Inconclusive Results

The day after my biopsy I was back the hospital to prepare for my next test, a PET scan. A positron emission tomography (PET) scan is an imaging test that uses a special dye containing radioactive tracers. These tracers are injected into a vein in your arm and then the tracer collects in areas of higher chemical activity, which is helpful because certain tissues of the body, and certain diseases, have a higher level of chemical activity (I.e. malignant tumors). These areas of disease will show up as bright spots on the PET scan.

I’m taken to a corner of the hospital with radioactive signs on the walls, given a comfortable chair to sit in for 45 minutes as the technician brings out a little metal box with the dye (it sort of looks like a miniature version of one of those things you see the bad guys carrying nuclear bombs in James Bond movies) and injects a teaspoon of it into my arm.

I recline and start considering everything going on. This is a scary test as it will be the one that reveals if any cancer has spread beyond my chest or to any other organs. I’m starting to accept that the tumor in my chest is malignant – not because of any negative thinking, simply because the percentages of a large, fast growing tumor in that part of the body being benign, is probably less than 10%.

The scan runs for about a half-hour. I find the MRI and Scans I’ve done over the years to be quite meditative. Just sitting, not moving and visualizing the machines extracting information from your body. We finish up, and I head home.

A few hours later as I’m preparing to go to a yoga class, I get an e-mail from the hospital: “You have a new test result”.  And without hesitation I’ve downloaded and opened the PDF… I close my eyes, take a deep breath, center myself, make a short consecration and then dive into the results:

Head and Neck: CLEAR

Chest: The large heterogeneous mass centered in the anterior left upper lobe is focally hypermetabolic (SUV 27.0), and broadly abuts and invades the adjacent left upper and mid mediastinum including the superior mediastinum and prevascular space. There at least two distinct areas of central photopenia within the mass, compatible with areas of central necrosis.

A few low left mediastinal lymph nodes are mildly hypermetabolic.
Specifically mild metabolic activity in a 12 mm short axis AP window lymph node (series 3, image 120, SUV 3.4), and mild hypermetabolic activity in a 8 mm lower left paratracheal node (series 3, image 118, SUV 2.6).

Abdomen/Pelvis: Clear

Musculoskeletal: Clear

In a PET scan, anything with an SUV over 2.5 or 3 is considered suspicious for malignancy, although higher numbers can sometimes be caused my inflammation. My tumor of SUV 27? Definitely cancer. And the two slightly active lymph nodes I was already aware of from the CT Scan two weeks ago. What a relief! Cancer in ONLY one place! What a funny moment – the worse case scenario (metastasis to other organs or bone marrow) was found to be untrue and while I was reading for the first time a definite diagnosis of a malignant tumor, there was relief because as I said above, the numbers were already predicting such a result. I ran off to yoga class, finding myself actually laughing out loud a few times at my mixed feelings at a cancer diagnosis AND the relaxation that it had not spread. 

Now all I needed to do was wait until the next day to get the results of the biopsy with the doctor. I walk into the room accompanying by my sister Carrie and friend Laurie, and the surgeon who I saw the week before comes in. He starts off by saying the biopsy is showing ‘some kind of tumor’ and I interrupt with a joke, yeah that’s why I’m here, what kind? He goes on to basically say the biopsy was inconclusive. Despite the 7 samples, none were good enough to be analyzed by a pathologist to make an accurate diagnosis. I will need to repeat the biopsy next week, therefore delaying any diagnosis.

He assures me that they are doing everything they can, that this happens sometimes with large tumors that have areas of necrosis inside (when tumors grow very rapidly, the insides of them often die because they are unable to get blood and oxygen). The PET scan shows some of these areas so the next biopsy will be more accurate etc. He says that he and the other doctors on the tumor panel have been meeting and discussing my case, that I will be treated in a much more aggressive manner than an 85 year old with a similar condition…

And again to that nocebo effect that I warned you about earlier. I appreciated the surgeons straight forwardness, so I asked him what he and the team think it is given the available data they have? He looks at me and says, well the radiologist thinks its lung cancer, he’s one of the best radiologists I’ve ever met, and he’s never wrong….  More on this in the next post!

I leave the hospital, rather deflated that I need to repeat the biopsy and will need to wait another 8-days until any results are clear. A bit more deflated that they think its lung cancer. The biopsy is scheduled for the next Tuesday and a follow-up with an oncologist on Friday.

The date is January 23rd.

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