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Scan Questions

abita's picture
abita
Posts: 778
Joined: Dec 2017

For my lung scan two were unchanged, one increased by .2 cm. The liver one shrunk by half. 

Is there ANY possibilty that maybe some of the cells are just dead but still occupying space? I know I am grasping at straws, and that it could have been much worse. I was really expecting/hoping for shrinkage and definitely not growth.

NewHere's picture
NewHere
Posts: 1171
Joined: Feb 2015

Before I say the following, I have found it easier for me to expect the worst and hope for the best.  The couple of times I got hopeful during all this (expecting a good scan and getting a dud) it was harsher to deal with than reverse.

That being said, sometimes tumors can grow even while be affected by the chemo.  I had a couple, including my largest one in my lungs, that finally stopped growing.  (About 5cm).  More of my tumors showed signs of dying after 20 rounds of chemo, whereas I thought by this time whichever ones would have responded would have.  Unchanged is not bad, not perfect, but not bad.  Means they are stable which is a big part of the game.  And they may not have begun shrinking yet if they are dying.  Also the increase of .2 cm very well may be considered slow (probably is in fact) based on the size of the tumor on last scan and space between the scans.  And without a doubt the liver going down by half is flat out awesome news and shows that the chemp is working to a good extent.  

Some other thoughts - some tumors grow before shrinking but not sure how often when on chemo vs immunotherapy 

"Atypical response — usually tumor enlargement followed by shrinking — is seen in 20% of cancer patients who respond to immunotherapy, according to a study of response patterns in patients with a variety of tumors, including melanoma, genitourinary carcinomas, and lung tumors."

I think I had seen something about that on chemo, but cannot find it.  

Also sometimes chemo takes longer to reach certain areas depending on the vascular set up.  

Lastly, for us chemo for life types - I propose we all get together to celebrate when they make the break-through to get us off this.  Every day it gets closer.

abita's picture
abita
Posts: 778
Joined: Dec 2017

well, they all shrunk on the scan after 4 infusions

NewHere's picture
NewHere
Posts: 1171
Joined: Feb 2015

The fact that they started to shrink is good news.  Also something to keep in mind, there is some margin of error in all of this.  Especially when small growth or shrinkage.  So .2 cM may LITTERALY be aboslutely nothing.  Examples - there was study where Radilogists were given a bunch of scans to review.  Including duplicates of the same scan.  And the duplicates had different results from the same person.  Another example - I was in an immunotherapy trial with all of my mets.  But the trial doctors were told to specifically look at the same mets each time because of the reasons of the first study I mentioned.  I think it was 8-10 of all the cancer I have.  Last example, somehow in the two years since my cancer came back inoperable in my lymph nodes and elsewhere, there was one report in the middle where the report said no lymph node involvement.  Of course it was wrong.  

Basically it sounds like (to my uneducated eye, but cancer patient "I stayed at a Holiday Inn Last Night" persepctive, but of what you said the shrinkage of the liver tumor by half sounds like something you can hang your hat on.  I am not sure the others are the same (i.e., the small growth very well can be in margin of error/how things measured/even timing of contrast compared to timing of scan.)

As Tru said, each bit of good news is fine to enjoy.

Trubrit's picture
Trubrit
Posts: 5139
Joined: Jan 2013

Grasp at straws, or whatever you want to call it.  Good news is good news on the liver. Shrinkage is shrinkage. Run with it as fast as you can.  Tell yourself, if your liver mets shrink, then so can the other. 

While you are obviously working on those mets, top it off with lots of positive thoughts. 

What is in the future is in the future.  

We'll see this as a step in the right direction. 

Tru

SoCal42
Posts: 78
Joined: Jul 2017

I know that after lung radiotherapy, I was advised that it might take months for tumor cells to die off and disappear following treatment, so they didn't even schedule a scan until four months later, and even then the radiation oncologist wanted to wait several more months for another scan before really judging the effectiveness of the treatment.

Annabelle41415's picture
Annabelle41415
Posts: 6474
Joined: Feb 2009

If you have done 4 treatments and some are not growing and the other shrinking it sounds like it is keeping it stable and working.  Your treatments will continue working.  You got some positive news. Thanks for the update.

Kim

myAZmountain's picture
myAZmountain
Posts: 329
Joined: Apr 2018

LUng sugeon that I see and who painstakingly explains my CT scans has told me that there are variation in the "thickness" of the slices that the CT scan measures so that the scan doesn't always slice the tumor in exactly the same spot than can account for slightly different measurements, also if you are on the scanning table a little more to one side or you are not inhaling there can be slight differences from scan to scan--also if read by different radiologists as well. I thik the fact there is no new growth and decrease in existing is fabulous news for you, So happy to hear!!

 

abita's picture
abita
Posts: 778
Joined: Dec 2017

Thanks! Tomorrow I will get my doctor's take on it. I have to say, I am so glad that I got to see it early rather than wait. I think I spent many hours Saturday looking at past scans, and I feel like there are things my previous oncologist never told me. That really annoys me. I have definitely started looking at them, so that is good.

 

abita's picture
abita
Posts: 778
Joined: Dec 2017

So, my doctor said my scan was good, but he scheduled another scan for the 22nd. 

myAZmountain's picture
myAZmountain
Posts: 329
Joined: Apr 2018

Assuming its a CT scan ?  Hope that is is even better than the last one! 

abita's picture
abita
Posts: 778
Joined: Dec 2017

Yeah it is a CT. So, I should be happy checking to make sure on track so soon. But I can't help but wonder if he is worried.  Too soon is better than too long I guess

abita's picture
abita
Posts: 778
Joined: Dec 2017

I wonder if my not taking deep breaths changed anything. I only breathed about halfway when they said breathe in

Trubrit's picture
Trubrit
Posts: 5139
Joined: Jan 2013

and hope that your Onc sees what he wants to see, which is shrinkage. 

Tru

abita's picture
abita
Posts: 778
Joined: Dec 2017

I know. You are so right. I should be happy he is basically checking again.

Butt's picture
Butt
Posts: 354
Joined: May 2018

I was told by my oncolgyst that liver usually responses to chemo better than lungs. eg after 6 chemos a person who had 5 on 4 cm met can have 2 on 3 cm met. When I had a recurrance I developed multiple tiny mets on my lungs like 2 mm . They do slowly increasing even if I am on chemo. Butt.

abita's picture
abita
Posts: 778
Joined: Dec 2017

Maybe you have a typo. What do you mean where you start 5 on 4 cm can have 2 on 3 cm? I think you are saying the ratio of loss for lung mets vs liver mets.

And I would be okay with it taking longer to shrink lung mets as long as they shrink so thank you, I hope your oncologist's words apply to mine.

 

2 mm is very small. I had a 4 mm spot that was never active until this Jan. They grew to 3 spots by the time I got on a chemo that shrunk them. They shrunk after 4 infusions then now are same size after 6 more infusions. 

Butt's picture
Butt
Posts: 354
Joined: May 2018

There is no typo. If you reread the sentence you will see that I am talking about a significant decrease of a met in a liver after chemo.

abita's picture
abita
Posts: 778
Joined: Dec 2017

Whatever, I did reread it, and I thought you were giving a comparison that your doctor explained to you about if a liver met decreases by x amount, a lung met decreases by y amount. The typo was I was not sure if your use of "on" was that one was liver one was lung, or if you meant "or" or "by"

Butt's picture
Butt
Posts: 354
Joined: May 2018

I got it. You are right. It had to be by. I translated wrong from Finnish. 

abita's picture
abita
Posts: 778
Joined: Dec 2017

I figured that was the case, but was hoping that your doctor had given you the ratio of if a liver met shrinks by half, you can expect that a lung met shrinks by an 8th. 

Butt's picture
Butt
Posts: 354
Joined: May 2018

They wouldn't know. it is very individual. Have you thought about a T cell trail? I know MD Anderson has it.

abita's picture
abita
Posts: 778
Joined: Dec 2017

No. Hoping this works. They shrunk a lot the first 4 infusions so hoping it starts working like that again before next scan.

zx10guy
Posts: 259
Joined: Dec 2013

myAZmountain is correct.  All scanning technolgies utilize sampling slices when taking a image of your body.  The slices are combined into a single picture when viewed.  Because of this sampling, there is a variability in accurate measurements at the mm level.  If I recall correctly, CT scans have a 2mm variation.  In addition as myAZmountain mentioned, the way you lay on the table also affects the sizing of a feature of an organ from one scan session to another.

I have two established hemangiomas in my liver since diagnosis.  I can see going through past scan reports that the measurements of these lesions can vary by a couple to a few mm and will often vary depending on which Radiologist is reading my scans.

abita's picture
abita
Posts: 778
Joined: Dec 2017

Thank you! Yes I am hoping it was an error and that my tumors are shrinking. 

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