It’s Tuesday 68 days ATN and 28 days into chemo.
PET Scan Results: Seek and ye shall find – just not what you’re looking for
The PET/CT scan report came back on Thursday, a day later than expected. I suspect the radiologist was puzzling over the scans. As was I, which is why I waited a few days to post this since I wanted to ask my oncologist what it all meant.
On the good side, there was no evidence of mice, squirrels, rabbits or metastatic disease. None of those liver hypodensities lit up. There was evidence of normal metabolic activity, which meant that the scan wasn’t compromised in some way. And of course my brain lit up (it loves glucose and we all know my brain in particular is one huge tumor. It’s classed as transmetastatic and known to metastasize strange and mostly incomprehensible thoughts to anyone in hearing or reading range.)
On the odd side, the primary tumor didn’t show up either. This of course just gives more credence to my theory that this is all an elaborate hoax intended to make me wake up with the rising sun. I asked my oncologist about it and she mentioned that it could be a result of the chemotherapy affecting the tumor. If only Anthem hadn’t taken its sweet time authorizing the scan it would’ve been done before the start of treatment… But in her after-visit notes she added that “occult disease” can’t be ruled out either. That was a head scratcher. Did she think I was hanging out with witches and sorcerers? After turning to the all-knowing Internet I found that “occult disease” in this context refers to a cancer that simply doesn’t show up in scans. For example if metastases are detected but no primary tumor can be found then that’d be considered “occult”.
Now if the primary tumor didn’t light up could there be metastases that didn’t light up? According to the oncologist, yes it’s a possibility. But she always emphasized that if metastatic disease is present it always declares itself. I suppose this is much like having termites in your house. You might never see them but you’ll eventually notice evidence of their presence. In any event if metastases were detected then it wouldn’t change the course of treatment, and a further examination of the liver will apparently be done at the time of surgery in any case. I seem to recall a mention in one of the earlier consultations that if metastases were present they would be removed during surgery, so that makes some sense.
While the tumor is apparently not fond of glucose, what the PET did detect was a small area of my prostate taking up the FDG. What this means is a bit unclear – the radiologist suggested correlating it with PSA levels in the event its a carcinoma. The oncologist wasn’t terribly worried about it and noted that my PSA levels were normal in May. In addition the amount of FDG uptake was small, and there are apparently reasons other than cancer that can cause tissue to take up FDG. She indicated that I should have a routine prostate screening at my next physical just to be sure. Apparently in radiology these things are called “incidentalomas” – something that was found that’s unrelated to what you were looking for. I found a study that looked at prostate incidentalomas and, at least in that study, only 7.4% of them turned out to be carcinomas.
Something tells me this is All Caper’s Fault. It’s just the type of stunt she’d pull if she were hiding out somewhere in my body. I think I’m going to name that incidentaloma Caper…