Procedures

On Friday I had my first PET/CT and echocardiogram since my treatment began. I don't yet have the results, but hope they will be ready when I see my oncologist tomorrow. I am very hopeful!

I, who knew next to nothing about imaging before all this began, am becoming a "lay" expert in these types of procedures. This is probably a good thing, since I will likely have many dozen more over the next few years as we attempt to beat back this cancer. Now, this may not translate into the most interesting of all posts, but nonetheless, I thought I would share some of what I have learned and what they are like for me.

I am completely amazed at the technology we have available to us for diagnosing and monitoring disease in our bodies. I really had no idea what things had evolved to beyond standard x-rays. Have you seen the recent GE commercial where a man is remembering all the beautiful things he has seen in his life? This man, at the end of recounting various splendid scenes, says that even compared to all these natural wonders, the most beautiful thing he has ever seen is the radiology image that detected his wife's cancer in time to save her. I totally get this ad now.

Right now the PET/CT is the test we are most interested in, because it will show how the liver tumors are responding to treatment. I will be repeating this every 9 weeks or so indefinitely. PET stands for Positron Emission Tomography. The PET scan, when overlaid on a CT scan (which is basically a 360 degree x-ray) lights up cancer cells, sometimes even when they are too small to be considered a tumor or able to be seen on a CT alone.

The PET scan is part of what is called "nuclear medicine" because it uses a radioactive tracer to find the cancerous cells and light them up for the "camera". This tracer is attached to glucose and injected via IV for "uptake" into the highly metabolic (usually cancerous) cells of the body. Bone scans, too, are nuclear medicine, but instead of attaching the radioactive tracer to glucose, they attach it to phosphate instead.

To prepare for the PET/CT scan, I can eat no carbs for 24 hours prior and not eat at all for 6 hours prior. After they inject the tracer I have to lie perfectly still for 45 minutes (seriously, I cannot even read or check my email--I generally fall asleep) while it races around my body attaching to all the cancer cells.

While they are placing the IV, I get to pound three cups of unappetizing oral contrast for the CT part of the scan. The CT places the images of the organs where they are so the PET results have some context.

Once in the scanner I place my arms over my head and lie without moving for another 20-30 minutes. The first part is the CT scan, which goes very quickly and then comes the PET scan which takes much longer. Both are in the same machine and are virtually indistinguishable from one another except that they put another type of contrast in my IV for the CT part.

By the time I get off the table I am practically glowing and would most definitely set a geiger counter off. All this radioactivity might concern me if I were perfectly healthy, but as it is it doesn't really bother me. I like to joke..."What's it gonna do, give me cancer?!" This is an oddly refreshing point of view.

Reading the radiology report from a full body scan is really interesting because, not only do they point out all the areas where they found cancer and how active that cancer is (as measured by the rate at which it sucked up the tracer), but they also indicate non-cancerous things. For instance, I learned from my last scan that I have a non-obstructive kidney stone and a non-symptomatic maxillary sinus cyst. Who knew? (And, yes, I know, who cares?!)

In addition to the PET/CT, I also must have regular echocardiograms, as the drug I am taking puts me at some risk for heart damage. So far all my EKGs have been normal but this is a deeper picture, via ultrasound, of how the heart muscle looks. This is a quick (15 minutes) and easy procedure, although I remain of the opinion that ultrasounds of babies are far more interesting.

So, apologies for this less than riviting post, but I thought some of you might like to know what these various procedures entail and what they are like. It just may make the results I hope to share tomorrow a little more relevant.