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Residual mass after CT-RT for anal Cancer

devendra13
Posts: 2
Joined: Oct 2013

Hello everyone,

I am not a cancer survivor but my father is. I hope its ok for me join this network. My father completed standard CT (Mitomycin-C + 5FU two cycles) + RT (60Gy/30 fractions on IGRT) protocol for anal cancer (squamous cell carcinoma) for a 9 x 7 x 5 cm mass that had invaded his left posterior acetabular column ( left hip bone). Treatment finished on 30 August, 2013. We did first PET-CT scan yesterday (7th Week after the end of the treatment). It still shows a 4 x 3.6 x 2.8 cm mass. However, it is written that there is no demonstrable abnormal FDG intake in the mass. Dr. told us that this traslates to "Cancer is gone and this is just scar tissue".

I am having hard time digesting this fact. I hope to know more from the community here. Is there a cancer survivor out there with similar mass after RT treatment which turned out to be just scar tissue? What are the chances that the cancer has not gone completely and will be back in that large mass?

Thank you for your time,

Devendra

eihtak
Posts: 809
Joined: Oct 2011

Hi, how nice of you to post on behalf of your father, although I am sorry for the need. In answer to your concerns.....most if not all of us who were scanned just 2-3 months after treatment had a similar report. Much inflamation and scar tissue results from this treatment and some is a permanent side effect. I am 2.5 years post treatment and still have scar tissue, although considerably less inflamation than 2yrs ago!! I always think of radiation like a microwave........when you take food out it continues to cook for a couple minutes. After the last radiation treatment, it was still "cooking" tissue for a while and thus creating scar tissue. Some doctors recommend avoiding scans too early to avoid this confusion.

Please stay in touch and keep us updated, until then, I will have your dad and you in my thoughts and prayers as he moves forward.

mp327's picture
mp327
Posts: 2818
Joined: Jan 2010

I admire you for coming here on behalf of your father.  I can certainly understand your concern about the mass showing up on the follow-up scan.  However, eihtak has already given you some good thoughts to keep in mind.  The radiation does continue to work for awhile and there seems to be some controversy as to when that first post-treatment scan should be done.  My med onc ordered mine not even 6 weeks after my treatment ended, against the recommendations of my rad onc, who wanted to wait 3 months, his reasoning being that there would still be radiation present and it would show up as a hot spot.  Well, he was right.  I had the scan at less than 6 weeks and the SUV was still pretty high.  It freaked me out, as I thought that the treatment had failed.  However, it was determined to be inflammation/scar tissue/remaining radiation and NOT residual cancer.  I am now 5 years post treatment and am doing very well, with no sign of recurrence upon last exam.  I do think, based on my own experience, that your dad's scan may have been a bit premature and that the results are hard to evaluate because of the reasons I've stated.  Inflammation can easily show up on a PET scan, which is why a person is told not to exercise 24 hours prior to the scan, as the simple act of exercising can cause inflammation in the tissue.  Also, scar tissue is very common after this treatment, which eihtak described very well.  Anything cooked too long in a microwave can look like scar tissue, just like our insides can turn to scar tissue from this treatment.  I'm betting that most of us have scar tissue post-treatment.

Your feelings of doubt and uncertainty are normal.  I rarely use the term cancer-free to describe my status, as there's always that lingering doubt.  We all go through it as survivors and/or family members.  My hope is that your father will be evaluated again in a few weeks with digital rectal exam and anoscope and your fears will be eased.  May he get all good news.  Please come here whenever you have questions, doubts, fears, or just need to vent.  We are here for you! 

lp1964's picture
lp1964
Posts: 825
Joined: Jun 2013

I myself have/had rectal cancer but received the same treatment as your dad. About 10 weeks after radiation I had a scan that indicated almost no change to my cancer. I was very disappointed. About 2 weeks ago I had my rectum removed alongside the cancer and the pathology report which is more detailed than any scan since the look at everything under a microscop, indicated no cancer at all. It was all scar tissue. So no worries.

All the best for your dad and your entire family. 

Laz

devendra13
Posts: 2
Joined: Oct 2013

I would like to thank everyone for their replies. It does put my mind to rest a little. The treatment has been long and painful for my father. So I am hoping that all this effort pays off. One cannot make generalisation from a few individual cases, none the less, it is heartening to know that people all over the world have gone through similar process and survived.

Thank you once again for your support. We have a scan planned after four-six weeks from now. I will keep you posted.

Devendra

erikire
Posts: 11
Joined: Nov 2013

I completed treatment of 6 weeks radiation and chemo (1 mytamican booster + daily Xeloda) on Aug 5th.  First PET scan 30 days after revealed 80% reduction and much lower SUV levels.  Had second PET scan yesterday, 3 mos. post-treatment and doctor told me mass is still there and active so they want to put me on another round of just Chemo - mytamicin + xeloda again.  I'm very dissapointed but realize they are trying to avoid surgery. 

I was T4 N0 MO, large tumor - 9cm x 6.8cm. 

Would love to hear more of your story. 

mp327's picture
mp327
Posts: 2818
Joined: Jan 2010

I'm very sorry to hear that there was not complete resolution of your tumor and that you have to undergo more chemo.  Please keep us posted on how things go.  I wish you all the best.

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