Have the nodes disappeared into thin air???

Hello Doctor, In April 2006 I was diagnosed with OVCA Stage IIIb, serous cell, grade 3 cell.  Cancer had spread to the stomach lining, liver and there was pleural effusion in the lungs.  CA125 was at 2,500.  Taxol and carboplatin was administered from May 2006 to October 2006 and CA125 was then 11.  I have not taken any chemo since Oct 2006 and tumour marker has climbed all the way to 520 as of now.

December 2007 CT Chest Scan reads as follows:  There has been interval progression (since Oct 2007) of bilateral anterior epiphrenic lymphadenopathy, with increase in the number of epiphrenic nodes on the right and enlargement bilaterally.  The largest confluent node on the right now measures 2.4 x 2.2 cm (axial image 94) compared to previous measurements of 1.6 x 1.4 cm.  There is now right internal mammary chain lymphadenopathy with a 1.8 cm internal mammary chain node identified on axial image 65.  Mild right anterior mediastinal lymphadenopathy is present and there is lymphadenopathy in the left superior mediastinum along the lateral aspect of the arch of the aorta and the aortopulmonary window extending along the lateral aspect of the left hilum.  No pulmonary lesions are identified.  There is no evidence of pleural fluid.  

May 2008 Chest XRay reads as follows:  The heart size is normal.  There is mild, lobulated widening of the superior mediastinum.  Both hila are mildly elevated.  A small right pleural effusion is present.  A thin linear density is seen in the right lung base.  Otherwise the lungs and pleural surfaces appear unremarkable.  No bony abnormality is seen.  Impression:  The appearance of the mediastinum is suggestive of adenopathy.  A small right pleural effusion is present.

Doctor, does this mean that the nodes from December 2007 CT scan have disappeared/shrunk, or is it that they are not showing on the XRay?  Doctor, THANK YOU SO MUCH!!!!

[HeinrikMD]

Hi,

Comparisons of CT scans with X-rays tend to show more details in the CT. The X-ray does report a suggestion of lymphadenopathy – this is the area in the middle (where the heart is) which is actually consistent with the CT. You could easily imagine the Xray frontal view as being muddled due to different overlapping anatomical structures (with the heart obscuring most nodes near it), as compared with a CT which takes cross-sections (the best description I could think of here is the section created by a magician cutting an assistant/audience member in half) where the nodes that are otherwise behind the heart in the frontal view are no longer hidden.

I’m wondering though why this X-ray was taken in the first place? Chances are, it wasn’t done to re-evaluate changes from a baseline CT image.

[BeachGal7]

The XRay was taken because I can't stop coughing, and antibiotics is not helping.  I have gotten in touch with my oncologist.  Thank you for your great explanation.

[HeinrikMD]

Hi,

The XRay was taken most likely to look for features of pneumonia, not really to make an interval assessment of the cancer involving the chest.

Of course we’d like it so much, if there is imaging evidence that the cancer is really regressing, your positive attitude though, is enough to be thankful for. Keep up the fight.