More pretty awful information ... here's summary from last week's PET scan. Hard to read, and a bit less specific than the advanced machinery at Mayo.

Oncologist most concerned about the pleural effusions mentioned; however she has scheduled Gem-Abraxane start on Thursday. But, she has scheduled a thoracentesis on Monday, prior to our appointment with her ... I am increasingly concerned the oncologist is doing what oncologists do and not understanding my sister needs a more direct input.

She is still draining 1 liter of peritoneal fluid per day.

She returned from a care facility on Wednesday, after 28 days. We arranged for 0800-1200 shift of caretakers, three times per week home health care, twice weekly PT and twice weekly OT. Vitas (palliative and hospice organization) has visited and assessed her, but she will not discuss hospice - only "getting better." Hospice cannot happen during chemotherapy since chemo is considered attempted cure. Bit of a Catch 23.

I am emoting too much, so I'll stop and let you read the PET summary.

"FINDINGS:
Neck:
There is physiologic activity in the neck.

Mediastinum:
Physiologic activity is seen in the mediastinum.

Lungs.
There is no hypermetabolic pulmonary nodule. There is a 9-mm pulmonary nodule within the anterior segment of the right upper lobe, but this may be too small for PET resolution. There is a moderate-sized right pleural effusion and moderate to large-sized left pleural effusion. There is associated passive atelectasis within both lungs.

Abdomen/pelvis:
Cirrhosis is evident. There is a metallic CBD stent in place extending across the pancreatic head, where no hypermetabolic lesion can be visualized. The pancreatic body and tail shows severe atrophy. There is a large volume of free fluid through the abdomen. There is nonspecific metabolic activity of the uterus which has a somewhat lobulated appearance, with a maximum SUV of 5.8; this may relate to the presence of fibroids. There is a 2.4-cm right adnexal hypodense lesion which could represent a necrotic fibroid. In the region of the left adnexa, what appears to represent an exophytic 3.5-cm fibroid could represent an independent left adnexal mass. There is a left-sided approach peritoneal drain extending to the right lower quadrant of the abdomen.

Osteoarticular Structures:
No concerning areas of hypermetabolic activity are seen among the osteoarticular structures. There is mild bilateral hip osteoarthritis. There is mild bilateral SI joint osteoarthritis. There are degenerative changes through the visualized spine and there are postoperative changes at the lumbar spine, with a posterior pedicle screw and bar fixation.

Additional Findings:
There is some mildly increased FDG activity along the right abdominal wall where a peritoneal drainage catheter was recently removed. There is mild edema of the body wall. There is nonspecific and nonmasslike, linearly distributed FDG activity over the anterior peritoneal cavity, with SUV max of 5.8.

IMPRESSION:
1. Cirrhosis and ascites.
2. Metallic CBD stent in place. No hypermetabolic activity is seen at the reported pancreatic malignancy.
3. Lobulated and hypermetabolic appearance of the uterus, perhaps related to the presence of fibroids. Please correlate clinically and perform ultrasound evaluation. It is difficult to exclude an independent left adnexal mass lesion.
4. Bandlike distribution of hypermetabolic activity along the anterior peritoneal cavity. This could be inflammatory, but metastatic omental disease cannot be excluded, although this may be inflammatory given the peritoneal drainage history.
5. Bilateral pleural effusions.
6. 9-mm pulmonary nodule within the anterior segment of the right upper lobe. No associated hypermetabolic activity detectable. This could be too small for this PET resolution.