No scans???

Mine does blood work, diagnostic CT's and PET scans. I've felt better knowing that they're checking me with everything they have just in case one method isn't "picking up a signal." But what's most important is your comfort level. You're the one ultimately responsible for your care and if you want the additional tools, then it's time to look for another doctor.

It would depend on what stage you are. I do not believe ASCO recommends surveillance scans for Stage III.

Summary of ASCO guidelines for colon cancer surveillance
History and physical examination: Every 3-6 mo for first 3 y and annually thereafter; should include test coordination and patient counseling.

CEA: Measure levels every 2-3 mo in patients with either stage II or stage III disease for at least 2 y after resection of tumor and liver metastases.

Liver function tests: Data suggest that regular monitoring is unnecessary.

Fecal occult blood test: Not recommended for surveillance for colorectal cancer recurrence.

Chest radiography: Not recommended unless CEA level is elevated or patient has symptoms suggestive of pulmonary metastasis; panel did not reach a consensus on this point.

Colonoscopy: Every 3-5 y to detect new cancers and polyps; routine annual colonoscopies not recommended for all patients.

Not recommended: Routine monitoring of CBC, pelvic imaging, CT.

Key: ASCO, American Society of Clinical Oncology; CEA, carcinoembryonic antigen.

Source: Benson AB, Desch CE, Flynn PJ, et al. 2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol. 2000;18:3586-3588.

My husband had a Pre-surgery CT, a PET Scan 1 month after surgery (because the Pre-surgery CT showed absolutely nothing), and a CT after chemo. The oncologist had ordered another PET but insurance would not approve it. He thought he could get another PET because the PET 1 month after surgery showed a hypermetabolic lymph node that could be "post-op inflammation or carcinoma."

I do not think he will have any more scans unless the CEA begins to rise.

MA

Before you rush out and try to find a new oncologist, perhaps you should be asking him this question rather than us. I know we all have opinions that you can take into consideration, but we are not doctors. I too am treated at MD Anderson but my onc there felt that every 3 months was a bit excessive and has told me that MD is now going to every 4 mos. At least in the GI dept....
At any rate, blood work is not a good indicator for everyone, but for some folks, myself included, it is really quite accurate. Also, it is true that a CT scan can show very small nodules, but there is often nothing to be done surgically until they have reached a certain size (around 1cm for lung mets, for example). I wish my doc would say it was OK to just have blood work. I do not want to be exposed to all the radiation from repeated scans. For example, last year in Feb. of 04 I was found to have 2 spots on my lung of unknown origin. The thoracic surgeon said they were too small to operate on. My CEA was .9. I had a PET scan which came back negative. Then in May I had a CT and the radiologist said they (the nodules) were granulomas. Then in August my CEA was like 1.8 or something and the nodules had doubled in size. My PET at that time was again negative. In October when I had my surgery to remove them they were approx. 1cm in size, my CEA was 3.6 or thereabouts and my PET was finally positive. In otherwords, I could have gone from Feb. to Oct. w/o all of the "you have cancer, you don't have cancer" BS and it would have spared me a lot of peace of mind.
That is my opinion on the matter.
The decision whether or not to seek another doc is ultimately yours to make.
Best of luck to you, Susan.

Working with a doctor you like is hugely important. Mwomack's post below is right in that most approved guidelines do not call for routine CT or PET scans. But, like a lot of other medical centres, mine does do routine scans. In my case, especially because my CEA (blood marker) was never elevated. I am a strong supporter of routine CTs. Agan, in my case, a routine CT detected a very small tumour in my lung (two years after my original diagnosis/surgery) - when I had no elevated markers or anything. It was caught so early that I was able to have surgery to remove. I feel like that routine CT saved my life! (Also, they were able to compare with a CT done a few months earlier, to see the change...)
Might your doc be agreeable to a routine schedule of scans even tho it is not their usual practice? I realize their might be implications for insurance -- but maybe s/he can find a way around that....
Good luck

Hi Ron. I have found the PET scan to be the most refined way to pick up rapidly growing cells. My CEA hasn't always been reliable, but the PET even picked up a small skin cancer that was unrelated to colon cancer. Radiation is a concern, especially after receiving radiation treatment, but monitoring the cancer is my priority.
It seems that intuition about one's condition is often correct. I wasn't due for a CT scan for 6 months, but I just didn't feel right and shared this with my oncologist. He immediately ordered a CT which showed the cancer had recurred. I can't imagine having waited 6 months under those circumstances. Thankfully I'm now doing well.

jana11 said:

Woe!! What stage were you? I agree with all the rest. That seems ridiculous. YOu don't need PET scans, but some other imaging is important: eiher CT, ultrasound, something!

Definately get a 2nd opinion.

Good luck. jana

Personally, I went through treatment in Texas because of convenience and family to help me with my daughter and I am now with an Oncologist in Colorado and they are very similar in the way they want things done.

I was Stage III Colon cancer with One affected Node. By both doctors, I am to be seen and screened with both blood work and a PET/CT every three months and a colonoscopy every year for the first three years, at least. If everything checks out fine, I may reduce my colonoscopy's to every 3 years or so. I'm not sure if the Onc is going to reduce the # of PET/CT's or not.

I had an interesting discussion with the Tech performinng the PET/CT (btw, it is a combined scan) and their opinion is that the results of the scan far outweigh the risk of being exposed to that small amount of radiation. That the PET/CT is the highest form of technology that is currently available to scan for cancer.

It's interesting and often frusterating when it comes to all of the differenting opinions. It's hard to figure out what is right and what is wrong.

Good luck,

Patricia