Question I have a question following up my family member's recent CT scan results. She is currently undergoing chemotherapy for metastatic pancreatic cancer and just finished a round of radiation therapy for a metastatic tumor near the trachea. The results read "On review of the lung windows, atelectasis/consolidation is seen within the right lung base. Linear changes are seen within the left lung base. The previously seen subpleural right apical nodular density is not identified on this current study. There is an ill-defined opacity see within the right upper lobe on image 36, which may reflect a component of atelectasis." In the Conclusion: "The interval increase in the right pleural effusion with associated atelectasis/consolidation. There is a small nodular density within the right upper lobe which may reflect a region of atelectasis."
Other parts of this CT scan are encouraging - the radiation appeared to be effective in reducing the chest tumor. I am concerned about whether the pleural effusion and associated atelectasis may represent the beginning of metastatic involvement in the lungs. Our oncologist did not seem to concerned about these findings and the pleural effusion does not significantly affect breathing (though there is some shortness of breath). However, the ill-defined opacity does have me concerned about whether there is potential spread to the lungs. I know this could just be a side effect, but do you have any more information about this possibility? And, anything that should be done now in light of the fact that this may be a possibility?
A related question, the CT scan also revealed a new tumor on a kidney adrenal gland, which "raise[s] concern for metastatic involvement. A repeat PET CT scan is recommended." Our current plan per our oncologists suggestion is to continue with our chemotherapy regimen and take another CT scan in about 7-8 weeks. Should the repeat scan be sooner or should we push for a PET scan instead? Should we make any other changes?
Thanks very much in advance.
Answer It is possible that this effusion and the atelectasis do indicate cancer growth but the information at hand is not enough for any conclusions. The same can be said with regards to the opacity. I think BOTH a CT scan AND a PET scan should be done earlier, say 4 weeks.
I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine.
M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps. You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128 I have no restrictions in the number of questions there. I also answer questions in these other categories: General History,
Education/Credentials I'm a medical doctor and specialist in medical oncology and radiation therapy