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Thread: PET scan hot spots due to infection ?

  1. #1
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    PET scan hot spots due to infection ?

    I had my PET scan today that was suppose to confirm remission and it didn't.

    I was diagnosed with Stage 2a HL in March, have completed esp BEACOPP and ABVD (2 rounds each) as well as 30gy radiation.

    Initially cancer was found in neck and mediastinal lymph nodes.

    Today I had a PET scan (my first so far) and I lit up like a Christmas tree. All my lymph nodes were hot spots (all the way down to my groin). So either my cancer has spread a lot and its not looking great. Or I have an infection.

    I am waiting for the full report and the opinion of my onc, however the consultant today wasn't hopeful and thought that my onc will look to do a biopsy.

    Obviously will wait and see what the doctors say, but just wanted to share and to ask if anyone has had such a dramatic PET scan that ended up being infection. I do currently have a mild case of pneumonitis due to radiation to the lungs. Maybe I am just clutching at straws, but one can hope.
    I am 36
    diagnosed 24.03.2011
    two nodes removed by mediastinoscopy
    Performance - generally healthy
    Hodgkins 1A
    2 rounds BEACOPP complete, 2 rounds ABVD.
    30Gy Radiation
    18/10/11 CT scan showed enlarged lymph nodes in groin and in armpit
    PET scan confirmed enlarged lymph nodes and multiple hot spots
    12/11/11 Biopsy performed and confirmed no evidence of lymphoma.
    30/11/11 Finally confirmed as in remission

  2. #2
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    I had a false positive PET scan in May. I lit up 6.4 on a node near my spine, and lower numbers on nodes in my pelvis. The radiologist and my onc told me my DLBCL had relapsed, and to get ready for an SCT. The nodes lit up because I had been doing a lot of running and because I threw my back out the day of the scan.

    False positive PETs are not uncommon, which is a big reason some docs don't order them and some US insurance companies don't pay for them absent evidence of disease.

    Any evidence of infection? How do your labs look?

    Here's hoping there's no HL in any of those lights.
    Diagnosed at 57 years old on December 7 '09 with DLBCL, stage III, bulky
    Completed 8 cycles of R CHOP 21 May 24 '10
    Completed 18 sessions of radiation July 21 '10
    NED since May of '10

  3. #3
    Administrator Top User Kermica's Avatar
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    False positives are not uncommon at all, Monty. As Schnauzer indicated, one of the reasons they happen is that the patient exercises even a small bit, which causes an increase in uptake. Of course, it also could be infection related. I would say, at this point, you need to see what the onc says and you may need to have a biopsy to get clarity. i also had a false uptake which led to a biopsy of a node in my neck - which was negative for lymphoma so hang in there and try to stay on the positive side of the what ifs.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  4. #4
    Administrator Top User ChemoMan's Avatar
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    Hi Monty

    PETs are notorious for giving false positives. Even exercising 24 hours prior will light you up! Wait for the verdict from the Doc and try not to jump to any conclusions yet.

    Let us know what happens and here's hoping it was your pneumonitis as you suspect. If this condition made you cough vigorously at any time in the 24 hours prior to the scan then there is a good chance that is what it is.

    Good luck
    Age 58
    Diffuse Large B cell Lymphoma
    Stage 2a
    Finished six cycles of R chop 21 26th May 2008
    Officially in remission 9th July 2008
    Remission reconfirmed 1st October 2008
    Remission reconfirmed 17th June 2009
    Remission reconfirmed 7th June 2010
    Remission reconfirmed 6th July 2011
    NED on the 2/01/2013
    No more scheduled visits to the Prof
    http://cancerforums.net/viewtopic.php?t=9620

    RULE NUMBER 1.....Don't Panic
    RULE NUMBER 2..... Don't forget rule Number 1

    Great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

    I may not have gone where I intended to go,
    but I think I have ended up where I needed to be.

  5. #5
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    Biopsy on Wednesday

    So after further analysis there are two real hot spots on the PET scan that are concerning - one under the armpit and one down by my groin. So I am having a biopsy on Wednesday for the armpit node (under general). I will keep you updated.

    Thanks for the support,

    Monty
    I am 36
    diagnosed 24.03.2011
    two nodes removed by mediastinoscopy
    Performance - generally healthy
    Hodgkins 1A
    2 rounds BEACOPP complete, 2 rounds ABVD.
    30Gy Radiation
    18/10/11 CT scan showed enlarged lymph nodes in groin and in armpit
    PET scan confirmed enlarged lymph nodes and multiple hot spots
    12/11/11 Biopsy performed and confirmed no evidence of lymphoma.
    30/11/11 Finally confirmed as in remission

  6. #6
    Administrator Top User Didee's Avatar
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    NSW Australia
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    Good luck with the biopsy. My thoughts are with you.

    Hugs.
    Aussie, age 58
    1987 CIN 111. Cervix lasered, no further problems.

    Years of pain, bleeding, women's plumbing problems. TV ultrasound, tests, eventual hysterectomy 2007, fibroids in lining of Uterus.

    Dx Peripheral T Cell Lymphoma stage 2B bulky, aggressive Dec/09.
    6 chop14 and Neulasta.
    Clean PET April/10, 18 rads 36gy mop up. All done May 2010
    Iffy scan Nov. 2011. Scan Feb 2012 .still in remission.Still NED Nov 2012.
    Discharged Nov 2014.

    May/2012. U/sound, thyroid scan, FNB. Benign adenoma.

    Out of all the things I have lost, I miss my mind the most.

  7. #7
    Administrator Top User Kermica's Avatar
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    Good luck withthe procedure, Monty, and let us know how you are afterward.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  8. #8
    Regular User
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    Dusseldorf
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    Thought I would let you all know that I have just been confirmed as in remission.

    They suspected that I had latent TB for a while, but that has been dismissed.

    Next PET scan in January. I've moved from Germany back to the UK so change in systems.
    I am 36
    diagnosed 24.03.2011
    two nodes removed by mediastinoscopy
    Performance - generally healthy
    Hodgkins 1A
    2 rounds BEACOPP complete, 2 rounds ABVD.
    30Gy Radiation
    18/10/11 CT scan showed enlarged lymph nodes in groin and in armpit
    PET scan confirmed enlarged lymph nodes and multiple hot spots
    12/11/11 Biopsy performed and confirmed no evidence of lymphoma.
    30/11/11 Finally confirmed as in remission

  9. #9
    Senior User
    Join Date
    Dec 2009
    Location
    United Kingdom
    Posts
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    Monty

    Great news!

    Those naughty false positives again!

    Cheers and continued good health
    21 yr old male (Our Son)
    Diffuse Large B-Cell Non Hodgkins Lymphoma
    Stage 1A Mediastinal Mass 8cm x 7cm
    Diagnosed October 09
    Started course of 6 x R-CHOP 14 in Nov 09
    Course complete Jan 2010
    Remission declared March 4th 2010
    Continues in remission March 2014

  10. #10
    Senior User
    Join Date
    Feb 2011
    Location
    Monroe, WA, USA
    Posts
    324
    That is great news indeed! Enjoy your success and the coming holidays, with great cheer!
    DX May 2010 fNHL - G1, S4
    TX - Clinical Trial through Fred Hutchison Cancer Research Center (U of Washington)
    6 cycles R-CHOP induction
    1 cycle Bexxar consolidation
    4 years quarterly Rituxan maintenance
    Consolidation completed Dec. 2010
    Clinical Remission declared Dec. 2010
    PET/CT - 2/22/2011 - NED
    BMB - 3/2/2011 - PCR-Negative; molecular remission
    CT scans semi-annually, latest 6/2014 - NED continues

  11. #11
    Administrator Top User Kermica's Avatar
    Join Date
    Jul 2009
    Location
    New York
    Posts
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    Very good news, Monty, I am thrilled for you. May the remission last forever!

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  12. #12
    Newbie New User
    Join Date
    Sep 2013
    Posts
    9
    Hey all,

    Just wanted to comment as this seemed similar to something that's just happened to me. I had stage IIA HL, had 6 rounds of ABDV and 15 radiation sessions. Had a PET scan 2 months after radiation finished, and there's an abnormal patch at the very top of my chest. My consultant thinks it's odd that lymphoma would appear in a completely new site, apparently. They're going to scan in another 3 months, and biopsy then if they can, according to the scan results.

    Has anyone experienced anything like this? It feels pretty horrible.

    xx

 
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