Clarification received from the surgeon

Rwan · January 2013

Hello,

I'm 35 years old man with nasopharyngeal carcinoma. I just finish my treatment,35 radiation and 5 chemo+5 FU. I just receive my MRI report and it is very confusing,looks like there is some cancer cell left or other part of my left side of my nose. Now i have no idea what will be next since i finish the regular treatment! there is anyone here who took any different type of treatment? or anyone can explain me in summary my mri report?? it will be a big help,,

i have an appointement next week with the surgeon,,,,to remove the the lymphnode???? i no idea....

this is my MRI report,Thanks

There has been interval improvement in disease involvement of the the nasopharyngeal mucosa with persisting signal abnormality in the basisphenoid and mild thickening of nasopharyngeal tissues. There is however,now T2

Hypointense tissue extending along the left aspect of the nasal septum and abnormal soft tissue extends interiorly along the medial wall of the nasal cavity and the inner aspect of the left nasal bone to reach the anterior aspect of the left nasolacrimal duct. There is also suspected extent of the disease along the mucosa of the middle and anterior ethmoid air cells. Findings are most suspicious for direct tumoural invasion, likely from disease spread from mucosa of the rostrum of the sphenoid bone to the posterior nasal septum.

The previously noted retropharyngeal and level 2 and 3 lymphadenopathy has significantly decreased in size. The previously enlarged retropharyngeal lymph nodes measure 1.5m on the right and 1.3 cm on the left (prior 2.5 and 2.3 cm respectively). They are T2 hypointense on today’s study. The more inferiorly situated retropharyngeal lymph nodes that measure 9 mm on the right and 11 mm on the left have remained stable in size. There is a persistently enlarged 12 mm left level 2b node (prior 19 mm)

Impression: Interval decrease in prominence of nasopharyngeal soft tissues, with interval significant decrease of bilateral level 2 and 3 and retropharyngeal lymphadenopathy.

There is suspicion for local disease spread to the nasal cavity along the nasal septum, involving the left middle and inferior turbinates extending to the anterior aspect of the left nasolacrimal duct.

longtermsurvivor · January 2013

Hi Rwan

I can certainly understand your concern and confusion, as this is a pretty difficult MRI scan to understand. In fact, not knowing how your radiation was done, it is almost impossible. If you just finished radiation, it is no surprise that the nodes are still prominent. This prominence will likely only need to be followed for a time. The nodes themselves should continue to shrink for quite awhile. Of more concern is the new finding of thickening along the nasal septum. This could be the result of swelling from radiation, or it couldd be tumor. This is the area of most concern, and is where the surgeon will focus his attention. The area of the nasal turbinates is easy to see with a small flexible scope, and may be looked at in the office. Alternatively, I suppose, this area may be examined and biopsied under anesthesia. It all depeends on the equipment available and the experience of the surgeon you are seeing.

We all have the problem of the anxiety produced by these reports, and the wait while it is decided what, if anything needs done. Remember it isn't cancer until it is proven to be cancer. I'm sorry I can't be more definite in my reply. keep the faith.

Pat

blackswampboy · January 2013

medical judgement

I hope you'll call your oncologist with questions regarding your MRI report, as soon as possible. most of us here are non-professionals--not qualified to offer medical judgement on your case (however, I believe Pat above is a professional).

my own inclination would be to not draw conclusions from written report until getting a clear explanation from my doctor(s). it is unfortunate that they sent you an MRI report without discussing it with you in person.

my own non-professional experience is that radiation can continue cooking for many weeks after treatment, which is one reason that docs routinely defer post-treatment scans until many months following treatment.

please don't jump to conclusions until you get more info and clear professional opinions.

best wishes and blessings to you!

phrannie51 · January 2013

Like BSB, I'm not a pro at any of this....

and certainly couldn't read a scan report with any expertise (hugging myself that nobody send me a copy to worry and fret about before I saw my Dr.). I do know this, however....since you just finished 35 radiations, your tissues are injured and damaged....and it takes a LONG time for them to heal. I know it's very hard to not worry while you wait to see your Dr. and get the real skinny on what all this means....the chances are that whatever is in that report isn't new to him....he's seen it before.

How long after finishing treatment did they do this scan??

p

Billie67 · January 2013

phrannie51 said:
Like BSB, I'm not a pro at any of this....
and certainly couldn't read a scan report with any expertise (hugging myself that nobody send me a copy to worry and fret about before I saw my Dr.). I do know this, however....since you just finished 35 radiations, your tissues are injured and damaged....and it takes a LONG time for them to heal. I know it's very hard to not worry while you wait to see your Dr. and get the real skinny on what all this means....the chances are that whatever is in that report isn't new to him....he's seen it before.

How long after finishing treatment did they do this scan??

p

I'd have to agree with the others
If you just finished radiation you probably....no you definitely have swelling and damage to your tissues. It takes months for that to go down. I'm curious to know when exactly you finished radiation. My doctor wouldn't let me get scanned until at least 3 months and we still saw significant swelling. I'm now at 6 months out from treatment and on my exam 3 weeks ago we still saw swelling. Don't jump to conclusions and trust your doctor to get to the bottom of this. I wish you the best.
Billie

Rwan · January 2013

longtermsurvivor said:
Hi Rwan
I can certainly understand your concern and confusion, as this is a pretty difficult MRI scan to understand. In fact, not knowing how your radiation was done, it is almost impossible. If you just finished radiation, it is no surprise that the nodes are still prominent. This prominence will likely only need to be followed for a time. The nodes themselves should continue to shrink for quite awhile. Of more concern is the new finding of thickening along the nasal septum. This could be the result of swelling from radiation, or it couldd be tumor. This is the area of most concern, and is where the surgeon will focus his attention. The area of the nasal turbinates is easy to see with a small flexible scope, and may be looked at in the office. Alternatively, I suppose, this area may be examined and biopsied under anesthesia. It all depeends on the equipment available and the experience of the surgeon you are seeing.

We all have the problem of the anxiety produced by these reports, and the wait while it is decided what, if anything needs done. Remember it isn't cancer until it is proven to be cancer. I'm sorry I can't be more definite in my reply. keep the faith.

Pat

Thanks

Thanks Pat for your reply and information. The radiation was completed last august,so i had 35 days of radiation + cysplatin twice

than a break for a 6 weeks i had 2 cycle of chemo cysplatin + 5 FU all completed my treatment by the end of November 2012. I already see the my radiation oncologist with the new MRI report,he wasn't very clear,he sugested to see the surgeon problably because of the lymph node and to proceed with biopsie.

The doc also did the check with his flexible scope and didn't see anything. Dyou think they will be a need for a surgery to remove the lymphnode?

Rwan · January 2013

phrannie51 said:
Like BSB, I'm not a pro at any of this....
and certainly couldn't read a scan report with any expertise (hugging myself that nobody send me a copy to worry and fret about before I saw my Dr.). I do know this, however....since you just finished 35 radiations, your tissues are injured and damaged....and it takes a LONG time for them to heal. I know it's very hard to not worry while you wait to see your Dr. and get the real skinny on what all this means....the chances are that whatever is in that report isn't new to him....he's seen it before.

How long after finishing treatment did they do this scan??

p

They did the scan...

After 1 month I had finished the treatment

Rwan · January 2013

Billie67 said:
I'd have to agree with the others
If you just finished radiation you probably....no you definitely have swelling and damage to your tissues. It takes months for that to go down. I'm curious to know when exactly you finished radiation. My doctor wouldn't let me get scanned until at least 3 months and we still saw significant swelling. I'm now at 6 months out from treatment and on my exam 3 weeks ago we still saw swelling. Don't jump to conclusions and trust your doctor to get to the bottom of this. I wish you the best.
Billie

I finished my radiation...

In August, 2012. Thanks for your support Billie>

longtermsurvivor · January 2013

Rwan said:
Thanks

Thanks Pat for your reply and information. The radiation was completed last august,so i had 35 days of radiation + cysplatin twice

than a break for a 6 weeks i had 2 cycle of chemo cysplatin + 5 FU all completed my treatment by the end of November 2012. I already see the my radiation oncologist with the new MRI report,he wasn't very clear,he sugested to see the surgeon problably because of the lymph node and to proceed with biopsie.

The doc also did the check with his flexible scope and didn't see anything. Dyou think they will be a need for a surgery to remove the lymphnode?

I honestly don't know

Given the size described in the report, it is a close call. Certainly if the FNA shows malignancy they will remove it, likely by a partial dissection. The real question will come up if the FNA is negative. THen you will be in a situation where you will need to decide whether to watch the node by simply repeating an MRI or a PET in several months, or to remove the node surgically. I wouldn't presume to tell you what to do, and I'm sure your surgeon will have some good advice for you in this regard. The good news is that if you've already been scoped and this nasal septum finding wasn't a big deal, you really are in good shape.

Don't let this stuff drive you crazy. It will just have to sort itself out.

Pat

Kent Cass · January 2013

Rwan said:
They did the scan...
After 1 month I had finished the treatment

MRI

I've always wondered about the MRI issue. I'm 11/2008 NPC unknown Primary, and have NEVER been thru an MRI for C. Had 5 PS/CT, and another 2 CTs, but never an MRI. Gather they've got a specific site they're watching for your NPC. If you are only out of tx for a month- typical that is WAY TOO EARLY for scans to show definite results, as swelling and tissue damage like scars could possibly show false-positives, and the like.

Are they 100% certain it's C? Only a biopsy can tell for certain. Way back when I remember several people whose first scans at 3-months out gave their Drs cause for alarm, and they were taken up for a Biopsy, and there was not a problem. For the PS/CT at 3-months out, generally it's regarded as scans to establish baselines, only, for which future scans will be compared. And, as I understand it, MRIs do not detect actual C, but rather abnormalities in tissue, etc. Pet Scans are the only scan I know it that is specifically designed to detect C.

So, are you in a large C Med Center? Did they tell you a known Primary has been found- in your left nostril?

kcass

Tim6003 · January 2013

Kent Cass said:
MRI
I've always wondered about the MRI issue. I'm 11/2008 NPC unknown Primary, and have NEVER been thru an MRI for C. Had 5 PS/CT, and another 2 CTs, but never an MRI. Gather they've got a specific site they're watching for your NPC. If you are only out of tx for a month- typical that is WAY TOO EARLY for scans to show definite results, as swelling and tissue damage like scars could possibly show false-positives, and the like.

Are they 100% certain it's C? Only a biopsy can tell for certain. Way back when I remember several people whose first scans at 3-months out gave their Drs cause for alarm, and they were taken up for a Biopsy, and there was not a problem. For the PS/CT at 3-months out, generally it's regarded as scans to establish baselines, only, for which future scans will be compared. And, as I understand it, MRIs do not detect actual C, but rather abnormalities in tissue, etc. Pet Scans are the only scan I know it that is specifically designed to detect C.

So, are you in a large C Med Center? Did they tell you a known Primary has been found- in your left nostril?

kcass

Hi Rwan...

I'm way out of my league to offer any advice or opinions..others on here are much better...but what I can do and did is whisper a prayer that this is all rad / treatment related and nothing comes of it ....

Keep us posted......

Tim

Rwan · January 2013

Kent Cass said:
MRI
I've always wondered about the MRI issue. I'm 11/2008 NPC unknown Primary, and have NEVER been thru an MRI for C. Had 5 PS/CT, and another 2 CTs, but never an MRI. Gather they've got a specific site they're watching for your NPC. If you are only out of tx for a month- typical that is WAY TOO EARLY for scans to show definite results, as swelling and tissue damage like scars could possibly show false-positives, and the like.

Are they 100% certain it's C? Only a biopsy can tell for certain. Way back when I remember several people whose first scans at 3-months out gave their Drs cause for alarm, and they were taken up for a Biopsy, and there was not a problem. For the PS/CT at 3-months out, generally it's regarded as scans to establish baselines, only, for which future scans will be compared. And, as I understand it, MRIs do not detect actual C, but rather abnormalities in tissue, etc. Pet Scans are the only scan I know it that is specifically designed to detect C.

So, are you in a large C Med Center? Did they tell you a known Primary has been found- in your left nostril?

kcass

Hello Kentcass,

Thanks for your note. My primary was found last year in june NPC tumour in Pharynx. The left nostril looks like a new one after a completed treatment based on the above MRI report. I will have more clarification after seing the surgeon tomorrow. Planning maybe to have a biopsy to clarify.

Thanks

Rwan · January 2013

Rwan said:

Hello Kentcass,

Thanks for your note. My primary was found last year in june NPC tumour in Pharynx. The left nostril looks like a new one after a completed treatment based on the above MRI report. I will have more clarification after seing the surgeon tomorrow. Planning maybe to have a biopsy to clarify.

Thanks

Clarification received from the surgeon

Hello All,

I just came from my surgeon.He confirmed me that there is no more tumour in my Right nose or any other place on both side.

sugested to re do another MRI in few weeks and if we receive the same report than a biopsy will be done.

Thanks to all for your clarification and support! We have great people here

Rwan

Kent Cass · January 2013

Rwan said:
Clarification received from the surgeon

Hello All,

I just came from my surgeon.He confirmed me that there is no more tumour in my Right nose or any other place on both side.

sugested to re do another MRI in few weeks and if we receive the same report than a biopsy will be done.

Thanks to all for your clarification and support! We have great people here

Rwan

Well...

It does sound great that no tumor is there, and is also great that they now have an MRI to compare the next one to. You seem to me to be way too early for a slew of scans, but I also know the nose is nothing to play around with- aggressive monitoring is important. And they are being aggressive- that's a really good thing. Keep us updated, and great to hear the positive news.

kcass

longtermsurvivor · January 2013

Kent Cass said:
Well...
It does sound great that no tumor is there, and is also great that they now have an MRI to compare the next one to. You seem to me to be way too early for a slew of scans, but I also know the nose is nothing to play around with- aggressive monitoring is important. And they are being aggressive- that's a really good thing. Keep us updated, and great to hear the positive news.

kcass

agree with Kent

This situation plays out over time. It sounds like the nodes are what they need to follow. Too many scans too early will confuse the issue. Be patient with this.

Pat

Clarification received from the surgeon

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