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Old 06-18-2009, 07:04 PM   #1
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what does cancer look like on ct scan

what does cancer look like on ct scan

 
Old 06-18-2009, 08:31 PM   #2
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Re: what does cancer look like on ct scan

As you probably know, a CT scan is one of several imaging techniques—this one primarily for looking at organs. The CT is a rotating x-ray beam which creates a series of pictures of the body from many angles that can be put together into a detailed cross-section image.

The patient typically takes some sort of contrast material (for mine, I drank a barium solution) which helps the radiologist more clearly identify the individual organs in the x-rays. In prostate cancer patients, the CT scan is used to look for prostate cancer which has metastasized, or spread. The contrast material might appear to have an irregular absorption pattern on the lungs or liver, for example, if PC has spread there. The contrast material also helps see the lymph nodes, which might be enlarged if cancer has spread there.

Have you recently had a CT scan?

 
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Old 07-16-2009, 05:30 AM   #3
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Re: what does cancer look like on ct scan

Just started reading this post. kcon, is it expected to see small nodes on a CT scan? Or is this an abnormal finding. Is the key word "enlarged nodes" to indicate possible lymph node metastasis?

 
Old 07-16-2009, 08:18 PM   #4
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Re: what does cancer look like on ct scan

I would like to be able to give a more definitive answer, but the best I can do is “maybe.” From what I’ve learned, what I wrote below is correct that lymph nodes “…might be enlarged if cancer has spread there.”

Nodal size criteria is used in CT scans to raise a flag for possible spread, but unfortunately it’s not a definite “yes” or “no” because of the many reasons for variation in size. As I have read, a 1.0 cm has become a standard threshold, but that leads some with normally larger nodes (via benign processes) falsely diagnosed, and can also lead to others with microscopic invasion below the threshold yet still with malignancy.

I’ve also read that nodal enlargement due to metastases typically occurs relatively late in the progression of PC…none of the factors in your husband’s dx indicate late stage progression. Stated in the inverse, metastases to the pelvic lymph nodes is found in only a very small percentage of patients with early-stage PC.

The text here in italics was added as a later edit to my original post. I wanted to additionally point out that the paragraph above ties closely with my previous comment on the diminishing trend to include PLND during surgery; recall in your thread ("My husband...") I wrote (post #38):
My understanding is that there is also a historical component, and the rule of thumb written above was not always the case. In the last several decades (i.e., the PSA-era), the incidence of pelvic lymph node metastases has decreased, specifically because more low risk cases are being found as a result of wide-spread PSA testing. A doctor my age trained 20-some years ago would have been taught by surgeons who regularly found advanced cases in the pre-PSA-era and always performed PLND as a matter of course.
My advice, sbear: (1) Let the doctor read the report. Let him interpret it for you. Certainly, any learnings you do before you go see him will help you ask intelligent questions while you are there in the office. (2) Keep in mind that, from my personal experience, the search for the best treatment plan BEGAN after all the testing was completed. I'm not personally aware of what, if any, further testing might be recommended IF (big IF) your doctor wanted to look further. I do know that an indication of spread to nodes would be unlikely given your husbands other dx circumstances.

I know that people have already thrown treatment options at you, but like I said in my reply yesterday in your post, I personally did not have any discussions or explorations into treatments until after the point of your upcoming doctor’s visit to review test results. I would encourage you not to get ahead of the horse, but take it a step at a time.

When's your follow up doctor appt?

Last edited by kcon; 07-17-2009 at 10:28 AM. Reason: added additional paragraph in italics

 
Old 07-18-2009, 02:57 PM   #5
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Re: what does cancer look like on ct scan

kcon, my husband has not scheduled a follow-up appt. yet, but after he meets with a radiologist for consult this week, he'll decide what tx to undergo. The ordering surgeon of the bone scan and CAT scan is at a different hospital from where these procedures were done, and he was on vacation last week. His nurse said she'll make sure he gets both reports to call us and go over the results. My husband is leaning toward going with this surgeon, and would most likely schedule surgery this month or next (provided his CAT scan was ok- as a layperson, I don't know what to make of it. I'll keep you posted---as always, thanks for your response

 
Old 07-19-2009, 02:51 PM   #6
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Re: what does cancer look like on ct scan

Quote:
Originally Posted by sbear1102 View Post
Just started reading this post. kcon, is it expected to see small nodes on a CT scan? Or is this an abnormal finding. Is the key word "enlarged nodes" to indicate possible lymph node metastasis?
Hi kra53m and sbear1102,

kcon has already covered the facts, but here's another look from a different viewpoint with some background and other imaging options.

The bottom line: the CT scan is extremely unlikely to be positive except in cases with clear high-risk PSA and Gleason characteristics, and even then positive scan results are unusual. I know it's hard to relax when you are awaiting results or interpretation, but you are almost certainly so entitled. The downside: CT scanning really should not be done on men with low-risk case characteristics, but it is still pretty much routine from what I'm seeing. Hopefully that will change as recently published expert judgement and guidelines, described below, reach more urologists.

Regarding nodes, yes, enlargement is what the doctors are looking for, and unfortunately it takes quite a bit of growth of the cancer before the CT scan can pick up something unusual that could well be cancer. This is from shaky memory, but I believe it takes a tumor about the size of a pea to show up on a CT scan for a lymph node. Basically, if the CT scan is negative, as is virtually always the case for men with low-risk case characteristics (and even with higher case characteristics), it is not telling you there is no cancer, rather it is saying there definitely is not [U]a lot[U] of cancer in the nodes. CT scanning may be more sensitive for other sites, such as the liver, but it is quite unusual for prostate cancer to go to those other sites early its existence when most of us are diagnosed. Prostate cancer really prefers the lymph nodes and bones as early targets.

Here's a key excerpt of what the outstanding book "A Primer on Prostate Cancer - the Empowered Patient's Guide," Dr. Stephen B. Strum and Donna Pogliano, said about CT scanning for prostate cancer in 2002 (believe unchanged in the 2005 revision), in the discussion of CT scanning on pages 62 and 63: "Unfortunately, a CT scan of the pelvis and of the abdomen is routinely ordered in virtually all newly diagnosed men with PC. However, it is our contention, based on published literature, that this is a serious waste of healthcare dollars while exposing the patient to unnecessary radiation and inconvenience.... For at least 90% of men undergoing baseline staging procedures, a CT scan of the pelvis is not indicated [meaning not needed]. In 99.9% of all newly diagnosed patients with PC, a CT of the abdomen is definitely not needed...."

This past April, the American Urological Association came out with its expert "Prostate-Specific Antigen Best Practice Statement," which covered various staging techniques, including CT scanning, as they related to PSA. Here's the key sentence about the role of CT scanning on page 35: "3. Computed tomography [meaning CT] or magnetic resonance imaging scans may be considered for the staging of men with high-risk clinically localized prostate cancer when the PSA is greater than 20.0 ng/mL or when locally advanced or when the Gleason score is greater than or equal to 8.... Although the histologic incidence [meaning occurence] of positive pelvic lymph nodes is substantial when PSA levels exceed 25.0 ng/mL, the sensitivity of CT scanning for detecting positive nodes is only about 30% to 35%, even at these levels (Flanigan 1996)." In other words, even when there is cancer in a node for a higher risk case, the CT scan is going to pick it up only 30% to 35% of the time. The AUA did indicate that endo-rectal MRIs showed promise, but they were not yet willing to give their full seal of acceptance.

So you ask what a CT scan looks like, and I hope I'm not being too cynical in writing that, for a man with low-risk case characteristics, it looks like extra money in the pockets of those associated with those scans, as well as some unnecessary inconvenience, cost and anxiety for us.

There are some scans that are really good at picking up lymph node and other soft tissue metastasis, but they are either expensive or really inconvenient, with a low payoff for low-risk cases. That low payoff is not because they cannot find small cancer, as is the disadvantage for CT scanning, but simply because the likelihood of spread for low-risk men is so low. Still, if you really want to nail down the key details of the case and can finance the cost through insurance or your own money, the two scans are (1) fusion ProstaScint and (2) Combidex MRI. Personally, if I had the extra money and time and was newly diagnosed, I would go to the Netherlands and get a Combidex scan just for added assurance.

Fusion ProstaScint is highly effective in scanning the whole body, but it is fairly expensive (around $5,000 several years ago as I recall; my regular - not fusion - ProstaScint was around $3,400 in early 2000). It can still miss really small cancers, but it will pick up almost all. It was a moment for celebration when my ProstaScint result was essentially negative for my high risk case - really unexpected; while there are a few false positives and false negatives for ProstaScint, my case for more than nine years now has behaved in a way that confirms my ProstaScint result. The Primer discusses both regular ProstaScint and the much more effective Fusion ProstaScint on pages 54 through 57, and includes an excellent graphic illustration as well as photos of both regular and fusion ProstaScint results. (The color graphics and photos are one reason the Primer is such a valuable resource to us; I can't think of any other prostate cancer book for patients with that quality of visual information. That is a great aid to our understanding.) The improvement in the fusion version is striking, though that particular image for a Fusion ProstaScint has been cleaned up a bit. ("Fusion" means that you are imaged with both ProstaScint and CT imaging, also sometimes PET imaging which is normally not useful for low-risk prostate cancer.) Insurance is probably still quite willing to cover Fusion ProstaScint for higher risk cases, but not for low-risk cases.

The Combidex imaging, formerly known by the unhandy acronym USPIO (Ultra Small Superparamagnetic Iron Oxide) for its special contrast agent, is unfortunately at this point available only in the Netherlands. It is highly effective at detecting any cancer in lymph nodes throughout the body. (This is the kind of reliable result we think we are getting from a CT scan (but are not) in the early days after getting our rude introductions to this disease.) The Prostate Cancer Research Institute has published several outstanding articles on Combidex technology and its key doctor in a fairly recent edition of its free newsletter "PCRI Insights". If you have the 2005 edition of the Primer (the second edition), you can read some information about Combidex.

Hope this helps,

Jim

 
Old 08-26-2009, 11:15 PM   #7
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Re: what does cancer look like on ct scan

It's just been suggested that I get "a PET-CT scan with C11-Choline as tracer combined with a F-18 bone evaluation." (That's a mouthful.) Any idea what this is, and how accurate it is in detecting metastasis? (Especially as compared to what you've already discussed?)

Thanks!

Gregg

 
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