What Should 'Follow-Up' Involve?

hi,  my follow up involves   a CEA  and image study of my liver by CT or by ultrasound.   Is that enough?????  What about an MRI or PET ???   I have stage 3 cc,  have done 9 cycles and I'm reading about everyone having all these tests done but it's not on my protocal.....what should I be asking for??    Anna

Get a PET scan along with the CT scan.  PET scan showed more clearly the stage of a recurrence which is much more helpfull in determining treatment decisions. If CT initially shows signs of growth or recurrence they will usually follow up with PET..  Either way the PET is the surest of the two.

Actually my follow up is similar to yours. I was stage 3, 2 node involvement and all I am got was bloodwork and an ultrasound. Interestingly, up here in Canada we do not have access to PET. It is available but is still being tested to determine diagnostic protocols. I am going to ask my Doc about this also.

 

Cheers 

anna

my husband's liver surgeon told him that after the first yr that they do either a pet scan or mri every six months- that is some rare cases that the test they do can cause cancer.  so instead of every three months they now recommend every six months. 

my husband's schedule after he finished his chemo lin may 07 was

august 07-  pet scan and chest xray and blood work

november 07- blood work and CEA count

january 08- colonoscopy

february 08- mri of the liver

may 08 - blood work and CEA count

august 08- pet scan and chest xray and blood work

so i am assuming thisis  the schedule he will be on for the next few yrs-  as long as nothing show up.  My husband was classified as stage four with liver involvement and two or three positive lymph nodes involved.

hope this helps

debbie

 

that's some good "free" health care

I scratch my head when I see all the testing during and post chemo done by others. I was stage 3a, and I've had my port flushed once with a shot of heparin since I finished chemo 10 weeks ago, and nothing else. Is my onc reckless or is all this testing a money generating thing ( I am being treated under a private health scheme, not the state)

There is no standard protocal.  It depends on your stage, on your doctors policy, on what is going on in your blood and on you.

I have Stage IV colon to liver.  I get bloodwork and a CT every six months.  I had 1 colonoscopy 1 year after my surgery. 

I know other Stage IV's who are no longer seeing their doctor after finishing their chemo. 

As a Stage IV, I'd rather get a CT every 6 months then not.  About a year ago I also had an MRCP (basically an MRI of my abdomen) to find out why my liver enzymes are still high.  But, it didn't answer any questions.   

Since some studies showed that PET scans aren't that effective in detecting cancer, some insurance companies dropped it. 

So it's up to the patient to be informed and also to decide what you want to do.  Some people are scared of the radiation they get from CT's and therefore don't get one.  I initially had to pay for my colonoscopy, but when they found something, the insurance company picked it up.    

Nor true - PET  sacn saved my life.  It showed the cancer recurrence and set the staging to allow selective treatment.  Every thing I have read on PET scan is VERY positive.  I would not identify problems without identifying specific sources.  Do you have them?  Please share .  I had recurrent cancer and received radiation along with Chemo in Dec last year.   I am currently on Folfox, etc, and have 3 treatments remaining.  We are going to do a PET scan in May this year after treatment.  It is the best and most widely used technology going on at this time

Don't get me wrong, I'm all for PET scans.  I believe they are beneficial.  Heck, I even agreed to pay for my own colonoscopy, however once it was discovered I had Stage IV colon cancer, the insurance company had to kick in, because obviously, it was medically necessary for me to have one. 

But when studies came out that showed that PET scans are not necessary for follow-up check ups that CT's were good enough, some insurance companies dropped them including mine.  So I rely on my CT and blood work to continue telling me I'm NED.  However, when my 5 years is up, I will pay out of pocket for a PET so I can feel confident that I am clean.   

I was just answering the above persons question on whether or not his doctor was being reckless.  I think it is important that a patient is informed and knows all of his options.  Even if his insurance won't pay for it, you can always pay out of pocket.  I know people who live in Canada and the UK who come to this country and pay out of pocket for the great health care we recieve in this country. 

So I do believe that PET scans are helpful.  I would encourage everyone to get one. 

Here are some sites

 http://mrw.interscience.wiley.com/cochrane/clsysrev/articles

 

http://jco.ascopubs.org/cgi/reprint/JCO.2005.04.0063v1.pdf

 

And

 

http://www.nccn.org/professionals/physician_gls/PDF/colon.pd