1. < Lung Cancer

Making sense of PET scan report

Posted by jcalkins @jcalkins, Oct 3, 2023

I'm hoping to get some help understanding the report from my PET scan I had last week. Unfortunately, I don'ts see my pulmonologist until a week from today and I would rather not spend the next 7 days with my mind wandering through every answer Dr. Google provides. I am a firm believer that worry only robs me of my joy today. But in this moment I'm struggling a little.

About 15 years ago we found a tumor on the right lobe of my lung. They had a hard time getting a biopsy because of where it was located. The ended up attempting a needle biopsy, but told me they couldn't actually get a biopsy because it kept "escaping" - They decided it was probably a hamartoma tumor because of the inability to puncture it. I was told to quit smoking (25+ year smoker) and we would keep an eye on it. I did quit that day.

Over the years the tumor would be seen on x-rays when I would have pneumonia or bronchitis. But I did not have any medical provider following it consistently.

Flash forward to 3 months ago, I had a nagging cough and a bit of trouble with breathing. Doctor tells me I have bronchitis and "by the way you have a spot on your lung that looks suspicious". CT scan ordered and a referral to the pulmonologist. Pulmonologist said the tumor looks concerning and that it had grown a bit since it was originally found. He says he does not think its a hamartoma and if I hadn't been a former smoker for 25+ years, he would probably wait and see a bit longer, but he wants me to get another CT in 3 months. About a week later, a friend reminds of the time I had my appendix removed and there was a small carcinoid tumor on the tip. I recall learning that carcinoid tumors are also frequently found in the lung. I provided that information to the pulmonologist and he sent me for a PET scan right away.

That was Friday. Today I got the report. This is what was at the conclusion of the report.

IMPRESSION:
1.7x 2.0 cm nodule which demonstrates moderate hypermetabolism with a peak SUV 2.6.
Moderate hypermetabolism is noted in the subcentimeter jugulodiagastric lymph nodes. Peak SUV measures 3.1 on the right and 3.2 on the left. No FDG avid lymphadenopathy is noted in the chest, abdomen or pelvis.

There are other details about Peak SUV measures for mediastinal blood pool (3.9) and Liver SUV (4.3). I have no idea what any of that means.

I would appreciate any insight anyone here might have. I understand that no one here can tell me a diagnosis, but I am hoping to learn more about what these details mean.

Thank you,
Jullie

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pb50 | @pb50 | Oct 10, 2023
In reply to @yellowstonelady "It seems this spot has been around for 15 years and it is now about 1.7..." + (show)
@yellowstonelady

It seems this spot has been around for 15 years and it is now about 1.7 by 2.0 cm. Do you remember how large it was 15 years ago? It seems to be slow growing. The SUV of 2.6 is low which makes sense for a slow growing spot. Usually 2.5 SUV is the cut off for suspecting cancer in a lung nodule. I am not sure about the node SUVs they talk about.

I had lung cancer 23 years ago which a huge 10-12 cm tumor on my right lung. I had a thoracotomy and they removed 2/3 of my right lung. Very painful. Very scary. I was only 46 so I was strong and recovered well.

All was OK for the next 21 years, then two years ago I had a new spot in my left lung with 4.4 SUV. We were pretty sure it was cancer. They were able to biopsy it to confirm. It was the same kind of lung cancer I had before. No way I was having another thoracotomy plus I didn't have much lung tissue to spare after the first surgery. So I had this tumor zapped with 2 days of SBRT radiation treatment. After the SBRT treatment, it took about a year for the cancer tumor to go away. It is now gone.

About 9 months ago they found a new spot on the remainder of my right lung. I have a CT scan every three months to check it. It can't be biopsied without risk of lung collapse. It had a 2.7 SUV. It has stayed about 1cm for the last 9 months although if they show the last 3 ct scans right next to each other and we squint our eyes it seems to be growing very slowly.

So what to do about a slow growing spot with a low SUV like this? Because I am about 70 and because I have shortness of breath already from previous surgeries, we have opted to keep watching this spot. There is a chance that I won't need to treat it. I am hoping that it will peacefully co-exist with me for the rest of my life. On the other hand, should it start growing again then I will need to treat it with more SBRT or an ablation technique. Even though it has a low SUV, it most likely is the same cancer I've had for the last 23 years.

If I were younger or had more lung tissue then I'm sure they'd treat my newest spot immediately. Not sure what your age or physical situation is. The two nodes that lit up on your PET seem to be concerning too. I don't have any nodal involvement showing on my PETs.

So it is hard to know what to do. I can tell you that instead of a thoracotomy like I had 23 years ago (major scar and pain and risky surgery), they often can now do something called VATs which is laparoscopic surgery leaving smaller scars and less recovery time. Also supposed to be less painful.

Jump to this post

Well you know I had VATS for left
Lower lobectomy. 3 smaller incisions. Not a walk in the park and I still feel like I have a vise grip on my rib cage when I try to breathe deeply. But all in all not terrible. And I’m 73.

REPLY
1 reply
yellowstonelady | @yellowstonelady | Oct 10, 2023
In reply to @merpreb "@yellowstonelady- Hello. I've just celebrated 26 years of lung cancer survival. I had my third SBRT..." + (show)
@merpreb

@yellowstonelady- Hello. I've just celebrated 26 years of lung cancer survival. I had my third SBRT last October, and they aren't sure what they'll do if another zapping or something else. I have also lost a lot of tissue. I hate that it limits me at almost 77 and still kicking.

Things have changed so much in the treatment and discovery of lung cancers. Sometimes nodes just act up to keep us on our toes, it could be inflammation and nothing else.

I think that waiting another 3 months for a CT scan is a conservative thing to do now, don't you?

Jump to this post

Thanks for telling me that. I can't tell you how much it helps to know that someone else is in the same limbo and making it through. Actually my onc said to wait for 6 months until my next CT which at first I was afraid to wait that long - but he said if I get worried of course I can always schedule a scan in three months. I checked with my GP/PCP and he showed me all the scans again and we looked at the spot again. He agreed completely that I could wait for 6 months until next scan. He's just my GP but I feel so much better when I talk to him about these things too.

I've been thinking that I should use this 6 months to investigate a second opinion at a larger institution in preparation for the worst case situation in 6 months. I'm sure they could offer me a multitude of treatment options....but this 6 months off is time of peace and rest. Not sure if I want to dive into more doctor visits and worry.

REPLY
jcalkins | @jcalkins | Oct 10, 2023
In reply to @yellowstonelady "It seems this spot has been around for 15 years and it is now about 1.7..." + (show)
@yellowstonelady

It seems this spot has been around for 15 years and it is now about 1.7 by 2.0 cm. Do you remember how large it was 15 years ago? It seems to be slow growing. The SUV of 2.6 is low which makes sense for a slow growing spot. Usually 2.5 SUV is the cut off for suspecting cancer in a lung nodule. I am not sure about the node SUVs they talk about.

I had lung cancer 23 years ago which a huge 10-12 cm tumor on my right lung. I had a thoracotomy and they removed 2/3 of my right lung. Very painful. Very scary. I was only 46 so I was strong and recovered well.

All was OK for the next 21 years, then two years ago I had a new spot in my left lung with 4.4 SUV. We were pretty sure it was cancer. They were able to biopsy it to confirm. It was the same kind of lung cancer I had before. No way I was having another thoracotomy plus I didn't have much lung tissue to spare after the first surgery. So I had this tumor zapped with 2 days of SBRT radiation treatment. After the SBRT treatment, it took about a year for the cancer tumor to go away. It is now gone.

About 9 months ago they found a new spot on the remainder of my right lung. I have a CT scan every three months to check it. It can't be biopsied without risk of lung collapse. It had a 2.7 SUV. It has stayed about 1cm for the last 9 months although if they show the last 3 ct scans right next to each other and we squint our eyes it seems to be growing very slowly.

So what to do about a slow growing spot with a low SUV like this? Because I am about 70 and because I have shortness of breath already from previous surgeries, we have opted to keep watching this spot. There is a chance that I won't need to treat it. I am hoping that it will peacefully co-exist with me for the rest of my life. On the other hand, should it start growing again then I will need to treat it with more SBRT or an ablation technique. Even though it has a low SUV, it most likely is the same cancer I've had for the last 23 years.

If I were younger or had more lung tissue then I'm sure they'd treat my newest spot immediately. Not sure what your age or physical situation is. The two nodes that lit up on your PET seem to be concerning too. I don't have any nodal involvement showing on my PETs.

So it is hard to know what to do. I can tell you that instead of a thoracotomy like I had 23 years ago (major scar and pain and risky surgery), they often can now do something called VATs which is laparoscopic surgery leaving smaller scars and less recovery time. Also supposed to be less painful.

Jump to this post

Thank you. Tha t is a lot of good information. I see the pulmonologist tomorrow for his read on the PET scans.

Some questions I have:
I read that the SUV numbers on my report are PEAK SUV and not Max. Which, from what I can gather PEAK is qualitative and Max is quantitative. But what does that mean IDK

And the SUV for the nodes is like 3.2 and 3.4
But it says the liver SUV is 4.6 I am hoping that's because the liver is processing the radioactive medication they injected.

REPLY
2 replies
pb50 | @pb50 | Oct 11, 2023
In reply to @jcalkins "Thank you. Tha t is a lot of good information. I see the pulmonologist tomorrow for..." + (show)
@jcalkins

Thank you. Tha t is a lot of good information. I see the pulmonologist tomorrow for his read on the PET scans.

Some questions I have:
I read that the SUV numbers on my report are PEAK SUV and not Max. Which, from what I can gather PEAK is qualitative and Max is quantitative. But what does that mean IDK

And the SUV for the nodes is like 3.2 and 3.4
But it says the liver SUV is 4.6 I am hoping that's because the liver is processing the radioactive medication they injected.

Jump to this post

Most docs I believe just rely on SUV MAX. But if you want an activity that may cause your head to explode, well here is everything you never wanted to know on the topic of uptake values…

https://www.sciencedirect.com/topics/nursing-and-health-professions/peak-standardized-uptake-value
REPLY
Lyran | @privatenurse | Oct 15, 2023

PET scans show hypermetabolic activity. Infection, inflammation, or cancer lights up.

REPLY
Moderator
Colleen Young, Connect Director | @colleenyoung | Oct 16, 2023
In reply to @jcalkins "Thank you. Tha t is a lot of good information. I see the pulmonologist tomorrow for..." + (show)
@jcalkins

Thank you. Tha t is a lot of good information. I see the pulmonologist tomorrow for his read on the PET scans.

Some questions I have:
I read that the SUV numbers on my report are PEAK SUV and not Max. Which, from what I can gather PEAK is qualitative and Max is quantitative. But what does that mean IDK

And the SUV for the nodes is like 3.2 and 3.4
But it says the liver SUV is 4.6 I am hoping that's because the liver is processing the radioactive medication they injected.

Jump to this post

@jcalkins, how did your appointment with the pulmonologist go? What did you learn? How are you doing?

REPLY
lynn1961 | @lynn1961 | Oct 16, 2023
In reply to @merpreb "@yellowstonelady- Hello. I've just celebrated 26 years of lung cancer survival. I had my third SBRT..." + (show)
@merpreb

@yellowstonelady- Hello. I've just celebrated 26 years of lung cancer survival. I had my third SBRT last October, and they aren't sure what they'll do if another zapping or something else. I have also lost a lot of tissue. I hate that it limits me at almost 77 and still kicking.

Things have changed so much in the treatment and discovery of lung cancers. Sometimes nodes just act up to keep us on our toes, it could be inflammation and nothing else.

I think that waiting another 3 months for a CT scan is a conservative thing to do now, don't you?

Jump to this post

You stated you had your third SBRT last October. Was each SBRT in different lobes?

REPLY
1 reply
Moderator
Colleen Young, Connect Director | @colleenyoung | Oct 16, 2023
In reply to @geraldkl "I had a PET Scan done in July. My report did not provide all of the..." + (show)
@geraldkl

I had a PET Scan done in July. My report did not provide all of the information that you had in your report. However, I did have a nodule that was 2 cm. This nodule showed up red on the PET Scan which indicated it was probably malignant. I had a biopsy that verified it and due to the size of the nodule, 2 cm or larger, they had to remove the top lobe of my left lung. The PET Scan covered my brain to mid thigh and this was the only red indicator. If you can see your scan that would be a good start to see if there are any nodules or other nodes that show red. During the surgery they collected samples of several lymph nodes and all of them were negative for cancer. Other than the swelling and intense pain for nearly 2 months everything came out OK and I am cancer free. Of course I could not get pain medications after 2 weeks because everyone said that they were on back order from the manufacturer.

Jump to this post

@geraldkl, a belated welcome. Hi hip hooray for NED (no evidence of disease) after surgery. Did you have any other treatment besides surgery? What type of lung cancer did you have?

REPLY
Mentor
Lisa, Volunteer Mentor | @lls8000 | Oct 24, 2023
In reply to @lynn1961 "You stated you had your third SBRT last October. Was each SBRT in different lobes?" + (show)
@lynn1961

You stated you had your third SBRT last October. Was each SBRT in different lobes?

Jump to this post

HI @lynn1961, welcome to Mayo Connect. Have you or a loved one been scheduled for SBRT? Do you have lung cancer?

REPLY
lynn1961 | @lynn1961 | Oct 24, 2023

Yes, I have stage one lung cancer and I start SBRT on Nov 1st.

REPLY
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