Average time for 1st scan after adjuvant BEP

[melanie]

My husband finished his 1xBEP April 1st. The Doc told him his first scan should be sometime sept/oct. That seems like a long time to me. Is that normal, or should we push for one sooner?

[Skywalker]

This seems reasonable to me but I'm not sure what the right answer is and may depend on your comfort level. I would look up the NCCN guidelines and go with that. It's probably not necessary to do a 4-6 week post treatment scan because it's adjuvant and his first CT was clear. A lot of the surveillance schedules call for the first scan to happen after 3 months and then to switch to 6 month scans after that. If it would make you and your husband more comfortable, push for a 3 month scan instead.

[melanie]

Thank you!

[mike123]

Melanie, I met with my oncologist yesterday.

He is mostly following NCCN guidelines which I believe say annually for stage 1B with 1xBEP - however because of the pathology (EC which is aggressive) he wants to do a scan one month from now.

Most relapses for 100% EC happen within two years, usually year one.

It will be a CT and then he was willing to discuss MRI for future scans. I also asked him if he ever had a patient who had stage 1B with adjuvent chemo that had a relapse and he said no and I also asked if he had patients who fit that criteria in the first place (stage + chemo) other than me! (yes).

So hopefully this will have been the worst of it for both me and your husband.

[melanie]

Thanks for your reply Mike123!

His oncologist and urologist said they same thing your oncologist said- never seen a relapse with stage 1 after 1xBEP and not to worry. Basically every question we had about relapse and future treatment possibilities, their response was "You had BEP. You're done." Their blase attitude towards it is an odd combination of comforting and unsettling, if that makes sense?

The guideline sort of confuse me actually. They state 6 months for abdominal CT and 6 months for chest xray. So that would mean only one view of the abdomen and one view of the chest each year. That doesn't feel like enough.

My husband spoke to his urologist about that concern and he recommended doing a CT with full view of abdomen and chest every 6 months that way you aren't getting any extra imaging but you do get 2 views of both areas each year. The oncologist agreed so this is the new plan I think.

Neither said they felt the need to do a scan sooner though, but I got the feeling if he really wanted one they would do it. So I guess we just have to do the blood markers every 2 months for now and have that be enough to set the mind at ease....I am not very good at that!

Now that we are just in the wait and see phase the reality of the next 5 years of surveillance (or really the rest of your life, since cancer is so strange and sneaky) is hitting us. Learning to live with the threat will certainly be a challenge. I do hope the anxiety calms down at some point.

I hope you are doing well in your recovery and wish you all the best in every way!

[Mike]

To me, the NCCN Guidelines, which are not perfect and follow up varies from place to place, is an abdominal +or- pelvic CT annually for 2 years after BEPx1 as adjuvant therapy. I don;t see a huge harm in doing one at 6 months, especially given that it looks like the pre-op CT and start of the BEP may have been as far a 6 week apart? If you haven;t started adjuvant therapy within 6 weeks of the clear CT scan then some experts will re-do a CT before starting the adjuvant therapy. I am not sure that a chest CT is necessary and the chest X-ray should suffice unless there are other issues that would drive the need for the chest CT (questions on the X-ray or new involvement in the abdomen, etc.)

Mike

[melanie]

Thanks Mike! Its all very confusing to me. I think since it was EC they want to see the chest just as often as the abdomen/pelvis cause that one can skip around. His first diagnostic Ct and chest xray were done after his I/O. BEP was started exactly 4 weeks after I/O so I think that is in the safe time range. We will bring this up again at his next appointment just to make sure we are doing the right thing

[Mike]

I agree that the timing looks great and with minimal number of scans, if they are absolute at wanting a chest CT, then I probably wouldn't argue, especially if they have low dose parameters set on the machines. Our Dial it Down campaign can give you more info on low dose CT technology https://dialitdown.org/ and questions to ask, etc.

I was to have 16 scans in 5 years so dose was more important than for just 2 or 3 scans. Outside of thoracic symptoms though a Chest CT is probably unnecessary and more up to the individual I suppose.

Mike