Very long but need any advice on 6 month CT scan

Angiebby75

 

So I have been following and posting here randomly . I dont always know what to say but try to help. You all have been a great help to me. I am here agian for any advice and prayers. I just had my six month scan results today and I am really trouble and scared. Here is my history again. Stage 1 Grade 1  4.5cm. No Rhabdoid or Sarcmotoid features. Limited to the Kidney. No lymph nodes involved. Margins: uninvolved my carcinoma. I first DX because I was having stomach pain, which lead to Ct that found the mass on kidney. I was always told the stomach knot I felt is a hernia or scar tissue from other hysterectomy. I had an robotic partial that went well. Then day 2 in hospital the nurses tried to move me and I fell and ended up bleeding from my kidney so took the whole kidney. I had a real hard recovery. Here is a history of what my scan show. They last being the most recent. My oncologist stated she is confused and not in total agreement with my last  CT report.  Alot of my report state from last or previous. When its never  been mentioned on any report. She wants me to have a biopsy. Any advice will be grealty appreciated. 

 

10/19/2017 prior to surgery

 4.4 x 4.2 x 4.6 cm heterogeneous enhancing left renal mass with stable appearance since prior examination.
2. Mildly enlarged left periaortic lymph nodes, measuring up to 12 mm in short axis.
3. Prominent spleen, measuring 13 cm in craniocaudal dimension.
4. Small fat-containing umbilical hernia.
5. Moderate to large volume of stool seen throughout the colon.
6. 2.5 cm right adnexal low density, which may represent right ovarian etiology. If clinically indicated, pelvic ultrasound can be obtained for better evaluation  I had ob ultra sound and was told cyst was gone.

 

12/28/17 First Ct after to surgery

Post left nephrectomy with no residual or recurrent mass lesion identified. No CT evidence of metastatic disease within the abdomen/pelvis.
2. Cystic lesion in the right adnexa measuring maximally 2.2 cm and unchanged from 10/19/2017
3. Mild hepatosplenomegaly which appears unchanged.
4. Please see above for complete discussion.

subcentimeter hypodense lesion in the superior pole the right kidney measures maximally 7 mm and appears unchanged. This is difficult to characterize due to its small size but likely reflects a small cyst. The right kidney and ureter appear normal otherwise. Patient is post left nephrectomy. No mass lesion identified in the left renal fossa. Retroperitoneal hemorrhage seen previously appears completely resolved.

 

5/22/2018 6month scan

CT CHEST:
1. No evidence for metastatic disease in the chest

CT ABDOMEN AND PELVIS:
1. Surgical changes of prior left nephrectomy
2. Enhancing nodular density identified in the right lower quadrant anterior abdominal wall, best seen on image #65 series #3, that may be metastatic in origin given the interval increase in size and the enhancing nature of this finding.
3. Suspected enhancing nodule identified in the right rectus abdominis musculature, also likely metastatic in nature
4. Splenomegaly

 

Gallbladder: The gallbladder is distended with a smooth thin wall.
Biliary tree: There is no evidence for intra-or extrahepatic biliary ductal dilatation.
Liver: The liver demonstrates normal appearance. No focal abnormalities are seen. Normal contrast enhancement is noted.
Spleen: The spleen is enlarged measuring 14.4 cm in length.
Pancreas: Normal morphology without masses or inflammatory changes.
Adrenals: Normal size without masses.
Kidneys: The right kidney is unremarkable. The left kidney is surgically absent. There is no evidence for enhancing soft tissue density in the left renal fossa.
Vasculature: No evidence of aneurysm or other significant vascular pathology. No evidence of dissection.
Lymphatic system: No pathologically enlarged lymph nodes are seen.
Bowel: The stomach is normally distended with no focal wall abnormality. The duodenum is normal in caliber along its course. No focal abnormality is seen. The small bowel is normal caliber. There is no focal stricture or dilatation. There is moderate colonic fecal stasis. The appendix is not seen.
Peritoneal structures: No evidence of free air or free fluid. No masses. The omentum and small bowel mesentery are normal.
Retroperitoneum: No focal retroperitoneal abnormality is seen.

Abdominal wall: Small fat-containing umbilical hernia is noted. There is a suspected enhancing soft tissue density identified in the right lower quadrant abdominal wall as seen on image #65 series #3 that measures 34 x 21 mm (previous 24 x 15 mm). There is an additional nodule identified in the right rectus abdominis muscle as seen on image #52 series #3 measuring 20 x 18 mm (previous 19 x 17 mm).

CT PELVIS:
Urinary bladder: The urinary bladder is distended with a smooth thin wall. No focal abnormalities are seen. No posterior filling defects are seen on delayed phase imaging.
Soft tissues: No other significant abnormalities in the pelvic structures. No free fluid or lymphadenopathy. The ischiorectal fossa and inguinal regions are normal.
Bones: No significant abnormalities in the bony pelvis. 

JerzyGrrl

For starters...

Hi, Angiebby --

For starters, it's good to know that your oncologist wants to get some details on this. True, what we all want to hear is, "Nope, didn't find anything," but the fact that you're getting your follow-up CT scans means anything found won't have too much time to get ahead of itself. IF it even IS something. The radiologist's report is confusing due to choice of words, too. "May" isn't the same as "likely," so "also likely" doesn't reasonably follow "may" at all. (Personally, I prefer the phrase "might could," but don't think that that double construction will show up in your CT report).

So?

1. The radiologist doesn't have adequate info to know for sure.

2. Your oncologist wants to get more info. Yay!

3. Prayers? You got 'em! And...

4. Keep us posted, please --

MelBlessed

Ct Confusion

I’m sorry your going thru this.  It is frustrating to get maybe or maybe not reports. Good thoughts and prayers for you and your oncologist to get it figured out!

Angiebby75

Thank you for your replies.

Thank you for your replies. Yes it is especially when, I know it’s been there from the beginning. But prior CT’s reports and Drs never mentioned of it as a concern or other than hernia. 

stub1969

Appointment?

Angie--I hope your doctors reaction provides you some comfort.  She sounds like a very thorough and caring person.  I'm glad she is requesting a biopsy so you get some real answers.  I'm praying for peace and comfort for you.  Keep us updated----and please continue to post and offer support and advice to our members.  You are a wealth of knowledge!

Take care,

Stub

Manufred

There are always options.

Radiology is not totally precise and in fact subjective to a degree.  A biopsy is more definitive.

However metastasis is a common outcome after nephrectomy and if that is what you have, that too can be dealt with.  Numerous examples on this web-site alone. 

I hope your oncologist is up with the latest options and is able to guide you to whatever follow-up treatment you may need.  And life goes on........

Allochka

Hi Angie,

Hi Angie,

so sorry you are going through all this stress!

Metastatic disease so soon after Stage 1 Grade 1 kidney cancer sounds veeeery unlikely. Especially in this place (lungs is the most "popular" place).

The fact that these masses were never mentioned on previous reports, but the last report does state comparison with previous images - most probably masses were there before, just never mentioned by radiologist because they looked benign.

Could you get not only a biopsy, but also a second opinion on CT images from experienced radiologist? Radiology is a complicated and very subjective thing.

My husband's very first CT was misread by radiologist (misread thing wasn't connected to his kidney cancer, it was unrelated issue about another organ, but still - mistakes are possible).

 

Good luck to you, keep us posted and try to get a second opinion!

Alla

todd121

CT Scan

I find your scan report a little overwhelming in details compared to mine. I wonder if you're at a cancer center/cancer hospital or not? My advice would be to have your scans at a cancer center/cancer hospital so that your radiologists are very experienced looking at cancer.

I'm glad your oncologist is taking it seriously. I'm not sure about a biopsy versus wait and see. Is your oncologist very experienced with RCC would be my next question? RCC is a fairly rare cancer and many oncologists don't see much of it. If you can get an opinion from someone that sees a lot of RCC, I'd feel better.

My only advice would be to try and get to a cancer center if possible where you can have an RCC expert oncologist and radiologists that are very experienced with cancer to do your followups. If that's not possible, at least you have an oncologist that is looking into the issue and willing to investigate and stay on top of things. That's a good thing.

I agree that a met so soon after a grade 1 stage 1 tumor is pretty unlikely.

I know easier said than done, but don't worry. Just do what you need to do, but try and let go of the worry. It only adds to misery and does you no good. It's one of the lessons that comes with time in having this disease. You're better off if you can let go of the worry earlier rather than later. Know that everything is going to be ok no matter what happens. Of course stay on top of things and do the next indicated step to take good care of yourself.

Prayers for you,

Todd

Angiebby75

Thank you all for the prayers

Thank you all for the prayers and advice, I will be looking into getting a second opinion from another radilogist and maybe oncologist. Todd121  I am at local hospital in Ohio. There is cancer center in the hospital. It is still under construction.  I only live an hour from Ohio State that has a center, and Cleveland Clinic is 3 hours away. I had intended on using Cleveland to begin with but insurance delays prevent it for the nephrectomy. My urologist just turned me over to the oncologist. I have never seen him since the follow up after surgery. I am looking for urologist oncologist. I am not sure how experience my oncologist is with rcc. She seems knowledgeble and is very attentive to my needs, I get same day call backs and test results.  But I want to do whatever is best, so I going check into a specialist also.  

Allochka

OI'll repeat myself - please

OI'll repeat myself - please get a secong opinion from radailogist. Come on, Stage 1 and grade 1? And mets on abdominal wall after just 6 months? I find it hard to believe...

Angiebby75

Allochka ,thank you for your

Allochka ,thank you for your post I will for sure taking

your advice an be getting a second opinion with a radiologists before the biopsy.

Manufred

When do Mets Start?

Mets on abdominal wall (peritoneum) are not uncommon for mRCC - had some myself.  Time after operation is no indicator cause some of this may have gotten away well before your op. 

By all means ask again, but biopsy is probably the most definitive way to go.

Best Wishes,

Fred

Allochka

Manufred, thank you for

Manufred, thank you for correcting me and putting things into right perspective!

Alla

donna_lee

Was in your shoes 11 years ago...

but with a single lymph node that had enlarged between the 6 month and 9 month CT's post nephrectomy (and other parts & piesces). The biopsy was positive and I made haste to get on the surgery schedule to have it removed  What can you do?  Cry some, schedule the next month, and get that sucker out!  Then recover.

The following year, repeat the above scenario when a node in the low pelvis was found to be enlarging.  Couldn't biopsy but it sure did light up on a PET scan.  Surgery #3, 10 years ago.

Both of them had already been part of the mets migration at some point, but were not large enough to show on any of the previous tests.

Click on my user name for a more in-depth review of the journey.  Every couple of years I go back and reread what I wrote, and it still holds true.

I wish you well on this journey.

Hugs,

donna_lee

todd121

Angiebby75 said:

Thank you all for the prayers

Thank you all for the prayers and advice, I will be looking into getting a second opinion from another radilogist and maybe oncologist. Todd121  I am at local hospital in Ohio. There is cancer center in the hospital. It is still under construction.  I only live an hour from Ohio State that has a center, and Cleveland Clinic is 3 hours away. I had intended on using Cleveland to begin with but insurance delays prevent it for the nephrectomy. My urologist just turned me over to the oncologist. I have never seen him since the follow up after surgery. I am looking for urologist oncologist. I am not sure how experience my oncologist is with rcc. She seems knowledgeble and is very attentive to my needs, I get same day call backs and test results.  But I want to do whatever is best, so I going check into a specialist also.  

Urologic Oncologist

I hate this term. A urologic oncologist not an oncologist at all. It's a urologist that specialises in kidney masses and their treatment using surgery/ablation and so on. It's a specialization of a urologist who is a surgeon. On the other hand, an oncologist is in internal medicine doctor that specialized in cancer and treats systemic cancer by either using chemo or drugs, or referring you out for test (radiology) or treatment via surgery or radiology. An oncologist is an internist. They usually have specialties in hematology in addition to internal medicine and oncology.

What you really need is a medical oncologist that has expertise in RCC. A kidney cancer oncologist. The Cleveland Clinic is one of the best in the country (I think, maybe others can pipe up and give their opinion). It'd be worth seeing someone there in my opinion, if they are closely connected to kidney cancer/kidney cancer research. It's a rarer type of cancer and it's fast-changing area.

Best to you,

Todd

Angiebby75

Thanks for the prayers and

Thanks for the prayers and the advice. I will be doing both I have an appt set up for a biopsy. I called the Cleveland clinic for an appt waiting on call back. The oncologist office referred the scans to be looked at by another radiologist but it’s at the same clinic though,  I am still trying to get another doc to look at the scans since I have a week or so before the biopsy. My Fmla at work doesn’t renew until August so I cant take weeks off work until then. I won’t wait if it jeopardize my health. But I don’t want to risk my job and health insurance either. I’m still praying for a miracle that all is well. 

todd121

Angiebby75 said:

Thanks for the prayers and

Thanks for the prayers and the advice. I will be doing both I have an appt set up for a biopsy. I called the Cleveland clinic for an appt waiting on call back. The oncologist office referred the scans to be looked at by another radiologist but it’s at the same clinic though,  I am still trying to get another doc to look at the scans since I have a week or so before the biopsy. My Fmla at work doesn’t renew until August so I cant take weeks off work until then. I won’t wait if it jeopardize my health. But I don’t want to risk my job and health insurance either. I’m still praying for a miracle that all is well. 

Thinking of you

Wishing you the best. Hope you get things sorted out soon.

Peace,

Todd