Scans after BEP x 3

[Saustin0612]

I just finished cycle 2 and am starting cycle 3 Monday. My oncologist wants to do a CT scan tomorrow and PET scan after cycle 3. Is it routine to do a scan after cycle 2? I want to avoid as much radiation as possible...is this routine?

[Mike]

I am not sure why your physician would want to do a CT scan after round two. Are they concerned that there is disease progression, such as are your tumor markers increasing or are you having new symptoms? If not, then what are they going to do with the information? If the CT is good then it isn't like they are going to stop chemotherapy or at least that shouldn't be crossing their mind.

As far as the PET scan, I am not aware of a role of PET in nonseminoma cases. Do they have a good reason for doing the PET? There are false positives that could cause more bad than good and I personally would avoid the PET and just go with CT scan after chemotherapy is completed.

If my physician did not have great reasons for doing a CT scan after round two and for doing a PET scan then I would ask them to consult a center of excellence to get input for my treatment and monitoring plan. Our friends at the TCRC have a great list of those centers of excellence at: http://tcrc.acor.org/experts.html

Mike

[Saustin0612]

Mike,
Thanks for the response. I called my primary oncologist at KU med and he also questioned why the oncologist who is overseeing my chemo in my hometown wanted to do a scan after 2 cycles. With that being said, I went ahead and did the scan. There was no need for a scan other than to make sure that the treatment plan is working according to my hometown oncologist. I got my results today and both paraaortic lymph nodes have decreased from 1.6 and 1.5 to .9 cm respectively. Once cycle 3 is complete, I plan on going back to KU med for all of my follow up appointments. Dr. Hashmi - KU doctor has said that there is no need for a PET scan. Because I went ahead and got the scan after 2 cycles, I wonder if we will do another after cycle 3. Guess we will wait and see. Thanks for posting the centers, I didn't' know there was such a list. I appreciate the information.

Scott

[Mike]

Hi Scott,

I am glad that your KU doctor weighed in and also agreed that there is no need for a PET scan. The shrinkage of the nodes is great and hopefully, they shrink further. If the nodes are 1 cm or greater after chemotherapy then an RPLND would be needed but, if less than 1 cm, some experts just watch things while others do an RPLND if they are visible at all. Hopefully, they will just disappear but you can worry about that after getting through the next cycle as they have shrink quite a bit already. Usually, I have seen the CT scans done a month or so after chemotherapy has ended to get the final results.

Mike

[JeskiM69]

Scott,

Your CT scan in the middle of chemo is not usual; as you now know. I am glad it's showing that the chemo is working. Typically you would get a CT done about 4-6 weeks post chemo. I am not too sure what they will do now.

In my opinion I would want to get a scan done sometime after chemo just to be sure that nothing changed after that last cycle and the tumors are still shrinking. It may be that you go for one 6 weeks after or maybe at the 3 or 6 month checkup. This first year or two post chemo is when a recurrence would be most likely, so in either case you are likely to get a scan or two in before the big 1 year post chemo anniversary.

On another note: Is your Onco at the KU campus in Lawrence or Wichita ?

My wife and I are both grads from KU (Lawrence) and my wife grew up just north of Wichita. We usually travel up there once a year or so.

- Matt

[Saustin0612]

Thanks for the reply. My primary oncologist is Dr. Hashmi at KU campus in Shawnee Mission. I really like him; he's thorough and has great bed side manner. He cancelled the PET scan that my overseeing oncologist wanted to schedule. I see Dr. Hashmi December 16th as my first follow up. I am not sure when we will do another scan, but like you all both said I would imagine 6 weeks or so once the chemo is completed; then get on some sort of surveillance. I am not sure if the surveillance will be the same as when I was stage 1a, but i expect it to be pretty regimented and thorough to make sure we catch any sort of relapse. Doc told me I have a 95% cure rate with chemo; however, I know that my tumor is 80% embryonal and those grow back easily.