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CT or PET for follow-up

markatger's picture
markatger
Posts: 315
Joined: Feb 2005

Hi again everyone,

What are people who are considered NED getting for scan as follow-up? My oncologist plans on doing CTs instead of PETs. I asked him why and he said it gives a better picture. That PET scans are better for monitoring response of existing cancers to treatment.

I though I was going to get PET scans for follow-up, so I'm a little surprised.

Thanks,
Maria

shmurciakova's picture
shmurciakova
Posts: 910
Joined: Dec 2002

PET is a diagnostic tool used to determine whether something found on a CT is cancer or not. It is usually ordered if something shows up on the CT scan. I get CTs and blood work (CEA) every 4 months and then after 2 years every 6 months. After 5 years once a year. You start counting from the day your treatment ended. I hope that helps.....

KathiM's picture
KathiM
Posts: 8077
Joined: Aug 2005

Maria,
I'm getting CT scans, also. If it shows something, then on to PET and MRI and Ultrasound...PET only shows cells that are activly 'feeding'. In theory, there could be cancer, and the PET doesn't show it...happened with my breast cancer...
Hugs, Kathi

taraHK
Posts: 1961
Joined: Aug 2003

My understanding (and it's simplistic!) is that CT is more accurate in detecting lesions, but PET is better able to indicate whether a lesion is malignant. If you have suspicious results on a CT, you might then have to have a PET. But the reverse is also true!

I used to be on routine CT scan for follow-up. Currently, I am having PET as first test, but that is somewhat related to the pecularities of the medical system I am in....

Tara

chynabear's picture
chynabear
Posts: 483
Joined: Jul 2005

Both my treating and my follow-up oncologists agreed on my follow-up treatment with PET/CT's every 3 months or a PET and CT every 3 for at least the first year.

The clincher is that insurance can, and does seem to frown on the PET sometimes. I have been in battle with my insurance company regarding the PET I had in Nov 2004 after surgery (that they initially paid) and PET/CT I had in July 2005 after chemo (they said no pre-approval required). They claimed it wasn't "medically necessary." After pointing out to them that they are using reference material that is SIX YEARS OLD!!! they relented and FINALLY paid them. Of course, we had other arguements that I think helped to pursuade them... but anyway.

I have been told the combined PET/CT is the most accurate, followed by the PET and CT (separate) followed by just a CT. I'm sure the MRI fits in here somewhere as well.

I would check with your insurance about the use of PET's and PET/CT's and based on that info decide what YOU need for follow up.

Betsydoglover's picture
Betsydoglover
Posts: 1256
Joined: Jul 2005

Hi Maria -

I think in part it may depend upon what Stage you are. I am definitely Stage IV - in fact we recently had the original biopsy rechecked just to be absolutely sure.

My oncologist has me getting a full body PET, a diagnostic CT of chest, abdomen and pelvis (w/wo IV contrast) and a PET-CT fusion where they overlay the PET on the CT. She feels that this is the standard of care for Stage IV (but you ended up not really being Stage IV, right?). My insurance company always pays for CTs right away, and the laugh is that they pay for the PET-CT fusion right away - then they drag feet on the PET, ask for statement of medical necessity, manage to drag it out and finally alway pay for PET 2-3 months later. What a game!

I am essentially having these tests every 2 months - my last one was in late April - next one is tomorrow. The doctor says that depending upon results she may gradually push the schedule out a little, but not much. I'm all for that given that I am Stage IV.

Regarding PET vs CT, my oncologist believes that PET adds an additional layer of truth to the CT. Also, even though it is a popular notion, and probably generally true, I am a living example of someone who has had cancer show up on PET, but not on CT. There was one suspicious area on CT prior to my surgery, but turned out just to be a cyst or something of the sort. However, the liver was examined during my colon surgery, something suspicious was noted (something not on CT) and biopsied positive. Three weeks post surgery I had PET, CT and fusion done and the biopsied area lit up on PET, all the while nothing showing in that area on CT. So, that's my story, and at least for Stage IV patients early on is probably a reasonable follow-up protocol.

Take care,
Betsy

shmurciakova's picture
shmurciakova
Posts: 910
Joined: Dec 2002

That is very interesting because for me it was the other way around. I had lesions show up on my CT scans at 4mm that did not show up on a PET scan for months later when they grew to 1cm. I had 2 false negatives on the PET overlay before they finally lit up 8 months later.
I guess it just depends on how your individual tumors behave.

MarkWalz
Posts: 58
Joined: Jan 2006

CT's for me. It all has to do with insurance cost with my doctor. The PET scans are better, but way more expensive. The doctors can get CT scans easy, the PET scans only so often.
That is my two cents.
Take care , what we want is good results in either one.
Mark

shmurciakova's picture
shmurciakova
Posts: 910
Joined: Dec 2002

Actually the PET is an overlay that goes with the CT scan. It is like various layers in GIS, if you know what I mean....If the lesions that show up on the CT "light up" on the PET then they can assume that they are cancerous.

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