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Tumor growth in three month follow up MRI
Interested in others experience to understand imaging. Radiologist reports "Hepatic metastases have mildly increased in size from prior CT Dec 2024 and MRI November 2024."
I do not understand mildly increased term when segment 4 lesion increased on one side 23.8% and Segment 2/3 increased 36% from 1.1 to 1.5.
My tumors had not increased in the prior three months when I was not taking the octreotide shot or any other treatment. The tumors seem to grow once I started octreotide. Anyone have similar experience?
I do not understand the variability of growth. Thanks.
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INTERPRETATION
EXAM: MR PELVIS W AND WO CONTRAST, MR ABDOMEN W AND WO CONTRAST
CLINICAL INDICATION: Metastatic NET. New diagnosis of grade II neuroendocrine tumor metastatic to liver, unknown primary site.
TECHNIQUE: Multisequence, multiplanar MRI of the abdomen and pelvis was performed with and without intravenous contrast. ESRC.2.13.3
COMPARISON: 12/3/2024, CT OF THE CHEST ABDOMEN PELVIS. 11/15/2024, MR ABDOMINAL OUTSIDE IMAGE CONSULT
FINDINGS:
Lower Thorax: Trace bilateral pleural fluid.
Liver: No hepatic iron or fat deposition.
Hepatic lesions:
* Segment 4 lesion measuring 5.2 x 2.4 cm (23:40) measures 4.2 x 2.4 cm on prior CT.
* Segment 7 lesion measuring 1.2 x 1.0 cm (23:28) previously measured approximately 0.9 x 0.9 cm.
* Segment 2/3 lesion (23:25) measuring 1.5 x 1.3 cm previously measured 1.1 x 0.9 cm.
* There are approximately 5 additional arterially enhancing and diffusion restricting lesions throughout the liver.
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Good point about Octreotide, I would definitely be asking the Dr.
I made it almost 2 full years after my initial SBO/NETS diagnosis. Surgery was hopefully the cure, Dr said I didn’t need shots or chemo & followed up with regular scans every 6 months. It wasn’t until 8/24 CT that Dr followed up with a PET Dotatate scan due to bowel wall thickening. My entire abdomen lit up, discovered peritoneal mets. I never felt bad or had any pain, crazy how NETS can spread! Some of the cancers he removed were the size of lead in a pencil. I’ve been taking Octreotide for 7 months. Good luck to you!
I’ve been on Ocreotide for over 2 years, approx 16 tumors on my Liver. There has been no new tumors since then, and about 3-4 showed some slow growth. After approximately 18 months on Ocreotide, I started Lutathera treatmens, after 2 treatments, still no new tumors, and a few started to shrink, no growth.. Had my 3rd treatment last week.. praying for the same results. My best to you..
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2 ReactionsThanks for sharing. Do I understand that when you were diagnosed two years ago, you had surgery to remove the tumors with CT scans every 6 months as follow up. How large were your tumors at the time when they were removed? In 8/24 two years after the surgery a PET Dotatate was ordered because of what was seen in the CT and cancer was seen in the peritoneal.
How have your scans looked over the last 7 months you have been on Octreotide? Any change in the tumors? Where are you being treated? Thanks again.
Thanks for sharing. Since your tumors were only showing slow growth what was the reason for changing to Lutathera treatments? How do you compare the two treatments side effects for you? Does you doctor say what would cause him to reconsider and perhaps change treatment? I am interested in at what would cause a reassessment of treatment. I had one doctor tell me 20% growth of te tumor would lead to reconsidering treatment. Thanks.
@splendrous, my oncologist is located at the Springfield Clinic Cancer Center. My oncology surgeon is located in Naperville at Edward-Elmhurst Health Hospital. Both are fantastic!
Here is my history from beginning to current. Any questions, please ask!
DIAGNOSES:
1. Stage III (T3 N2 M0) well-differentiated neuroendocrine tumor of small bowel,
diagnosed in September 2022, 2.2 cm, grade 2, with 4 lymph nodes involved, status post
segmental resection in September 2022, Ki-67 score of 3-5%.
2. Recurrence of neuroendocrine tumor seen in July 2024 that showed peritoneal involvement, now stage IV disease. S/p peritoneal and omental resection, repeat small bowel, sigmoid colon, and liver segemental
resections performed October 1, 2024.
Pathology showed extensive involvement of the low-grade well-differentiated neuroendocrine tumor involving the peritoneum, liver, and lymph nodes.
TREATMENT:
Octreotide started October 29, 2024
P/o CT 3/2025
1. There is a new/worsening 1 x 1.7 cm enhancing ovoid focus of soft tissue in the right pelvis tethering the right superolateral vaginal fornix and right lateral wall of the cecum, concerning for metastatic disease.
2. New 1.3 cm soft tissue lesion in the deep subcutaneous fat of the left gluteal region, concerning for a metastatic implant. This may be amenable to
percutaneous biopsy via ultrasound. (This is from the Octreotide shot).
3. Evidence for colitis.
4. No evidence for metastatic disease in the chest.
5. Foci of tree-in-bud nodularity in the lungs are stable, possibly related to chronic atypical infection.
Continue Octreotide injections, follow up PET scan in 3 months.
I believe, at a point every scan showed growth, on a few of the Tumors, then a PET scan showed them active.. most of the tumors had no growth.. At that time we talked about what would be my next step to stop the growth if possible.. we talked about Lutathera treatments, risks and success percentages. Then with the knowledge of the few that were growing, when would be a good time to go to the next phase.. We discussed it for a while, then decided I wasn’t going to wait until the tumors effected me functionally.. I guess as far as side effects I’ve been blessed, outside of being tired for a day and sometimes a little nausea, I’m fine.. And the results were good… I know deciding what to do next and when to start is stressful..
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