Referral to Oncology based on this PET…..

PipLily

Hello! Sorry for the long post. I would just like some help sorting through this report. ( I am an RN- but don’t routinely have much clinical day to day experience in this area) I understand no-one here is able to give medical advice :) Just looking for some real life input to help our swirling thoughts right now.
Quick background- my 34 yo daughter had a slightly tender small lump to the side of her breast, near armpit , in August after a bug bite. But got it checked- this led to a Mammogram, biopsy of a different spot ( turned out to be a Fibroadenoma), and a follow up ultrasound of the original lump/ axillary area in November. US still showed lymph node of 1.2 cm- no change, but since it hadn’t “gone down “, Radiologist recommended CT Chest. This then showed same Axillary node, but now another couple Axillary nodes on the opposite side as well. ( She had just received her flu vaccine 12/1- 3 days prior to CT Chest). So then, Radiologist recommends PET scan.
Fast forward to yesterday, PET scan done- and her PCP is sending in a referral to Oncologist. And the word “Lymphoma “ has been tossed around as to what we are obviously trying to rule in or out. The results are as follows, which doesn’t look HORRIBLE to me, but also isn’t nothing, given there is some uptake. A couple things I don’t understand- there really aren’t any numbers or “values” assigned to the uptake areas. Is that normal? Seems like a less than adequate reading? And also, the part about the symmetrical Tonsillar / Nasopharyngeal issue- I searched and searched, but is that an area that is commonly involved with Lymphoma?

”FINDINGS:
Head and neck:
Intracranial: No mass, mass effect, or worrisome activity is appreciated.
Extracranial: Symmetric moderate to severe nasopharyngeal and tonsillar activity is noted. There are mildly enlarged bilateral cervical chain lymph nodes with mild activity with the largest and most FDG avid noted at level 2 on the right (fused axial image

Lymphatics: Probable residual thymic tissue again noted with low-level activity. Prominent to borderline enlarged bilateral axillary lymph nodes are redemonstrated. These demonstrate low-level activity similar to that of mediastinal blood pool.

IMPRESSION:

1. Mildly enlarged cervical chain and bilateral axillary lymph nodes with low level to mild activity due raise a concern for a lymphoproliferative disorder given their appearance. Recommend a hematology oncology referral.
2. symmetric nasopharyngeal and tonsillar activity is noted as well, potentially reactive/ inflammatory though, with lymphoproliferative disorder involvement not excluded.

3. Probable residual thymic tissue with low level activity.

I cut and pasted the only abnormal parts. Everything else was clean. My daughter has had zero other symptoms or complaints- weight loss, night sweats, fatigue, etc, although I know that isn’t always the case anyway.

Just looking for any thoughts on these PET results that I can share with my daughter. She is a really scared young mommy of two precious baby girls, so I appreciate any advice I can give her as we wait for the Oncology appointment.
( Appreciate this forum so much- it was just an immense help as I helped my husband through cancer four and a half years ago. Sure didn’t want to be back, but it’s a great place to be for help!)

PBL

Sorry for your concern. As you have noted yourself, you will not be getting proper medical advice here - at least not from this responder. Your post calls for a couple of remarks though:

• the extract from the PETscan report you have shared here notes low activity, which, if dealing with something cancerous, would most likely suggest very small and/or very indolent variety;
• symmetry - also noted - more generally points to inflammation/infection (being a mother of young children, she may have a slight cold…), not cancer;
• what seems to have prompted your daughter's PCP to refer her to oncology to rule out lymphoma is the aspect of her axillary nodes. I suspect this might stem from some descriptive elements in the ultrasound report (architecture of the nodes…?). If that report does not mention anything fishy, then the referral may be an attempt to calm your daughter's anxiety.

I hope this helps. Do keep us posted on her situation.

PBL

Just a complementary note: yes, tonsils and adenoids are part of the lymphatic system and as such can be involved in lymphoma.
As to the absence of uptake values in the report, I would assume that the oncologist will have access to the complete set of images and will be able to read those.

PipLily

https://csn.cancer.org/discussion/comment/1719624#Comment_1719624

Thank you so very much for replying. You have included good useful information. As far as the architecture of the nodes on ultrasound, the only thing that was ever mentioned was on the initial ultrasound, the size was slightly enlarged. The one of concern still contained a fatty hilum. So I know that is good. The CT scan that found the opposite side axillary node or nodes, was the arm that had recently had the flu shot injected in that same side. The CT scan mentioned enlarged nodes, but didn’t say anything as to abnormal shape or anything. My daughter has an appointment with the oncologist the first week of January, so I guess we will have to hang tight till then. It’s the darn waiting……

As a side note- yes, the little girls all have had some degree of cough and runny nose for about two weeks now. My daughter herself has had an extremely low grade scratchy throat and some intermittent nasal stuffiness on and off as well. Maybe that’s the explanation for the Tonsils/ nasopharyngeal comment on the PET. I think my mom/ nurse brain is trying to justify everything in a positive light right now!! Just hoping!

Thank you so very much for replying!!

PBL

Hello,

Yes, the waiting bit is always pretty unnerving - and never gets any easier.

Becoming a parent often brings a lot of anxiety about what should become of our children should anything happen to ourselves, so… Here's hoping the referral was just out of an abundance of caution.

Enjoy the holidays with your daughter and the little ones and do keep us updated on the outcome of that appointment, whatever it is, as that can always be helpful to another anxious reader down the road.

PBL

PipLily

https://csn.cancer.org/discussion/comment/1719649#Comment_1719649

PBL- I 100% will provide an update! Thanks again for responding!