CAT scan question

Kathleen808

Hi Everyone,
We have a question in regards to CAT scans. When we looked hard at the results of ****'s 3 cat scans, they only ordered abdominal and pelvic area. The two since surgery don't show any evidence of disease. However, they only looked at the bottom parts of his lungs. I panicked and called a radiologist friend of ours. He said that rectal cancer can bipass the liver and mets can go to the lungs or spinal area but that colon cancer always (or almost always) shows mets to the liver before anywhere else. Somehow I think there are people on this board with colon cancer who have had mets to the lungs and not to the liver. Is that true?
I am pretty ticked at the oncologist here who ordered the scans. Dr. Lenz's report asked for chest, pelvic and abdomen.
Thanks for the info.
Aloha,
Kathleen

shoppergal

Cat scans
I don't understand, if the dr ordered a cat scan,and from what my onc has told me they are usually taken of the chest abdomen and pelvis,why wasn't it done? I would want to have the scan redone to involve all three areas.

I usually go for a pet scan instead of a cat,I'm not really sure why each dr does different scans. I just had to have a follow up scan for something that was found near my kidney, and my onc ordered a pet & cat scan. When I got the call from the hospital the day before my scan to fill me in on the particulars, I was told I was being scanned from my head to my legs. I never had my head and legs scannned and for some reason that made me a little nervous. When I spoke to my onc the next day about the results I asked her why she requested the head and legs. From what she explained, when both cat and pet scans are done together (and it was done on the same machine)thats how it's done, it wasn't that she suspected anything. She feels it's better to check everything to be on the safe side. plus it puts her patients at ease.

PhillieG

Have not had that scan, it's always been all 3
They always do the 3, chest, abdomen, and pelvis on me. I would not be comfortable with only 2 parts being scanned. If they ordered 3, they should have done the 3.
That does not mean something is wrong, but it does not rule it out either.
I'd be pissed because that means you have to redo the whole process.
-phil

taraHK

lung no liver
Hi Kathleen,

Sorry you had this experience -- frustrating!!

Not to add to your woes but I am one of those folk who had mets to lung but never liver. Mind you, I was diagnosed with rectal cancer, not colon. My understanding is that rectal cancer pts are more likely to have mets to the lung (I can't remember where I heard this....so please take with a pinch of caution).

Tara

Kathleen808

thanks
Hi All,
thanks for the replies. I'm trying to relax but I am so mad at the doc here in Hawaii. Why did he only order the pelvic and abdomen? I know we need to let it go but then I am wondering if **** has never had a true chest cat, should he have one now? I guess the answer is yes. However, he just had the pelvic , abdomen one a week ago. So... do we wait another 3 months? I think I will call Dr. Lenz at USC and ask what he should do. We thought **** had lungs clear but now the truth is we don't really know.
Aloha,
Kathleen

PhillieG

Kathleen808 said:

thanks
Hi All,
thanks for the replies. I'm trying to relax but I am so mad at the doc here in Hawaii. Why did he only order the pelvic and abdomen? I know we need to let it go but then I am wondering if **** has never had a true chest cat, should he have one now? I guess the answer is yes. However, he just had the pelvic , abdomen one a week ago. So... do we wait another 3 months? I think I will call Dr. Lenz at USC and ask what he should do. We thought **** had lungs clear but now the truth is we don't really know.
Aloha,
Kathleen

Hi Kathleen and ****
He could very well be all clear in the lungs, but like you said, "we don't really know". I would certainly let your Doctor know what happened and more importantly what did not happen. I would rather err on the side of having it done again.
I'm glad I could be part of the group that gave you guys some input, sorry it was on this topic.
I'd rather tell you what to see when visiting NYC (not hospital wise either)
;-)
-phil

Wenchie

Lung Mets
Kathleen:
I have lung mets (5) and have a clean liver...at least they think it's clear.

CherylHutch

Colon Cancer with Lung Mets
Hey Kathleen (good to see/talk to you again!)

I don't know about those stats that colon cancer always (or almost always) shows mets to the liver before anywhere else. Then again, maybe I'm just an enigma. I had colon cancer and when my CEA started rising, a PET scan was ordered and they found it had spread... to the right adrenal gland and to both lungs. My liver is just fine... or has been all along. I suppose it could spread there too at some time but it definitely spread to the lungs and the right adrenal gland. So I certainly didn't fill the pattern.

As for what scans are used... it really does depend on the individual situations. As much as we'd like to say A, B, and C have colon cancer so they should be getting the same treatments and same scans of the same body parts... it doesn't work that way. The only thing A, B and C have in common is that they have colon cancer... but once that has been diagnosed, the actual treatment plans will vary and can vary considerably (that's why we should never really compare treatments and wonder why no two are exactly the same).

I can't remember... has **** had a PET/CT scan before? This is the one where he would have been given an injection of an isotope (radioactive glucose) and then would have to remain quiet for an hour before the scan which takes about half an hour. If he has had a PET/CT and the doctors were happy that his lungs were not affected, then they might only be concerned at this time with the pelvic and abdomen. I'm sure when you talk to the oncologist he/she will be able to explain the reason why only two scans were ordered.

I'm sorry... someone else on this thread (and now I forget who) was questioning why some doctors order only CAT scan and why some order PET scans. Again, for many different reasons... and also because the two scans work totally differently. CAT scans are like super super xrays... PET scans don't take pictures of the bones/organs but take pictures on the molecular level. The difference in price between a CAT scan and a PET scan is huge. A CAT scan is usually $1000 or less.... a PET scan is $5000 - $7000 per scan. So an oncologist is not going to order a PET scan if they are not looking for anything on the molecular level... and it is actually possible to miss something on a PET that a CAT would pick up.

IE: A PET picks up metabolic activity on the molecular level. So if you have a metabolically active growth, it will show up on the PET. But if you have "numerous" nodules/tumours that are too small to be metabolically active, then nothing will show up. I had numerous (12) nodules scattered on both lungs. Only 1 lit up the PET scan, the others didn't even show up. So, anyone reading my PET scan would have said that I have one malignant spot in my lungs... whereas, when a CAT scan was done, it found all 12. I had the malignant one removed, now I have 11... but none are metabolically active. So, depending on which scan is ordered would be whether one would even see them now or not.

Confusing? Yes... but if you have faith in your doctors, you have to give them the benefit of the doubt that they know what they are doing and why they are doing it. Obviously, if you don't understand or it really does look like a mistake has been made, then talk to them. Have them explain why. If you still aren't satisfied, then by all means get another opinion... and if that one doesn't make sense, get another one. As has been said before, we all have to be advocates for ourselves and part of being an advocate is understanding what is being done for/to us and why... and likewise, if we feel something SHOULD be getting done and it isn't, then question it and find out why it isn't being done

You are such a great advocate/caregiver, Kathleen!!

Hugggggs,

Cheryl

serrana

cat scan question
Sorry you are having this problem.....good you are on top of it and asking questions
I had rectal cancer and it metastesized to the lung, not to the liver.
It took 6 months from the first spot on a CT for it to "light up" on a PET/CT. Remember that even when things "light up" w/ the glucose it doesn't mean it is a tumor, it can be an infection ( old or new) or healing tissue from a surgery or something. Serrana

Kathleen808

thanks
Thanks everyone for all the info. I called the oncologist office today and asked exactly what was scanned in Jan and Feb and last week. They said Jan 12, the day **** had his colonoscopy and they found the 9cm tumor they did pelvic and abdomen. Then in Feb 09 they did pelvic, abdomen and chest. they were ordered on two different sheets but both were done ( the doc had said on the phone in feb that all was clear but we did not have that paper and **** could only find the order for the pelvic and abdomen) Then, last week they only did the pelvic and abdomen. We feel much better knowing all was clear in Feb. However, we will tell the doc we expected last week's scan to include the chest. We will be more vigilent reading the orders next time.
Thanks for all your time and info. We are very grateful for you.
Aloha,
Kathleen

kimby

Kathleen808 said:

thanks
Thanks everyone for all the info. I called the oncologist office today and asked exactly what was scanned in Jan and Feb and last week. They said Jan 12, the day **** had his colonoscopy and they found the 9cm tumor they did pelvic and abdomen. Then in Feb 09 they did pelvic, abdomen and chest. they were ordered on two different sheets but both were done ( the doc had said on the phone in feb that all was clear but we did not have that paper and **** could only find the order for the pelvic and abdomen) Then, last week they only did the pelvic and abdomen. We feel much better knowing all was clear in Feb. However, we will tell the doc we expected last week's scan to include the chest. We will be more vigilent reading the orders next time.
Thanks for all your time and info. We are very grateful for you.
Aloha,
Kathleen

2 Sheets
Yep, that does sound right. I know all my results have a report on the abdomen/pelvis read by one radiologist and another report that is read by the thoracic radiologist. It does seem that you should get a copy of both without asking and it should have been mentioned along the way.

Also, I would make sure that a chest scan is included in every single scan from this point forward. It is just so important to be up to date with info and if you are already getting all that done, it just makes sense. I sometimes wonder if medical professionals are so busy they forget to slow down and think. Common sense could really go a long way, but I guess we're all human.

That is exactly why I get copies of everything. It isn't that I don't trust my team. I just need to know what's going on and to make sure nothing is missed that is important to me. Like I said, they are human too.

I'm VERY happy to hear your news that ****'s lungs are clear. Congrats on that!

Kimby