Several techniques are used to detect the recurrence of a tumor like Mesothelioma. Very few are reliable and many patients have recurrences that aren’t detected until the cancer is again in an advanced state. Frankly, unless one can look into the chest cavity, the imaging tools available to doctors simply aren’t good enough yet to be bulletproof.
BWH was asking for quarterly thoracentesis testing to be carried out so they could get fluid samples to be analyzed for pathology. I found out this was a separate clinical study and that I could opt out of it. Frankly, this test is notoriously unreliable and damned uncomfortable as well. Doing it once a quarter just wasn’t in the cards for me.
Most patients get CT scans done with intravenous contrast to improve the images but this test cannot differentiate between scar tissue formation and cancer cell growth. Consequently, the CT scan isn’t foolproof either.
Shortly after I landed back in Newport Beach, Dr. Barth told me about a new machine that combined the images of a CT scan with the images of a PET scan. PET scans monitor metabolic activity in the body by imaging the body’s consumption of sugar that has been tagged with a radioactive isotope. Hot areas are usually a sign of excessive activity and unless this is the brain, heart or sex organs, it can be a sign of cancer activity. The problem with PET scans on their own is that they can warn you that something is cooking, but they can’t tell you where. By combining the two technologies into a single image map, doctors now have a much more accurate tool for spotting suspicious activity inside the body.
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Figure 4: details of a hot spot near the heart wall |
Dr. Barth scheduled me for a PET CT fusion scan and the results were interesting to say the least. The first test came back completely clear, showing a nice dark chest area without a hint of unacceptable activity. Six months later, the comparison scan, (shown above), revealed a small hot spot or area of activity located next to one of the valves of the heart. This was near the area of the Gore-Tex patch whose purpose was to prevent the heart from moving into the empty right chest cavity.
The rest of the chest remained negative, including the areas of the incisions and the diaphragm. This hot spot was so tiny, it would never have been spotted on a CT scan alone and close examination of it revealed that a slight thickening of the tissue in this area had taken place.
A third test, six months later showed that the hotspot was still there only less active and absolutely no larger. We concluded that it was unlikely to be cancer or a recurrence and was more than likely a response to irritation caused by the heart rubbing against the Gore-Tex patch. I was glad to hear that it was chronic inflammation rather than cancer but we still need to keep an eye on it. With only conventional testing we would never have been aware of it.
As these machines keep improving, it will be possible to find, identify and react to recurrences much more easily and effectively than ever before. I am counting on it.
