PET whole body scan
CT scan obtained for attenuation correction and localization purposes. images generated from the base of the skull to the proximal thighs.The patient is S/P gastric pull-up surgery for esophageal carcinoma.
There is an intensely hypermetabolic 1.7 cm focus with an SUV of 11.7 nestled between the pancreas and the clips anterior to the abdominal aorta, inferior to the origin of the celiac axis, indicating a new metastatic lesion. There is also a more poorly defined focus superior to the origin of the celiac axis at the surgical clips at frame 110 with a maximal SUV of 4.4. It is uncertain whether this latter focus represents neoplastic disease or possibly only inflammatory changes.
Within the mediastinum however, there is also a new 1.6 cm intense lesion with a maximal SUV of 9.7. This node, in the right prevascular space anterior to the SVC at frame 73, would also represent distal neoplastic spread.
Elsewhere, there are no other FDG avid lesions to indicate additional potential sites of hypermetabolic neoplasm. Specifically, the lungs, liver and bones are free of FDG avid lesions.
IMPRESSION:
Mediastinal hypermetabolic metastasis. Additional metastatic lesion inferior to the origin of the celiac axis. Inflammatory or neoplastic changes more superiorly as detailed above.
Not a bad prediction, eh? So the cancer has spread to behind my pancreas and in front of my heart in two lymph nodes. Lymph nodes appear to be places where cancer can hide and make a reappearance. The plan is...well, there is no plan yet. Surgery is not an option, nor is radiation therapy. The only option is chemotherapy, but since the cancer resisted the TCF treatment I had, they have to come up with something else. TCF is usually administered after surgery at the end of the ordeal, but the MGH is one of the few places where they do it before, since it responds so well. And it did respond incredibly well before the surgery. For it to appear so soon after the chemo is rather extraordinary. Clearly they have to go hard at this, but as for how, it's up in the air. The oncologists won't even know about it until Monday. I should know by the middle of the week.
My facial hair just started showing signs of growing back, but my the time I get to really see something, it will be gone again. I've been back at work full time for a few weeks, and I may not see the end of my project. Again. And they don't have a clue if the regimen they pick will even slow this down. It's like trying to catch ALL the terrorists in the Middle East. They hide out a while, then show up again when you least expect it in new terrorist cells. Heh, cells.
I have to say, it's been about 6 and a half hours since I found out, and I've been shocked, pretty stable and then downright depressed. I was saying some pretty pessimistic things about my future. I know that there is plenty of hope, but I can't seem to access it as easily as I once did. But I guess I will fight on. Not really much choice, anyway, since I am not too tired to fight. I hope I never am.