CT Results/Lesion

[milashka]

I posted a week ago re signs of recurrence. I have had some vague pelvic pain and bladder urgency, so oncologist ordered a CT scan even though exam and tumor marker were normal.

Thankfully, everything is clean - no abnormalties, no fluid, etc. Except for a 5 mm hypodense lesion on the liver that "appears to have slightly enlarged since last scan." Last scan was Sept 07 (14 months ago). They say it could be the same size and just appear different because of the stage in enhancement pattern. Worst case, it grew from 3 mm or so to 5 mm in 14 months. No biggie. But the protocol says, repeat CT scan in three months.

I know, probably nothing to worry about. But I don't know if I want another CT scan so soon. All that radiation for something that small...plus the barium sulphate did a number on my intestines this time - I felt really sick. Will have to discuss that with my oncologist.

Has anyone else had lesions showing before?

[milashka]

Okay, got a call from my oncology office, my doctor looked at the CT report, and also re-read the last report of Sept 07, and said I have nothing to worry about. He is not at all concerned. While cancer can never be ruled out, the lesion is miniscule and likely a cyst, and he feels that if it was OvCa it would present itself bigger and/or with other spots showing in the abdomen. He said I was clean - NED.

I myself add: for now. It might look different next time around. But that's how it always is anyway, so I take it!

Next check-up (Ca125 and pelvic exam) in April. At that point we will discuss how to proceed, and whether or not to keep monitoring this and how closely so.

Cindy: You may want to add a particular thread to your watch list (there is an option box below your posts). This should make it easy for you to track things. I have also seen an option somewhere, maybe in the profile (?) where you can set how the posts show in the forum...

[Cindy809]

Sounds like you have a great doctor.  I wish the posts would come up to the top to keep things current.  I just happened to see that you responded.  Please keep us posted and if I miss your post send me a message.....Cindy

[milashka]

Oh and the one that disappeared, it disappeared while I was in remission. I had my last chemo 3/2006. From what I gather, it could have been a cyst that popped, or it could have just not been visible (hiding?) or, actually, they say that lesions that decrease in size are also unstable and could be cancer, although I am not sure if that applies to while one is in treatment. They never knew what it was - most reports said too small to assess, one said statistically likely to be a cyst. Now it's gone.

I have also had a 1.3 cm cyst on my kidney for the longest time (way before cancer struck). It's still there.

[milashka]

Thank you Cindy, for taking the time to respond.

My tumor marker is a good marker, I think. It was 1000 pre-op, 270 post-op, 60 after the first treatment, 19 after the second, and between 9 and 15 (12-13 on average) after that, so basically has been around 13  for three years now. Last week it was 13.

They did a CT every 6 months at first, then as I was approaching the two year mark they said no more scans, just CA125 and pelvic exam every 3 months.

I did specifically ask him about the lesion on the liver and he said it's nothing, you're clean. I thought it was odd but also know that CTs show a lot of stuff that everyone has and just doesn't know it, like cysts. The funny thing is, the first scan report post-treatment didn't mention the lesion, but the next one said the lesion is unchanged to previous scan. Ha! I have to question the consistency of radiologists' interpretation.

My doctor is a very good gyn oncologist, excellent surgeon, very conscientious, so I fully trust him. I believe he would have continued the CTs if the lesion, at the time, was something to worry about.

This CT was only done because I had urinary frequency and some vague pelvic pain that started 5 days before my appointment. It turned out to be a simple bladder infection but when I say I have symptoms, he immediately tests. Last year I had a few bouts of headaches, off to the MRI I went. Turned out to be just lack of sleep.

So yes, I want to know, why at first unconcerned, why now concerned? I guess because it was stable, and now might be unstable. I have yet to talk to him, I hope to do so at some point. I have many questions, and will post the answers here as I continue through this roller coaster.

[Cindy809]

Hi again...Ask your doctor why he wasn't concerned before this? Also ask him what he thinks about the one that disappeared?  Where did it go?  Were you on chemo?  Was it non-cancerous?  I think they are reacting due to the fact that it has increased in size.  Acting quickly with your liver is the best advise I can give you!!  Push for answers and get the best treatment possible.  Sorry, I'm not saying that to scare you but I have a lot of experience with the liver.  To answer your last question, yes the Petct will detect small disease (mm).  Some doctors use the scan others don't.  It is the only scan that works for me.  The protocal for ovca usually is every 3 months for a CT scan, pelvic and a CA125 once considered that you are in remission with no evidence of disease.  Since I have so much disease the Petct is the best scan to measure progression.  I have so much scar tissue etc. that the CT scan is not a good one for me anymore.  It doesn't pick up everything.  Now, that is me and not you.  Everyone is so different.  Did your doctor take a CA125 along with your recent CT scan?  Is it a good maker for you?  What grade are you?  I am 3 which is very aggressive cancer.  That is why I'm giving the advise to take care of it asap.  Hope this helps.....Cindy

[milashka]

I am just wondering why nobody was concerned about two hypodense lesions, the same size, that showed up on all the previous scans (one was 6 mm, also on the liver, and has now disappeared), and all of a sudden they get nervous because they caught on film that one has grown by like 2 mm. Over 14 months.

I remember the first time they mentioned that same small "hypodense lesion" on my liver, I asked my oncologist and he assured me it was nothing to worry about.

Sounds to me that a pet scan is a good way to see where all the centers of activity are, as surely it is not isolated to the liver only?

[Cindy809]

I hope your insurance company will cover a petct scan!  The reason for the petct is to see if there is activity.  Either way (if you decide on a pet or mri) something needs to be done about it.  With the Petct you would not have to drink the barium.  The contrast that is given is like crystal light.  This is to highlight the bowels (I think).  I'm not sure but if it does come back as active cancer you might have to do chemo even if you get RFA done.  Unfortunately the amount of radiation we have to endure is part of this disease.  Without it they wouldn't have found such a small amount of cancer to treat.  So we must realize that there are benefits to the scans.  Please keep us posted.....Cindy

[milashka]

Thanks for the suggestions. I thought about asking for an MRI, but Pet Scan may also be an option, provided my insurance will pay for it. I have heard some don't.

I am worried about radiation, one CT is equal to three years worth of normal living radiation (x-ray, about 10 days), and I already had about 6 or 7, and if they start monitoring the lesion by a CT every 3 months, I would say, no.

They may not need to give me barium, I think the liver only needs the iodine, however, if they shoot all that radiation through me, I might as well swallow the barium and take the discomfort, as I also have bowel troubles that I may want to monitor while at it.

And I think I'd rather do a RAF than chemo.

[crecco]

I have to agree with Cindy. RAF would be a good solution. But chemo might also work in getting rid of it if it would turn out to be a small tumor.
  I know the thought of more chemo is not what you would like to hear. But sometimes it just takes a small amount to get rid of smaller tumors plus it would help get rid of anything else that you might not be able to see yet.
  As far as the CT goes, is it possible that they could just give you contrast instead of the barium sulfate? Of all the CT scans I have had, I have only had to have the barium sulfate a few times. Mostly it is some other stuff mixed in kool-aid. You might even ask your Dr about a PET scan. But I would not worry a whole lot about the radiation from the scans. Eventually it reaqches the point where we have so many scans that we don't even think about that part of it. Plus when we do get worried, it is nice to be able to see just what is really going on.
   I could not really answer your question about the lesions as so far I have not had a problem with them, but I hope I did help in some way.
      Chris

[Cindy809]

Hello...I have a suggestion.  Since the barium sulphate is hard on you and the two CT scans will be very close together I don't think you will see that much of a difference.  With disease that small my oncologist  will order a PetCT.  I was shocked to read my last PetCT showed no tumor measurements. Very different from the past readings.  The radiologist explained he will determine  the increase in size by measuring the glycolytic activity from Max SUV. That will tell how much activity is going on.   My PetCt's have changed since I have so much tumor that they use this method to determine progression.  My oncologist will read the report to me and then we look at the scan ourselves to see exacly where everything is.  At this point if yours is a tiny amount of cancer and shows activity I'd consider RAF.  It is so small and after the gold standard of surgery for the liver RAF would be the best solution in my opinion.  I hope this helps...Cindy