pet scan/help us decide

Hello “Medical” –

SAY AGAIN! Some surgeon actually performed Cytoreductive surgery (Debulking) on your mom without doing a PET scan?  Egads! 

Both my husband and I have been diagnosed with cancer.  Back in 2002, part of his work-up prior to a treatment regimen, he received a PET/CT scan.  At the end of his pre-op chemo/radiation treatment, he had another PET/CT scan to determine the effectiveness of the treatments.

As for me, when I went to the emergency room at my local hospital, a CT scan was performed, and I was diagnosed with Peritoneal Carcinomatosis.  The doctor pointed out the various tumors “floating around in the peritoneal fluid in my abdomen.” 

Immediately, I sought a SECOND opinion at the University of Pittsburgh Medical Center.  There a PET/CT scan was ordered as part of my examination.  The PET/CT picked up cancer in both my ovaries as well, that was NOT previously detected by the CT Scan alone.  “Exploratory surgery” was also performed as well, before making their recommendations.

At that point, I was told that I would need to have a series of chemo treatments prior to any consideration of surgery.  So I came home and underwent a series of Carboplatin/Taxol treatments.  (A series of 6 treatments at 3-week intervals)  I then had another PET/CT scan which revealed that the chemo had reduced the size of the tumors enough that Cytoreductive surgery, commonly called “debulking”, could be performed.  That surgery was performed July 1, 2013. 

I am curious to know just what the “surgeon” removed in his “debulking” surgery without the benefit of a prior PET scan and/or any type of chemotherapy?  May I assume that your mom did NOT have a SECOND OPINION?

The PET Scan will detect “live” activity in a way that CT cannot do alone.   These days many medical facilities have a machine that combines a PET scan and a CT scan all in one.  It depends on what doctors are looking for as to what type of scans they perform.  PET scans are commonly used to detect cancer. 

You have asked for our personal opinion.  As for me, I will tell you that I am “surprised” that such a radical surgery was performed on your Mom without the information that a PET scan provides.  I can understand why your primary care physician is upset.  I think he is right to be upset, and I would say he is correct in ordering a PET scan for your mom.  So if you’re querying the ladies here, as for me, I’m voting with your primary care physician.  If this were me, I would have the PET scan? 

Loretta

Peritoneal Carcinomatosis/Ovarian Cancer Stage IV since 2012

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    1.  http://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/positron-emission-tomography-and-computed-tomography-pet-ct-scans

"Positron Emission Tomography and Computed Tomography (PET-CT) Scans

Approved by the Cancer.Net Editorial Board, 11/2015

A PET scan is usually combined with a CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET-CT scan is one way to find cancer and learn its stage. Stage is a way to describe where the cancer is, if it has spread, and if it is changing how your organs work. Knowing this helps you and your doctor choose the best treatment. It also helps doctors predict your chance of recovery..

How is a PET-CT scan different than a CT scan?

You might have had a computed tomography (CT) scan. Doctors combine these tests because a CT scan and PET scan show different things. A CT scan shows detailed pictures of tissues and organs inside the body. A PET scan shows abnormal activity. So, the two scans together provide more information about the cancer..."

 (I suggest you read the entire article referenced here.  It will help you to understand the benefits of a PET Scan.

  2.  http://my.clevelandclinic.org/services/imaging-institute/imaging-services/hic-pet-scan

Positron Emission Tomography (PET Scan)

A positron emission tomography (PET) scan is a unique type of imaging test that helps doctors see how the organs and tissues inside your body are actually functioning.

The test involves injecting a very small dose of a radioactive chemical, called a radiotracer, into the vein of your arm. The tracer travels through the body and is absorbed by the organs and tissues being studied.

Next, you will be asked to lie down on a flat examination table that is moved into the center of a PET scanner—a doughnut-like shaped machine. This machine detects and records the energy given off by the tracer substance and, with the aid of a computer, this energy is converted into three-dimensional pictures.

A physician can then look at cross-sectional images of the body organ from any angle in order to detect any functional problems.

What problems can a PET scan detect?

A PET scan can measure such vital functions as blood flow, oxygen use, and glucose metabolism, which helps doctors identify abnormal from normal functioning organs and tissues. The scan can also be used to evaluate the effectiveness of a patient's treatment plan, allowing the course of care to be adjusted if necessary.

Currently, PET scans are most commonly used to detect cancer, heart problems (such as coronary artery disease and damage to the heart following a heart attack), brain disorders (including brain tumors, memory disorders, seizures) and other central nervous system disorders.

How is a PET scan different from a CT or MRI scan?

One of the main differences between PET scans and other imaging tests like CT scan or magnetic resonance imaging (MRI) is that the PET scan reveals the cellular level metabolic changes occurring in an organ or tissue.

This is important and unique because disease processes often begin with functional changes at the cellular level. A PET scan can often detect these very early changes whereas a CT or MRI detect changes a little later as the disease begins to cause changes in the structure of organs or tissues.

How should I prepare for a PET scan?

A PET scan is usually done on an outpatient basis. Your doctor will give you detailed instructions on how to prepare for your scan, including what you may or may not eat or drink before your exam. Before undergoing the scan, be sure to tell your doctor of any medications—prescription and over-the-counter—that you are taking as well as any herbal medications and vitamins. If you are taking certain medications or have certain diseases, such as diabetes, you will be given specific instructions regarding preparation for your scan. Generally, most patients are told not to eat anything for a minimum of 6 hours before the scan. Heart patients are also told to not take any product with caffeine for at least 24 hours. Be sure to wear comfortable clothes to your appointment. You may be asked to change into a hospital gown during the test. In those patients that need an assessment of the area near the bladder, a bladder catheter may need to be inserted.

It is essential to tell your doctor if you are pregnant or think you might be pregnant before undergoing a PET scan because of radiation exposure.

How long does the test take?

Once injected into a vein, the radiotracer typically takes from 45 minutes to 1 hour to travel throughout the body and be absorbed into the organs or tissues to be examined. The scan itself may take another 30 to 60 minutes. The heart and brain studies take less time for imaging.

You will be asked to remain still for the entire length of the exam, since motion will reduce the quality of the images. Depending on which organ is being examined, there may be additional tests and additional dyes or chemicals used that may lengthen the total appointment time up to 2 to 3 hours. For example, patients being examined for heart disease may undergo a stress test in which PET scans are obtained while at rest followed by the administration of other drugs to examine blood flow to the heart under exercise conditions.

Does the PET scan pose any risks?

Although a radiotracer chemical is used in this test, the amount of radiation you are exposed to is low. The dose of tracer used is so small that it does not affect the normal processes of the body. However, the radiotracer may expose the fetus of patients who are pregnant or infants of women who breastfeed to the radiation. You and your doctor need to consider this risk compared with the need for and potential information to be gained from the PET scan.

How soon will the scan results be available?

A radiologist who has specialized training in PET scans will interpret the images, write a report, and deliver the results to your doctor. This process usually takes 24 hours.”

Hi, Medical,

i was diagnosed in March 2012 with ovarian cancer via CT scan and MRI assisted biopsy.  I had my first PET scan in December 2015 as part of a second opinion work-up at another cancer center.  The results were interesting, but the insurance refused to pay based on the fact that the results would not change the treatment plan. Which was true.  Even with the added confirmation, the second Gynocologic oncologist recommended the same course of action as the first.

my cautionary opinion for you is, do not get your second opinion from a generalist, even if you like them as your general doctor.  Get your second opinion from a Gynocologic oncologist with as much or more experience and credentials as your current oncology specialist.  That's my opinion, but also there are some research studies that show longer survival for ovarian cancer patients who receive their treatment from Gynocologic oncologists.

Just to share my experience.  I had gone through the surgery and chemo.  Then, when I got to the radiation guys, they ordered the PET scan.  They wanted to know if any of the lymph nodes or any tumors 'lit up'.  If they did, the radiation people were going to direct more focused radiation on those areas.  I wish you and your mother the best on your journey.

Lisa