Please help me understand PET/CT report after 3 cycles of 2nd line chemo therapy

[SatyaAruna]

Hi Dr. Goodman,

I have written to you previously about my mother. She had ovarian cancer recurrence in 6 months after surgery. And we are undergoing the chemotherapy with carboplatin+lipodox. After 3 cycles, we recently had PET CT scan and her WBC and RBC counts were too low and had afebrile neutropenia. Doctors gave her neupogen injections and her chemo got delayed by a week. Please tell me if there is any affect if the chemo is delayed?

My mother was previously diagnosed with Liver mets. The hysto pathology report after surgery (which is after 6 cycles of chemo paclitaxel+carboplatin) is as follows -
1) Bilateral poorly differentiated adeno carcinoma(50% viable tumor). Right and left ovaries - status post chemotherapy in a diagnosed case of carcinoma ovary.
2) Capsular breach and surface tumor implants seen - there are large areas of sclerosis and foamy macrophages(mainly in right ovary).
3) Right fallopian tube is dilated with foamy macrophages. Left fallopian tube shows tumor emboli in the lumen. Epithelium not involved.
4) Omentum is unremarkable.

After the surgery the recurrence seen after 6 months. And the CT scan reprot before stating 2nd line chemo is as follows.

1) Evidence of heterogeneously enhancing hypodense nodules are seen at the posterior peritonial surface of the right lobe of liver with eroding into the liver parenchyma. The larger one measuring 3.3cm. Suggestive of peritonial metastasis with infiltration of adjacentliver parenchyma.
2) Small well defined moderately enhancing leisons are seen in both adnexa measuring 1.5x1.4 cm on right side and 3.5x2.4 cm on left side. Suggestive of recurrence of ovarian leisons.

The PET scan report after 3 cycles of chemotherapy with carboplatin+lipodox is as follows

1) Both lung apices show small irregular opacities. Rest of the lungs are clear.
2) Multiple implants are seen on the inferior peritoneal surface of the liver.
3) Multiple nodules are seen in the Pelvic peritoneum.
4) A1.3 cm left iliac node seen.

PET Findings:

1) The peritoneal implants described on CT in the pelvis and inferior peritoneal surface of the liver show increased uptake.
2) The left iliac node also shows increased uptake.
3) The rest of the scan is unremarkable.

Impression:

PET-CT findings consistent with viable peritoneal and left pelvic nodal metastases.

Thank you very much for going through the reports.
Please tell me what is an increase uptake.
Does the PET-CT report show any improvement over the previous CT scan report?
The report says "Both lung apices show small irregular opacities." what does this mean? I am worried if it has spread to liver.
I am not able to understand the report. Kindly help me to know if the report shows any improvement previously doctors said there was liver mets. Now the report shows peritoneal and pelvic node metastses. Does it indicate growth of the disease?

Can we continue with the same treatment for her? Our doctor suggested to continue 6 cycles. Are there any better alternatives for treatment? Also her WBC levels are dropping since the 3rd chemo. How can we cope up with this problem?

Please help me in getting a clear picture on the current situation and what to do further.

Thank you so much for you time and kind response.

Satya



This discussion is related to Please help me to know the treatment options for Stage IV ovarian cancer recurrence.

[SatyaAruna]

Hi jr,

Thank you very much for your valuable suggestion.

Thanks
Satya

[jr1971]

Satya

You would probably be better posting this on the Expert forum (you will find the link further down the right side of this page).

On one of your questions: PET scans work by injecting the patient with a radioactive glucose. The scan then measures the areas which have the highest "uptake" of this sugar. Tumours tend to show increased uptake as they consume glocuse. There are measurements called "standardised uptake values" (SUV) which tell the person reading the scan the amount of glucose was consumed by the area in question and therefore the extent of the disease. Areas with high (in most cases a value over 2.5) SUV would be suspicious for disease.

PET on it's own does not confirm disease. Other things can cause a higher SUV such as inflamation and infection. The use of a CT scan alongside is so that the physician can match the increase SUV with some visible anatomic change.

I hope your Mother finds the right treatment.

Good Luck.