Do I need a PET scan for large IDC?

Bayla

Hi, 1st post. I have a large (4.8cm) IDC with 2nd spot biopsy pending. MRI showed no lymph nodes involved. My oncologist (who I will be switching away from) ordered a PET/CT scan and the surgeon said I don't meet criteria for it. Nurse said it's my choice. I cancelled it due to needle phobia and missing work. Do I need it now? I assume if they find + nodes in surgery, then they will order scans. Did anyone need a PET scan based on tumor size? If it's not in lymph nodes according to MRI, how could metastasis be seen anywhere else? Thank you!

exbrnxgrl

Bayla,

I’m sorry you find yourself in this situation. To answer your last question, breast cancer not only spreads through the lymph nodes but can travel through the bloodstream as well. I am curious as to why your oncologist ordered a PET scan as it is generally not standard of care for lower stage bc, which yours may be. I also don’t understand why the surgeon (though from info you’ve provided I agree that you don’t meet criteria) and a nurse are involved. As far as it being your decision, if you are in the US please check to see if your insurance will cover it. If it is not standard of care in your situation they may not pay for it. The chances of finding metastatic disease at initial diagnosis is small, radiation exposure is large and the cost of a PET is huge which is why it is not generally done for early stage patients. Take care.

ElaineTherese

I got a PET scan for a 5 cm tumor, but there was already some indication that my cancer had spread to one node (later confirmed with a fine needle biopsy). Also my cancer was Grade 3 (and growing like kudzu in the lab! my onc said). But, my oncologist was an aggressive scanner; she worked the insurance companies until she got the scans she wanted.

moth

I agree PET is very expensive and also exposes you to lots of radiation. But a regular CT might be a compromise if your oncologist feels it's necessary.

as exbrnxgrl said, cancer can spread through blood so you can have clear lymph nodes and still have spread. Also apart from the ones in the armpit, there are numerous other lymph nodes in the chest and neck area which are usually not well visualized and sometimes those are the cancer highways. About 6% of diagnoses are metastatic right from the start.

generally speaking scans are not indicated without clinical signs such as changes in blood values, abnormal examination of abdomen, bone or joint pain, respiratory symptoms. Some oncologists consider the size of the tumor because the bigger it is, the longer it has had time to potentially seed. Some also consider how close it is to the chest wall.

I think you should find out why your oncologist recommended the test. Or just wait and see what your new oncologist recommends since you're switching.

AliceBastable

Mine was a pretty run-of-the-mill smallish cancer, but my oncologist ordered a pre-op chest CT scan w/o contrast because I was a smoker at the time. I've had a couple PET scans ordered by a different doctor for a different cancer, but only when my follow-up CTs (w/contrast) looked iffy. I've never had PET scans as first-line exploratory imaging or even routine follow-up scans - they've just been to confirm or rule out things from CTs.

Sabbymama

My IDC was 7cm and I had two known positive lymph nodes prior to my surgery. My oncologist ordered a CT scan and Nuclear Bone Scans, but no PET Scan. After surgery, pathology revealed two additional positive lymph nodes (micrometastatic), extranodal extension, and lymphovascular invasion and I have still never had a PET Scan. They repeated the bone scan 6 months later to check on some "hot spots" but have said that they are "stable" and left it at that. I think in your case, perhaps a CT scan might be adequate and a follow-up bone scan would be in order if they find anything suspicious? Good luck!

ThreeTree

I had a large IDC (about 5.5 cm I think) and my surgeon who did the initial biopsies ordered all sorts of scans, but no PET. I had an MRI, a bone scan, a brain scan, and a CT with contrast. If contrast could be done with any of these, that's what I had - the full meal deal. This was right after the pathology came back (ER/PR+, HER-, Grade 2). It had attached to the chest wall, but there were no nodes apparently involved, and thank goodness the scans all came up clean.

I had not known that PET's put out so much radiation. Glad I read about that on here! Thanks to those who mentioned it.

Elderberry

ThnreeThree: My MO thinks a PET picks up more rogue cells than a CT. But - and a big but - at my age the risk of a PET causing some long term harm like some other form of cancer, is unlikely. So it is just do not get close to little kids for 6 hours and give the Border a note from your MO if your travel within - I think - 24 hours after the PET since the radiation sets off alarms. So far, I am not glowing in the dark.