Yesterday (Tuesday Jan 21st), my wife had another PET Scan. It is the first one in 2025. Her last was back in November. The results were even more dismal than either of us expected.
This PET scan was using a newer machine, and the results were written by a different doctor. The scan report didn’t give the size of tumors but only the SUV intensity. (Only three measurements were given. They will appear later in this post.)
Before proceeding, I will recap what an SUV reading is.
A higher SUV may indicate increased metabolic activity, which could be due to various factors, including inflammation, infection, or cancerous growths. Conversely, a lower SUV could indicate less metabolic activity. Generally speaking, metabolic activity is considered:
• “Low intensity” at <5 SUV• “Moderate” at 5-10 SUV
• “Intense” at 10-15 SUV
• “Very intense” at >15 SUV
Going into this we knew there were five tumors. The four originals that were on my wife’s neck and upper chest plus the one on her back which had been removed and had promptly grown back in a matter of weeks. If the PET scan had stopped here, I would not be blogging on this today; however…
The physician’s assistant showed us the scan as a whole body, front-to-back, but did not zoom in on any areas. By viewing the new scan, we knew there was at least one new tumor visible, but we were advised to wait for the results.
I will now go through the results of the scan. The report generally goes from head to toe.
Four tumors that already had chemo and radiation:
1 Right supraclavicular nodal SUV 3.8
2 Right superior paraesophageal SUV 4.6
3 Right posterior chest wall/pleural SUV 8.2
4 Focal uptake right lateral seventh and eighth ribs SUV 5.8
Cyst that regrew on her back after removal:
5 Posterior superficial subcutaneous nodule at level of eleventh rib SUV 8.6
(The cyst on her back was measured at 2 cm traverse (horizontal))
Next, the scan found an additional six tumors.
All six tumors were in what I would describe as the pelvic area.
6 Small deep subcutaneous module overlaying right superior gluteal region SUV 8.3
7 Deep aspect right inferior gluteal muscles SUV 12.0
8 Soft tissue just medial to superior left acetabulum SUV 6.6
9 Focal left gluteal muscle SUV 4.2
10 Focal uptake left greater trochanter SUV 5.4
11 Focal uptake proximal right femur just below the less trochanter SUV 11.0
As the infomercial says, “And that’s not all” because, sadly, there was more.
In my wife’s chest the scan found loculated pleural fluid collection in her posterior right chest measuring 7.4 v 5.5 cm
Loculated pleural effusion refers to the accumulation of fluid in the pleural space, the thin space between the lung and the chest wall. Unlike simple pleural effusion, where fluid accumulates uniformly, loculated effusion involves the formation of pockets or compartments within the pleural space.
The nodule right superior gluteal region was 9 mm.
Anatomy Terms
Superior = above
Inferior = below
Traverse = horizontal
Subcutaneous = deepest skin layer
gluteal region = external (outside) pelvic cavity
nodule = abnormal group of cells (think lump)
In two months, we went from five to eleven tumors. The cancer has spread to skin, muscle, and bone tissues. The fluid in the lungs is likely the result of the cancer being in the lymphatic system of my wife’s neck and chest. A web search seems to indicate that if a certain quantity of fluid accumulates that it will need to be drained. Given her history, the fluid is likely full of bad stuff.
Following the PET scan, we were called in on Friday (Jan 24th), for a CT scan. This scan was combined with a swallow test to see if fluid was leaking from the esophagus into the chest cavity. Thankfully, this result was negative.
However, the next morning, my wife began to cough up blood. This continued all weekend and on Monday morning, the office of her oncologist was contacted. We were instructed to go to the local emergency room for treatment.
My wife was admitted to the hospital. After poking and prodding her, the doctors decided to put a drain into her chest cavity and remove the pocket of fluid in her chest. They put a hole about 1/8 inch into the right side of her back. The hose went between her ribs. The portion of the hose inside of her was about six inches long. It was covered with a sizable dressing. This hose was connected to a much larger one that emptied into a rectangular box. The holding box had cascading sections which went from right to left. Each section was marked with lines to measure the amount of fluid discharged from the drain. The unit of measurement was cubic centimeters. In addition to the collection device, there was about another 160 CC’s that went to the lab for examination.
Once the fluid was removed, she could breathe easier, and she stopped coughing up blood. After two days, the chest tube was removed, and she was sent home. It was never determined why she was coughing up blood. There is a waiting list to test her for possible reasons. We are waiting to schedule an outpatient exam to learn more.
Meanwhile next week is removal of the cancerous cyst on her back (again) and more chemo.
Sees like the hits just keep coming.