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Old 06-23-2007, 09:42 PM   #1
Odette
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Join Date: Apr 2007
Location: Shaker Heights, Ohio
Posts: 86
Nervous about CT and Bone yes, but no PET Scan

Hello Friends,

I've been sitting on this problem for a week and would like to hear your opinion about it:
When last week I saw my oncologist he ordered the Bone and CT scan to be done early July, and when I asked him why no PET he said: 'It does not give me any extra information'. And that was that.

Background: January 2007 when my lump showed up in my neck (cervical lymph node) my radiation oncologist ordered the Pet scan which showed two uptake areas. Then this was radiated and I was considered NED. It was planned that I'll have scans every 3 months.

I had my second set of CT, Bone and PET scans in early April, which all came back at large negative except the other side of my neck lit up now on the PET scan. Had to go see an endocrinologist had thyroid ultrasound, thyroid biopsy which came back inconclusive - which means surgery . (The possible thyroid cancer is most likely unrelated to the BC.) Anyways, they recommend me to have thyroid surgery, which I'm postponing so I can do the Xeloda and Tykerb first.
I really counted on having the PET scan in July just in case ... If there is possible progression it would be good to know. If the thyroid area cleared up that would be even better. Maybe I won't need the surgery then
I just don't know how to approach it with my oncologist. He probably thinks fewer tests less anxiety. I feel on the contrary.
What would you do?
Would you insist on the PET or just try not worry?
Should I call my radiation oncologist? She would probably order the PET scan...
I could call my second opinion MSKCC oncologist ask her about it, but hate to go against my local doctor's advice. I guess I don't want him to feel like I don't trust him. Hmmm.

Please let me know what would you do?
What is your testing schedule? (Especially if your situation is similar to mine.)

Thank you friends,

Odette
__________________
May 18, 2006 Age 52,
Diagnosed infiltrating ductal carcinoma
er/pr- HER2 + 3.9 by FISH
June-August 2006 AC chemo
August-October 2006 Taxotere + Herceptin
November 18, 2006 Mastectomy 16 involved lymph nodes
Jan 2, 2007 start radiation
Stage IV, Jan 12, 2007 recurrence in cervical lymph nodes while on Herceptin, stopped Herceptin
Rad oncologist extended the radiation field, good response
Started Tykerb Xeloda on beginning of May 2007
Progression to lungs and conglomerate lymphadenopathy July 2007
Undecided about next treatment

'One does not get to choose one's adventures'

I'm experimenting with my diet, using green tea, flax seed curry and olive oil

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Old 06-23-2007, 10:32 PM   #2
mamacze
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Join Date: Sep 2005
Location: Madison, Connecticut
Posts: 638
Odette,
Why do we second guess ourselves?
If you are feeling you need another PET scan, than you ask for it again. It is certainly logical...the last one showed a change...you need another to compare to the changes and to your baseline. If I were you, I would call my onc back and say just that. If he still digs in his heels, just thank him and call your radiation onc for another opinion. If they still say no, go for another opinion at MSKK and if they agree with you; re PET scan, than it is time for a new oncologist...(and get the PET) and remember; you are paying them...dialogue with them!
Good luck Odette and let us know how you make out.
Love Kim from CT
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Old 06-23-2007, 11:21 PM   #3
SoCalGal
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Location: LA LA Land
Posts: 1,607
do the pet

Hi,
I am scheduled for a PET july3rd - it will be 3 mos since starting on ty/xe. My onc said that I should wait the 3 months - he said that if I went at 2 months it could be non-definitive. (I thought that women were scanned at the 2 month mark in the clinical trial but he said it would be better to wait the extra month. Also, my markers were dropping so he felt that was a good sign, and a reason to stay the course and wait for the scan.)

I think you should just call you ONC and tell him that you would feel a lot better having the complete PET scan. I'm sure he won't care. I doubt he'll take it personally.

I have met so many stage 4 woman lately - we are all pushy and that's why we're still here!

xoxo Flori
__________________
1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 06-24-2007, 06:30 AM   #4
Odette
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Join Date: Apr 2007
Location: Shaker Heights, Ohio
Posts: 86
Kim, Flori you help me be assertive!

Thank you Kim, thank you Flori for your quick response!
It would be easier not to ruffle the waters but when is the right thing easier?
I'll make those calls on Monday.

Flori, I've been on the T/X only for two months, but the scans would be 3 months from my last ones in April.

Hope yours are PERFECT on July 3rd.

Let you know what happened,

Fondly,

Odette
__________________
May 18, 2006 Age 52,
Diagnosed infiltrating ductal carcinoma
er/pr- HER2 + 3.9 by FISH
June-August 2006 AC chemo
August-October 2006 Taxotere + Herceptin
November 18, 2006 Mastectomy 16 involved lymph nodes
Jan 2, 2007 start radiation
Stage IV, Jan 12, 2007 recurrence in cervical lymph nodes while on Herceptin, stopped Herceptin
Rad oncologist extended the radiation field, good response
Started Tykerb Xeloda on beginning of May 2007
Progression to lungs and conglomerate lymphadenopathy July 2007
Undecided about next treatment

'One does not get to choose one's adventures'

I'm experimenting with my diet, using green tea, flax seed curry and olive oil

Odette is offline   Reply With Quote
Old 06-24-2007, 08:07 AM   #5
Carolyns
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Join Date: Jun 2006
Location: South Florida
Posts: 477
Odette,

I recently had a time when I was uncertain with the conclusions my doctor decided upon. Basically, I was told that we were going a certain route and I asked a couple of questions went home and began second guessing the choice made for me. I am a person that must buy into and understand the process and path that I am taking...whether it testing or meds. So, as a result I requested to see my doctor again, I told the doc that I did not understand the methodology and that going down a path without understanding the thought process was giving me anxiety. I said, "Please walk me through your thought process on selecting this...next step and not some of the others we could have taken...whatever the other next step would have been."

My doctor sat down and fully explained the thought process. I asked the "why's and why not and what about ...". I went well prepared with a list. Every question was answered and I felt empowered and confident when I left.

I hope that you can find the same peace of mind.

Best wishes, Carolyn
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Old 07-11-2007, 05:05 PM   #6
Odette
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Join Date: Apr 2007
Location: Shaker Heights, Ohio
Posts: 86
CT Was Enough to Show Progression

Hi,

Your note was very helpful. I did ask my onc about the Pet scan and he explained that every three months the CT and only every 6 months the Pet would be sufficient as long as I remain in remission. Also he said that he really did not expect it to show anything. Now this is the past.

The CT showed lesions in my lungs and quite extensive lymphadenopathy. I'm not crying I'm not angry not depressed I just really want to figure out what to do to put me into remission.
I have not seen him, only talked to him since this news, but he said he will have me scanned again in 4 weeks giving Tykerb /Xeloda another month to work. I think I'm going to ask him to at least add Herceptin to it.
Carolyn, you are on Tykerb and Herceptin, right?

Best,

Odette
__________________
May 18, 2006 Age 52,
Diagnosed infiltrating ductal carcinoma
er/pr- HER2 + 3.9 by FISH
June-August 2006 AC chemo
August-October 2006 Taxotere + Herceptin
November 18, 2006 Mastectomy 16 involved lymph nodes
Jan 2, 2007 start radiation
Stage IV, Jan 12, 2007 recurrence in cervical lymph nodes while on Herceptin, stopped Herceptin
Rad oncologist extended the radiation field, good response
Started Tykerb Xeloda on beginning of May 2007
Progression to lungs and conglomerate lymphadenopathy July 2007
Undecided about next treatment

'One does not get to choose one's adventures'

I'm experimenting with my diet, using green tea, flax seed curry and olive oil

Odette is offline   Reply With Quote
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