stem. The rituxan dealt with some of that and that may be why the back pains suddenly stopped when I began rituxan. He has ordered MRI of my lower back and brain. He says this was probably not something that would show up on a PET and will be hard to detect in any case. I am also having VNG teting.

Hop your tests come out well!

po18guy
Posts: 237
Joined: Nov 2011

CT scans reveal masses, such as tumors. They can also detect structural abnormalities in veins or organs, as well as circulatory problems, even hemorrhaging, especially if contrast is used during the scan.

PET scans detect metabolic activity that is above normal. Hyper metabolism occurs during your body's healing process, as in the case of a bone fracture healing or at a surgical site, where the incision is being healed, since extra work is being done there by the body. Hyper metabolism also occurs due to the rapid division of cancer cells. Thus, a PET will show where a large amount of metabolic activity is taking place. It is not definitive in finding cancer, but works to confirm what a CT and a biopsy find. It is useful for determining the stage of the cancer.

Say that you had surgery to remove a tumor, and had a PET scan immediately after. It would show hyper metabolic activity at the tumor site - but it would not be indicating cancer, as that had just been removed. What the PET would show is the body's healing process. This is why both PETS and CTs need interpretation of the images that they produce. Both PETs and CTs can produce an image that causes concern for the radiologist reading the image, but which turn out to be false alarms when physically checked by a physician. They are very useful tools, but basically provide an indication of something that your doctor needs to investigate further.

anliperez915's picture
anliperez915
Posts: 748
Joined: Sep 2011

Thanks Po for the info, very helpful :)

Sincerely,
Liz

GKH
Posts: 292
Joined: Jul 2012

Helpful reply!

GKH
Posts: 292
Joined: Jul 2012

Helpful reply!

I have had two PET scans both times they were done with a CT can. So thy used both.

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