3 months after finishing radiation, PET scan recommends lymph node biopsy

Kevmosmom

My husband finished 6 weeks of radiation in July, after having a tonsillectomy and a neck dissection that removed one cancerous lymph node and 29 additional lymph nodes. He has HNSCC-HPV-16+. Last week he had his first follow-up PET Scan and unfortunately it shows Prominent FDG uptake in another lymph node. The radiology who read the report has suggested an ultra sound biopsy. His Oncologist wants to begin chemotherapy asap. We see his head and neck surgeon tomorrow. I am so afraid they will want to do more radiation. That treatment is BRUTAL! and I am so afraid of how bad the effects from a second round of radiation will be. Has anyone else experienced this, and if so, what was your follow-up treatment and how are you doing now? Thanks for any and all insight.

Kevmosmom

I forgot to mention he has an unknown primary.

MarineE5

Kevmomom,

I am sorry to read that your husband has a questionable lymph node. The sure thing in my opinion is the Biopsy, and go from there. The uptake could be other things as well, an infection (That is what Lymph nodes do) or tissue healing. I am not sure your husband would be a candidate for more Radiation after just finishing it back in July. Not knowing how may Gy's he received, there is a limit to the neck area. His Radiation Oncologist should be able to provide that information to you.

My cancer was Base of Tongue and the Tumor was removed with safe margins. Part of my tongue was removed which has caused side effects in swallowing and some speech issues. I had similar treatment after 30 plus Lymph Nodes were removed in a Radical Neck Dissection. As you mentioned, radiation is harsh, killed my saliva glands. That was 20 years ago. I hope you get all the information you need soon so you and your husband can take the next steps in this road none of us volunteered to take.

My Best to You, Your Husband and Everyone Here

tom1953

https://csn.cancer.org/discussion/comment/1724817#Comment_1724817

Kevmosmom…

The rule I have heard many times is they will absolutely not repeat radiation to the same spot of previous radiation treatments. If it's not the same location, they may offer it. Wishing him the best.

Kevmosmom

thanks for the responses. We saw his surgeon today and he didn’t seem overly worried. (Although he has a very laid back demeanor.) He said if the biopsy comes back positive he will just remove the lymph node. Praying it is that easy.

MarineE5

Kevmosmom,

Sometimes a 3 month PET Scan results are a False positive. My Surgeon waited 5 months before scheduling a PET Scan for me.

My Best to You, Your Husband and Everyone Here

Kevmosmom

Thanks for the insight. I pray that that is what has happened.

Swoosh13

Hi Kevmosmom,

My husband did 33 rad and 7 weekly Cisplatin chemos for base of tongue SCC HPV+ 16 in mid-2023. First PET scan early 2024 showed something in his lungs. Drs were thinking it could either be inflammation from treatment, or infection OR?? So they sent him for a repeat CT of lungs 3 mos later and it was gone. Ironically he did have a sinus infection right before that first PET scan so who knows. Sounds like your dr has your husband in good hands. I always tried not to go to the worst case scenario (it isn’t easy I know). Also as a few others here have said, it’s also my understanding they won’t do more radiation to the head/neck area unless it would be in a different location. My husband just came up on 2 years NED and his oncologist was super happy when we saw him 2 weeks ago. I’ll be praying for that same outcome for your husband and you as well.

Logan51

The 3-month PET and CT are, typically, only to establish a baseline for the Radiology Drs. to compare future tests to. MY ENT said something showed on mine, but he wasn't worried…over 16 clean years ago.

And, many years ago at a major Hospital in LA, someone on this Forum had their Drs. open them up after the 3-month, and it was a False Positive- should never have gone thru the Op.: they removed a bunch of nodes and they all came back C-negative. Scar tissue is another possibility. A lot depends on the ability of the Radiology Drs. that view the image.

Kevmosmom

Thanks Logan! That makes me feel better. They have ordered the biopsy but for some reason can’t get it scheduled. That was 3 weeks ago. The doctors office said they are waiting for it to be reviewed. I am assuming that either Medicare or my husbands supplemental insurance are dragging their feet. That’s a little frustrating, but we are learning that nothing gets done quickly. My husband is optimistic and has a great attitude and I know that is half the battle. Thank God for the little things.

🙂

Kevmosmom

https://csn.cancer.org/discussion/comment/1724872#Comment_1724872

Thanks for the encouragement. I am working on not jumping to the worst case senario. Thank goodness my husband is so optimistic. 🙂 we both believe he has great doctors.