Pet scan results

[monetdegas1]

Doctor,
I am being evaluated for surgery. Had a PET/CT. Written report of course shows the malignancies in the colon and liver. However, there are a few things I don't understand in the summary.
1) Some moderate activity is present about some fatty tissue about the lower aspect of the neck consistent with activity in brown fat.
impression: There appears to be some activity in brown fat about the neck.
2) Degenerative changes of the spine are demonstrated. Some scoliosis of the thoratic spine is demonstrated. Increased activity is demonstrated in the majority of the osseous structures consistent with reactive bone marrow changes.
impression: There is increased activity in the majority of the osseous structures that may be due to reactive marrow changes.
Can you please explain these to me. I am stage 4 colon cancer patient. On chemo for 24 months now. Still on treatment, looking at resection surgery for colon and liver as well as chemo embolization to liver. Assuming there is no evidence of disease else where in the body.

[monetdegas1]

Hi again, I am going through with the surgeon's plans. And I am hoping for the best possible outcome. To be honest, I have grown very tired of chemo, 2 years is a long time, I was diagnosed in March 2006. But, I don't believe I have any other choice but to continue to fight this in whatever way my doctors think is best. And, I really do believe the Lord has brought me this far and He won't let me down now. Originally, I was told I only had 4-6 months, my doctor is amazed that I have done so well. I feel really good most of the time, have gained back every bit of weight I lost, and am told often that to look at me you would never know I was a stage 4 cancer patient.
I appreciate your answers to my questions and the quick responses, thank you so much. Would you mind if I keep in touch with you throughout this process?

[Fernando Roque, MD]

Hi.  The low ANC will only delay your surgery if it cannot be corrected.  Fortunately, this can readily be done through the use of medication such as Neulasta.

Having liver metastases means that you have stage 4 disease.  Ordinarily, colon cancer patients who reach this stage have no chance for a cure, but recent studies have suggested that patients whose liver metastases are not extensive can still achieve cure by a combination of surgical resection (metastasectomy) and chemotherapy after the surgery.  So what your doctor told you is correct.  But he is also right when he said that there are no assurances for a cure.  Anyway, let's hope for the best.  You're doing the right thing in deciding to undergo the procedure.

[monetdegas1]

please excuse my lousy typing....I really can spell.....just can't type!

[monetdegas1]

My last post was addressed to a Dr. Roque. However, I would appreciate a reply from him again or any other physicisan that would like to respond to my posts,
Thank you

[monetdegas1]

Thank you so much for your speedy response. I have been trying to keep myself from worrying about this with no luck! I am still on treatments and had hoped that if any of the written report was bad that surely my oncologist would have told me something. I have the scan on CD to take to the surgical oncologist next week.
I have treatments weekly(Erbitux weekly and Camptosar, every 2 weeks), until recently, as my ANC is now down to 347. Have received 2 shots of Neulasta in the last month or so. Will low white cell counts cause a delay for surgery?
Also, the surgeon has these procedures planned:
1) remove the left side of the liver and the right side of the colon(original tumor is there)
2) do chemo embolization into the portal vein to the remaining liver
3) go back and remove the right side of the liver
He said best case scenario was cure. No promises but had himself had seen it happen many times. (He is at Emory's Winship Cancer Institute) Would continue chemo through all of this and after surgey for another 6-8 months.
What do you think of the surgeries? Is a cure possible?

[Fernando Roque, MD]

Hi.  PET scan is different than other imaging modalities in that it detects radiation coming  from an increased uptake by body organs of a form of radioactive glucose, fluorodeoxyglucose or FDG.  Body organs with increased metabolic activity have an increased uptake of glucose (which serves to fuel the increased metabolism), so FDG gets more concentrated in tissues with high metabolic rates.  Cancer cells exhibit this characteristic, hence they concentrate more FDG and show more "activity" in PET scan.

The increased activity shown by your brown fat and thoracic spine on PET only indicate increased metabolism.  It does not mean the presence of cancer in those areas.  Brown fat has naturally higher metabolic activity compared to the other types of fat, so the finding in PET is expected for this type of tissue.  The activity in your thoracic spine was attributed to "reactive marrow changes".  This means that the bone marrow in your spine may be actively producing blood cells, which may be your body's way of compensating for the decrease in blood counts induced by the cancer treatment (I'm assuming that you're presently receiving chemotherapy?).  

As far as this report goes, there does not seem to be evidence of disease.