Scans, Nondules, Lesions, Possible Early Metastasis?

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Anonymous
Anonymous Member Posts: 1,376
edited June 2014 in Stage III Breast Cancer

Oh geez, I've been sitting here reviewing past scans my onc ordered for possible restaging. Though there were some questionable findings mentioned, I was cleared.  But.......I'm reading Chest MRI done on my clavicle and it says "On the T1 wieighted imaging the findings are less pronounced and there is some enhanced mass to gadolinium. "findings are non specific and could represent an early metastasis"

Then I'm reading my baseline 2009 CT that says "the lung parenchyma demonstrates punctate subpleural nodule in the left upper lobe. No other pulmonary nodules or infiltrates are seen".....Then on a 2010 restaging CT chest scan it mentions "there is a relatively stable indeterminate nodule involving the supeior segment of the left lower lobe, measuring 3 mm in transverse dimension."  Continued follow-up is recommended. Questionable subpleural nodule is also again see involving teh left upper lobe without change."  

The  liver, is also mentioned as having "a lesion too small to characterize."

I asked my onc about these findings on my last visit and he said that if It will ease my mind he will order new scans, but when he said that, I said no. I hate going thru scans anyway, and thought that he would definitely order them if he thought there was something.  I've had my baseline scan 2009, restaging scans 2010 & 11 and so far everything was unchanged.  But here's my issue .  Tomorrow is my next 6 month follow up with my Onc.  So I've been re- reading these scan reports and noticed that there is a new nodule on my lung in the 2010 scan and a follow up is recommended.  Now I'm going crazy wondering if there are any new ones or if there is any progression on the liver lesion, or the lung nodule, or the clavicle. So tomorrow I will be visiting with my Onc and I'm so nervous about discussing this with him.  I know him long enough to know he is a very pro active onc and will order new scans which will start this whole limb scanland process again.  Do any of you ladies recommend specific questions I can ask him?

Oceana

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  • fredntan
    fredntan Member Posts: 1,821
    edited January 2014

    that first part-enhanced mass to gadolinium- doesnt make sense to me . gadolinium is not part of body. it is rare metal.

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  • Celtic_Spirit
    Celtic_Spirit Member Posts: 748
    edited January 2014

    Because you have a history of cancer, radiologists are always going to note that a spot, nodule, or lesion could possibly be a metastasis. Also, some radiologists describe their findings in great detail, while others summarize the most remarkable findings and move on. On my post-chemo CT scan, the radiologist noted two sclerotic areas on my spine that could be metastases. My onc told me not to worry about them, they were probably just bone islands. That was 2008, and they've not turned into anything yet. What I would pay attention to is your pre-chemo scan reports and post-chemo scan reports. Did anything shrink or enlarge during that time? When you had your baseline CT in 2009, had you already completed radiation? (Radiation can cause scaring to the lungs, which will show up on scans and x-rays.) If there are terms you don't understand, I would go over them with your onc.

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  • flimsical
    flimsical Member Posts: 42
    edited January 2014

    I just had a chest CT to determine whether I need 25 or 28 RT to supra clavicle area.... that part was fine. However, he said "since they look at everything, they saw a few tiny spots on your back, and with your history I am ordering an MRI to rule anything out. It's probably nothing." Was he trying to ease my mind by saying that? I am practically comatose with this news. I don't know when my MRI is going to be yet, but I am freaking out.

    celtic - did you have a back MRI after you got those CT results?

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  • Celtic_Spirit
    Celtic_Spirit Member Posts: 748
    edited January 2014

    flimsical - I guess my onc had seen many instances of this before, so she felt comfortable not ordering further scans (fine by me!). I also have a benign bone tumor (I think it's called an osteochondroma) on my iliac crest. My onc said that all sorts of strange things show up on scans that most people would never know they had (because they don't hurt/cause problems) unless they'd had a scan. When I had my pre-chemo bone scan, the radiologist suddenly became terribly interested in my skull. I almost had a heart attack on the table! Turns out the plates of my skull fused funny when I was a baby. I never would have known!

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  • flimsical
    flimsical Member Posts: 42
    edited January 2014

    Well in my case it's my rad onc who is ordering the MRI since that's the treatment I'm in now. The CT wasn't ordered to detect metastases, but since the radiologist saw something, he's ordering the MRI for further investigation. When I had lung micronodules last year on a CT, my onc didn't even tell me until I asked, and he was like "it's probably just scar tissue." Thankfully he was right on that one, since there've been no changes during/post chemo. Honestly I wouldn't be surprised if my onc was like "oh it's nothing" regarding this too because of his positive attitude. However, I am just absolutely terrified. I hate this so much. I can't barely think straight.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2014

    Fredntan - gadollinium is a contrast medium used in MRI scans.

    Celtic -  My onc said the same thing regarding radiologists.. I was not started on chemo or rads until after my surgery. I did not meet my oncologist until after the surgery and patholgy came back.  I look back on that now and think that was really stupid to wait to consult with the Onc after the surgeries.  I guess I was in such an emotional fog just dealing with the diagnosis BS and PS,  and the fear and denial of chemo and rads, I didn't make the appointment with the onc until after the surgery.  Chemo and rads were started after surgical healing and my onc ordered scans.  I don't ever remember my BS ordering baseline scans.  I was initially told that the diagnostic mammogram showed a 4 cm tumor but no nodal involvement.  After the pathology came back from surgery, my tumor was 5.2 cm and 2 out of 18 nodes were positive for cancer.

    flimisicle - I so understand how you are feeling about the spots on your back.  I've been told that my sternum, and supraclavicle have "degenerative' changes that was shown with 'tracer uptake", and edema in the bone marrow in that area which could be a possible metastasis, but, yet again, as Celtic mentioned, a lot of this is radiologist spin on what they are seeing as "possible' but never probable in the final impressions.  So, it sounds like your onc is really being cautious so he can rule out and determine what the radiologists are saying.  I wish you calmness and peace before your scans.

    Oceana

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  • Celtic_Spirit
    Celtic_Spirit Member Posts: 748
    edited January 2014

    Here's the segment of the radiologist's report on my post-chemo CT scan from Oct. 2008: Increased conspicuity of small sclerotic foci in the right aspect of the T12
    vertebral body measuring 7 mm. A new sclerotic focus in the mid L1 vertebral
    body measuring 6 mm. The differences in comparison to prior exam may be due
    to different slice thickness (3.75 mm on current exam, 5 mm on prior exam);
    however, these may represent metastases. The increased sclerosis may
    represent treatment-related changes.

    Any radiologist worth their salt is going to flag an anomaly as a metastasis when dealing with a cancer patient...they don't want to be sued should it turn out to be cancer. Notice, too, that the radiologist notes that the test was slightly different from my pre-chemo scan; the thickness of the imaging is finer the second time around, thus, slightly different results. Unless mine is the world's slowest growing cancer, this was, in fact, treatment-related changes or bone islands, which are often mistaken for metastases.

    If you and/or your onc are really concerned about the findings in the first scan, definitely pursue further scans to get to the bottom of it and put your mind at ease.

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  • peacestrength
    peacestrength Member Posts: 690
    edited April 2015

    Oceana - glad you started this thread.  Scans show lots of things and I have been stressed for months about one of my scans.  

    Flimsical and Celtic - I had/have multiple lung micronodules.  My pre scan showed several and then after my 1st round of chemo 1 disappeared - all have remained.  I was diagnosed several years ago with sarcoidosis and hoping it's just that. But I am worried. I also had an infection during this time and was on antibodics - maybe they took care of a pocket of infection - not sure. My MO and lung specialist are watching me close and will have another scan next month.

    I had influenza last month with a horrible cough and my scan showed 2 more nodules either from the flu or they are radiation damage.  At any rate, it drives me almost crazy.


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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited January 2014

    Ocean, I am just a high risk for breast cancer girl, but I had a huge ovarian cancer less than three years ago. The "joke" is they call them "incedentalomas" when you have a bunch of scans. I now know I have some unspecified liver areas, probably fatty infiltration, some nodules on lungs, but probably nothing to worry about, a kidney cyst, a hemangioma on my spine, and an area on the head of my humerous spotted on a breast MRI, probably an arthritic cyst-type lesion. None of these warrant further investigation at this time.

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  • peacestrength
    peacestrength Member Posts: 690
    edited April 2015

    Melissa - thanks for your post.  It helps to know about others who's scans aren't perfect.

    What does a "clean" scan mean anyway?  You are clean but have nodules?  You are clean but have small vessel change in your brain - could be from chemo treatment or age - what!  Is it possible to have all perfect scans without anything showing?  So, are most scans not "clean?"  

    My doctors say that scans are highly flawed - really?  ....Ugh.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2014

    I just got back about an hour ago from my follow-up with Onc. I was dreading this visit, because I know he is not happy that I've stopped my Aromasin.  He doesn't think the lung nodules are anything much to worry about, but wants me to come back next week for chest CT. His onc nurse made me speak with the nutritionist because I had questions about Phytoestrogens in some of my food choices, and because my onc's phylosphy is NO ESTROGEN in any form, even flax seed & soy in my green smoothies. Sigh 

    peacestrength - A "clean" scan is one that clears you of any mets.

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  • peacestrength
    peacestrength Member Posts: 690
    edited April 2015

    Oceana - thanks for clarifying what a clean scan means.  Flax seed is a phytoestrogen?  I eat it everyday.  Have you had a chest CT before?

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2014

    My last Chest CT was in 2010

    Oceana

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  • flimsical
    flimsical Member Posts: 42
    edited January 2014

    Hi everyone - I just wanted to give an update. I had a long talk with my rad onc, and he even showed me my CT images. He apologized for scaring me, and said in most other people he would have passed this area over. It's really only one area of concern that he has. It's like 8 mm and barely noticeable, but I guess it's noticeable enough to warrant further investigation. He basically said "I really don't think that it's anything." While I feel a little bit better after our talk, I'm still scared shitless. All I want to hear is, "I can't find any evidence of disease." And then I could move on for now.

    Thanks for letting me hijack this post - I will keep following it for other members' takes on things.

    Thank you.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited January 2014

    flimsical - I do know exactly what you are saying. And I get it. My Onc sept quite awhile with me yesterday and I asked him about prognosis,  but he said I will not discuss prognosis with you.  I don't like to give prognosis' but I think it's because I want to stay off Aromasin, and I confessed to him yesterday I've been taking Vagifem.  I will see him in 4 weeks after the chest CT.

    Oceana

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited February 2014

    So, since I started this thread, I've had my CT Chest Scan to look at the nodules seen on previous scans.  Yesterday I requested a copy of the scan and got a call from my onc's office today.  They told me he will want to discuss the results of the scan tomorrow, first, and then I can have a copy.  Now, until I see him tomorrow, I'm going to be going nuts all night and worrying if the nodule seen on my base scan has grown or if the new one seen in 2010 has grown or if there is a new 3rd one now, or if they lit up.

    Oceana

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  • TectonicShift
    TectonicShift Member Posts: 752
    edited August 2014

    Sending good karma your way Oceana. I think you will do well tomorrow. It's totally common that you cannot have a copy of the report before discussing with doctor. I've tried to get reports early too and never could.

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  • peacestrength
    peacestrength Member Posts: 690
    edited April 2015

    Oceana - please let us know how you are.  As far as getting copies of scans before your appt. - I've decided to wait while I'm sitting in front of my MO to discuss - because I jump to conclusions too easily and cause myself too much stress.

    Prayers to you now and tomorrow.

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  • RosesToeses
    RosesToeses Member Posts: 721
    edited February 2014

    Oceana, I'm sorry for the stress you're feeling (and no matter how rational you try to be, a response like that is bound to be stressful!).  Praying you get good news!

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  • peacestrength
    peacestrength Member Posts: 690
    edited February 2014

    Oceana - thinking of you right now.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited February 2014

    Hi All,

    I had my appontment yesterday with my Onc. I was reminded how much I really do like him and trust him.  So here's the jist of the conversation.  He said the scan showed the nodules although  they've grown from 3mm to 4-5 mm. since the 2011 scan.  At first I was all concerned because they grew!!  But he insisted that they are stable and so small, he's not concerned.  I don't have the scan in front of me so I can't quote it verbatum but he insisted that If I'm really concerned he will send me to a pulmonary specialist, and I told him no, "I don't want to have another doctor to visit.  I trust you".  I just can't bear to go and see another one and going thru more appointments and tests, if I don't need to.  I'm just so glad the nodules didn't light up!  So I will see him again in June for another follow up.  I think I'm due for a bone scan then.  So this is what he also said to me and I'll quote.

    "Ok I'm not going to mention to you any more about the Aromasin, I know you don't want to take it anymore, and I understand, but please promise me you are not putting any estrogen "up there".  (Vagifem)  I know you feel differently but I don't want this cancer to come back.  Your 5 years out and any estrogen in your system is not good."   

    So I said to him, "Oh, doc, really?  my perenium down there feels like I just gave birth to a watermelon and my epesiotomy is ripping"  Can anyone relate????

    Oceana

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  • peacestrength
    peacestrength Member Posts: 690
    edited February 2014

    Oceana - sounds like you have a good plan.  Glad for you!

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  • jennyboog
    jennyboog Member Posts: 1,322
    edited February 2014

    Great news!  Glad to hear, it's so nice when you trust your dr.  And yes, I can relate :)

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