Small trial suggests the scans might help, but experts aren't so sure
by kah49 on Thu Oct 02, 2008 12:00 AM
Can anyone explain to me what hypermetabolic nodes mean? I have gotten a copy of my PET report and it says that I have 2 nodes, in chest area where my breast cancer was located, that are hypermetabolic with an SUV of 5-8, also a right ovarian cyst with physiologic uptake. This PET scan was done prior to chemo and radiation. I saw an onco gyno today about having my ovaries removed and he said the growth on my cyst was still there but he does not think it is cancer. Of course I'm still concerned because I don't understand all the termonology.
Any answers would be appreciated,
by trehouse60 on Sat Oct 04, 2008 12:00 AM
I'm happy to explain "hypermetabolic nodes," but before I forget, I want to say that since this PET was done BEFORE chemo and radiation, the previous state of these nodes quite possibly has changed, and therefore should be considered in comparison to a current PET.
PET scan measures metabolism, the process by which cells use sugar to produce energy. Hypermetabolic means those cells are metabolising more sugar than is normal for that type of cell. This is important in terms of cancer diagnostic because cancer cells have a much higher metabolic rate than healthy cells, thus they "light up" the PET scan.
Understanding uptake will help, also. The very slight amount of radioactive sugar they give with a PET scan is very quickly and highly absorbed by cancer cells, and certain other cells with a high metabolism, whereas normal cells pretty much leave it alone. Physiologic uptake would mean that the cyst cells absorbed the sugar, but were not exhibiting a high metabolism. This can happen with inflammation - places where the body is fighting an infection or disease process other than cancer will quite often show increased uptake of the sugar because those cells are more active and do have a higher need for energy, but not the WAAAAAY high metabolism of cancer. (Is why PET scans can show both false positive and false negative results.) Would be reasonable for the doc to say the cyst does not represent cancer.
As for the 2 nodes were labelled as "hypermetabolic" in a region with known cancer, their small size might make it difficult to really determine what was going on with them. Lymph nodes often just are too small to take up enough of the sugar to really light up the PET scan. Sounds like the radiologist was trying to say that these nodes possibly have something going on because they have higher metabolic activity, but the scan results were not enough to say they had cancer in them. (Remember, the lymph system is the garbage disposal of the body - the increased metabolic activity could have come from cancer cells in the nodes, or it could have come from the nodes attempt to carry away infection or inflammation, or even the byproducts of muscular activity.)
So, since you've had chemo and radiation - those two nodes may now present a significantly different picture. You didn't say how long ago you had your treatment - most doctors wait 4 - 6 months after treatment before doing another PET, to allow time for all the after effects to diminish and not be picked up by the scan. (Some docs say 3 months is sufficient - this would probably be dependant on the type of chemo and amount of radiation.) You might want to ask about having another PET scan to see what those nodes are doing now. This would give you an opportunity to see if the cyst is still taking up the sugar. If it is, and the dr still doesn't think it's cancer, ask him if you need treatment for an inflammatory process in that ovary - antibiotics, etc. Sometimes ovarian cysts resolve by themselves, sometimes they need some help. If you are having pain in that ovary, I certainly would insist that something be done about it. No sense hurting if you don't have to.
I hope I've been able to make this a little clearer than mud! And I wish you the best with these issues.
by kah49 on Sat Oct 04, 2008 12:00 AM
I'm so glad you were able to explain this to me without all the dr jargon, it's easier to understand. I finished chemo in May and radiation in the first of August. I just had a CT scan 2 weeks ago and my onco said everything looked normal, but, when I had the PET scan before I started the treatments, he also said everything was normal. I just happened to get a copy of the scan report and that's how I found out about the nodes. So now I'm having some doubts about my onco. I go back to see him in 3 weeks and I am going to get some real answers out of him this time. I had rather know for sure what is going on than to sit and wonder, you know?
But I'm glad you could explain all this to me, thanks alot.
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