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Why PET scans?

oldbeauty
Posts: 183
Joined: May 2012

I am due for my first mid-treatment CT scan on April 10.  Yesterday, I told my doctor I wanted a PET/CT.  He said it was not medically necessary from his standpoint.  But he said if I was sure my insurance did not place limits on lifetime PETs he would code the script to get the PET/CT OK'd.  In my heart, I know the reason I want the PET/CT is that I am terrified about having no insurance next year (I'm eligible for Medicare in 2019) and I want to be as aggressive with treatment this year as I'm able tolerate.  My recurrence is several small nodules in my lungs and I am not a candidate for surgery or radiation. I know there's only so many chemo drugs they can try so maybe I am being irrational about the scanning now.  I can revisit the issue when this round of chemo is done in June.

My question is how many ladies relied on just CT scan during treatment.  I assume most, if not all, got PET/CT's post-biopsy to see the extent of cancer. If you got PETs during chemo, why?  Thanks for any feedback.  Oldbeauty

CheeseQueen57's picture
CheeseQueen57
Posts: 781
Joined: Feb 2016

I've only had CT scans. One before surgery, one after chemo and before starting radiation and one 6 months later. Currently NED. I'll have my next one at the 6 month mark in August. 

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2542
Joined: Mar 2013

oldbeauty, I have had only 3 CTS (and I keep count because I do believe you can only have so many).  One before surgery, one for planning my radiation (I had IMRT external radiation - and brachy), one when my treatment was completed.  I asked about how often and was told unless you feel something is wrong there is no reason.  I am coming up on 5 years out of diagnosis.  I am counting my 5 years from when I completed treatment and that will be December 2017.  

I have heard gyn oncs say a PET scan tells them nothing (plus they cost $$ and not always approved by insurance).  Maybe this will help with a side by side comparison:

http://www.diffen.com/difference/CT_Scan_vs_PET_Scan

Kaleena's picture
Kaleena
Posts: 1928
Joined: Nov 2009

This is a good question.   Basically, it really is the insurance companies denying PET scans.   Like you said, it is not medically necessary - and the person who is making that decision is on the other side of the states.   Here's a run down.   If you are a diabetic, PET scans can give false positives so in that instance the doctor would really need to see the need for one.   In reality, you get less radiation from a PET scan than a CT scan.  Here are the different types

  • Imaging using X-rays

    X-ray imaging uses an X-ray beam that is projected on the body. When passing through the body, parts of the x-ray beam are absorbed. On the opposite side of the body, the X-rays are detected, resulting in an image. 



  • Molecular Imaging

    Molecular imaging provides detailed information of the biological processes taking place in the body at cellular and molecular levels and can indicate disease in its earliest stages.  This would include PET, PET/CTs

  • Other Types of Medical Imaging

    Some types of medical imaging work without using ionizing radiation, for example magnetic resonance imaging (MRI) and ultrasound imaging, and have specific uses in the diagnosis of disease.

    A PET scan is used to see active cancer.  It lights up on the image.   It uses radioactive sugar because cancer is attractive to sugar.   Muscle movements though can appear "lit up" so that is why you have to rest prior to the imaging.

  • Using a CT scan can show the size of tumors/masses, etc.
  • The combination of both PET/CT gives a clearer picture of a mass whether it is PET active.   However, even though something doesn't show up on a PET doesn't mean there are not cells there.  So everything has to be taken in consideration with scans.  Not all cancers are visible on a PET scan.
  • I've had almost everytype of scan.  I even had a PET/MRI scan.  It was a new type of scanning.   I have also been denied a PET scan from an insurance company too.
  • I hope this helps
Kvdyson's picture
Kvdyson
Posts: 789
Joined: Jan 2016

I only had CT scans until they discovered a mass in my chest (with a CT scan) and decided that a PET scan was needed to try to determine whether it's malignant.

Here's how I think about the difference (I am no doctor so this may not be medically correct): PET scans determine whether organs are working properly. CT scans determine whether organs have the proper shape and density.

For a PET scan, you get a radioactive glucose injection and then the scan follows it through your body. They know how each organ should metabolize the glucose so if something shows up as abnormally active ("lights up like a Christmas tree") then they can try to determine whether cancer cells may be causing the extra activity.

My gyn-onc told me that PET scans are more expensive than CT scans so insurance companies limit them. He told me that my insurance company will only approve two per year so that is what I'll get for now until the chest mass resolves itself (or is removed surgically).

If you already know that your lung nodules are malignant, then the PET scan may not be much help. From what I've read, PET scans are good at detecting malignancies in lung nodules but the evidence is limited in their ability to determine whether treatment for malignant lung nodules is working.

Good luck to you in whatever you decide and keep us posted! Kim

 

oldbeauty
Posts: 183
Joined: May 2012

Kaleena and Kvdyson for your input.  Very educational.  According to my insurance rep I have no limit on imaging, the only criteria being medically necessary.  I am torn bc my nodules were too small for biopsy.  I don't really doubt they are a recurrence bc I had scattered lesions there at my first recurrence but they resolved with the high dose progesterone I was on.  I have gotten only Taxol for four cycles and two doses of Carboplatin early on before it got pulled bc of elevated liver enzymes, a rare reaction.  The oncologist told me he plans to challenge me again with Carboplatin when my values are normal.  So that means chemo will continue whatever the scan shows, I guess. Given the good news today that the ACA vote fell apart, I think I will go with the CT this time.  I still have time to think on it, and I appreciate  the time everyone took to add valuable information.  Oldbeauty

Kaleena's picture
Kaleena
Posts: 1928
Joined: Nov 2009

When I originally got turned down for the PET scan, my insurance company said I could have a CT scan (which I previously just had one but they wanted another one), and then after that CT scan I was approved for the PET scan.   So instead of just having one scan, I ended up having 2 scans. (or 3 within a short period of time). 

What I am saying is go for the CT and if it comes up with something then your doctors can push to get the PET scan approved.

beccabtown's picture
beccabtown
Posts: 234
Joined: May 2016

I had a PET scan after my hysterectomy and before chemo began because a very high number of positive lymph nodes (25 of 38) were found during my surgery, but there was no sign of metastasis beyond my pelvic organs. My hematologist/oncologist wanted to be sure there was no cancer elsewhere. She was also having a discussion (disagreement) with my gynecologic oncologist about whether to follow the sandwich regimen for chemo and radiation or do all the chemo first and then do the radiation. The PET scan was needed rather than a CT scan in order to determine whether there was any metabolic activity outside the pelvic region. There was none. My onc has since told me that my insurance company would not approve coverage for another PET scan unless a CT scan first showed something suspicious.

I've also had three CT scans, beginning with one before my surgery, and am having another next week. I wouldn't need this one but my oncologist neglected to include my upper chest in the December scan, and the gyn onc and I want to know that everything is okay there.

If you were worried about losing coverage because of what was going on in Congress, you must be very relieved tonight. I know I am! I have Marketplace coverage and am still seven years away from Medicare.

Sandrine04
Posts: 76
Joined: Nov 2016

For me scan is not good. 

My scan is clean but The irm shows nodules.

In september I had a perfect scan to scan  pet but during surgery there was still a lot of cancer in my abdomen.

It's strange.Can..  

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