Slide 1:A Tabulated Summary of the FDG PET Literature Presented by Matty Smith-Lee


Oncologic Applications :Oncologic Applications Lung Cancer Colonrectal Cancer Melanoma Lymphoma Head and Neck Cancer Breast Cancer Brain Tumors Ovarian, Cervical, and Uterine Cancer Bladder Cancer Gastroesophageal Cancer Hepatocellular Cancer Muscle and Connective Tissue Tumors Pancreatic Cancer Prostate Cancer Renal Cell Cancer Testicular Cancer Thyroid Cancer Unknown Primary Tumor Miscellaneous Tumors


Lung Cancer :Lung Cancer Disease Background Lung cancer is among the most frequent and most lethal of cancers striking both men and women. It is most rapidly increasing tumor in industrialized countries. Most lung cancer are caused by smoking. Lung cancer accounts for 22% of all cancers in men and 8 % of all cancers in women Five year survival is achieved by only 13% of al lung cancer patients.


Lung Cancer :Lung Cancer Disease Background Basic treatment for non-small cell lung cancer (NSCLC) is surgical, with only 20% of patients presenting as operable. Patients who are not operable receive palliative chemotherapy or radiation. Small cell lung cancer patients respond well initially to chemotherapy and radiation and generally do not undergo surgery. Their long-term prognosis is poor.


Case Example :Case Example A 62 year old patient with known NSCLC was evaluated before planned lobectomy. Patient had no symptoms (e.g. headaches). FDG PET revealed extensive metastatic disease to the brain in addition to the primary cancer in the lung.


Lung Cancer :Lung Cancer


Why did FDG PET Help? :Why did FDG PET Help? Why did FDG PET Help? The FDG PET scan showed that the patient had much more extensive disease than previously thought, lobectomy was not a management option for this patient. The patient had no symptoms related to the brain metastases, but the FDG PET Whole-Body survey scan caught tumor spread to the brain.


Summary of Evidence for FDG PET in Lung Cancer. :Summary of Evidence for FDG PET in Lung Cancer. For staging: and estimated 37% change (Table 1) was noted in management effect, based on 1,565 patient studies (Table 24). Key Management Issues. Diagnoses the lung mass Staging NSCLC Assessing recurrence Monitoring response to therapy


Colorectal Cancer :Colorectal Cancer Disease Background The colon and rectum are parts of the large intestine and are responsible for absorption of various substances not absorbed by the small intestine. In western industrialized countries, colorectal cancer is the second most common cause of death from cancer. Primary treatment is surgical, leading to a 50% five year survival rate. Chemotherapy ( before removal of the tumor)is now more commonly used.


Colorectal Cancer :Colorectal Cancer Disease Background Radiation is sometimes used for rectal carcinoma and less often for colon cancer. Approximately 20% of patients with recurring cancers are eligible for futher resection, with half relapsing early because of previously undentified metastatic sites. Images helps to determine te spread (or lack thereof) of the primary tumor in the colon or rectum.


Case Example :Case Example A patient with carcinoma of the rectum was treated with surgery and radiotherapy. One year later, results of a blood test indicated rising carcinoembryonic atigen (CEA) levels. A CT scan did not reveal the site of tumor recurrence . An FDG PET study showed a liver focus which was proven by biopsy to be recurrent rectal cancer.


Colonrectal Cancer :Colonrectal Cancer


Why did FDG PET Help? :Why did FDG PET Help? The liver metastasis was identified as the likely source of this patient’s rising CEA blood marker. No other source was apparent. Patient isolated liver recurrence, surgery for removal of a part of the liver is usually a good option.


Summary of Evidence for FDG PET in Colorectal Cancer :Summary of Evidence for FDG PET in Colorectal Cancer For staging: An estimated 36% change was noted in management effect, based on 236 patient studies (Table 2). For recurrence: An estimated 32% change was noted in management effect, based on 915 patient studies (Table 2). Key management Issues. Evaluating suspected recurrence and restaging Assessing response to treatment Evaluation liver lesions for metastatic disease.


Melanoma :Melanoma Disease Background With an increasing mortality rat second only to that of lung cancer, malignant melanoma is the most rapidly increasing cancer in white populations, with incidence increasing at >5% per year since 1973. The most common cancer striking young women between ages 25 and 29, melanoma accounts for 18% of all cancers in young adults 15-39 years old. Melanoma risk factors include preexisting skin lesions and lighter hair color, with red-haired and blond individuals having 3 and 2 times greater risk appears related to strong solar ultraviolet light radiation.


Melanoma :Melanoma Disease Background Approximately 20% of patients who present with nodal metastases with no distant metastases are cured by surgery For isolated metastases to the brain and lung, surgery can improve survival. Thus FDG PET’s role in identifying truly isolated metastases is central to the making of rational decisions about radical surgical removal of metastases


Case Example :Case Example A 63 year old patient had a melanoma removed from the skin overlying the right scapula. A second metastasis was excised at the nape of the neck. An FDG PET scan was ordered to stage the patient’s cancer. Increased FDG metabolism was seen after surgery at the shoulder site. ( far right, top arrow). In addition, multiple metastases were seen within the anterior mediastinum, left lung, left adrenal, left axilla, and para-aortic nodes.


Why did FDG PET Help? :Why did FDG PET Help? The FDG PET scan showed that melanoma had spread to various tissues and that chemothearpy would be the only option.


Summary of Evidence for FDG PET in Melanoma :Summary of Evidence for FDG PET in Melanoma For staging: An estimated 26% change was noted in management effect, based on 283 patients (Table 3). Key Management Issues. Determining the stage of thick melanoma lesions at presentation Assessing nodal spread from lesions of intermediate thickness Confirming the recurrence of disease Monitoring response to treatment Restaging before surgical removal of isolated metastases


Lymphoma :Lymphoma Disease Background Both Hodgkin’s disease and non Hodgkin’s lymphoma are common malignancies that are increasing in frequency. They underlying problem in lymphoma arises form the individual’s white blood cells, cells involved in helping to fight infections. Both diagnosis and treatment HD begins as a unifocal disease located in a single group of malignant lymph nodes and spreads via adjacent associated lymph node groups.


Lymphoma :Lymphoma Disease Background Limited disease is treated appropriately with radiation therapy, resulting in complete cures ofr a high percentage of patients. Even after recurrence, treatment still may result in permanent cure. Patients with advanced disease have a poorer prognosis and usually requiring combined chemotherapy, sometimes radiotherapy and in some instances, high dose chemotherapy with bone marrow transplantation. In most patient the disease is ultimately fatal.


Lymphoma :Lymphoma Disease Background Long remission and cure can be induced effectively in high grade NHL, which has a better prognosis untreated, does not respond as well to chemotherapy and consequently can result in a worse prognosis after treatment


Case Example :Case Example A 27 year old man with lymphoma underwent an FDG PET study before chemotherapy in July 1999. At that time, evidence of cancer was found in the right shoulder and thoracic spine. The first follow up FDG PET scan showed nonspecific bone marrow response to chemotherapy. The second follow up scan demonstrated complete remission with the right shoulder and thoracic spine regions no longer showing increased FDG metabolism.


Why did FDG PET Help? :Why did FDG PET Help? FDG PET showed htat the chemotheray was working and that the cancer cells were being destroyed. This helped doctors know that further treatment was not nedded at that time and gave the patient a sense of relief that his condition was improving.


Summary of Evidence for FDG PET in Lymphoma :Summary of Evidence for FDG PET in Lymphoma For staging: an estimated 21% change was noted in management effect, based on 407 patient studies. For diagnosis/staging: an estimated 5% change was noted in management effect, based on 62 patient studies. For recurrence: an estimated 10% change was noted in management effect, based on 158 patient studies. Key Management Issues Staging the disease before treatment Monitoring response to treatment Detecting recurrence Making a differential diagnosis


Head and Neck Cancer :Head and Neck Cancer Disease Background Cancer of the head and neck is relatively uncommon in the western world, occurring in 2%-4% of all cancers The majority are squamous cell tumors with a variable aggressiveness that depends on site and histological appearance. Tobacco, alcohol usage and other factors such as chemical, fumes and viruses.


Head and Neck Cancer :Head and Neck Cancer Disease Background Multidisciplinary teams of head and neck surgical oncologist operating in specialized centers are required for good outcomes. Treatment is directed at maintaining the form and function of the head and neck structures as well as eradicating the disease. After treatment, conventional anatomical imaging procedures prove less useful because of the distortion of anatomy caused by treatment. FDG Pet is of particular importance in follow up imaging of suspected recurrence.


Case Example :Case Example A patient with a right alveolar ridge carcinoma was referred for FDG PET scanning before surgery for staging purpose. Ct results indicated that the tumor extended superiorly into the maxillary sinus. Registered PET and CT images showed uptake of FDG within the primary site arising from the alveolar ridge but not evidence of tumor within the sinus itself.


Head and Neck Cancer :Head and Neck Cancer


Why did FDG PET Help? :Why did FDG PET Help? FDG PET helped because it determined that the tumor was localized and did not extend into the maxillary sinus. This directly aided the surgery for tumor removal. Key Management Locating the site of primary disease Determining the extent of primary disease Staging of lymph node spread Detecting recurrence Assessing response to therapy


Summary of Evidence for FDG PET in Head and Neck Cancer :Summary of Evidence for FDG PET in Head and Neck Cancer For diagnoses/staging: an estimated 33% change was noted in management effect, based on 15% patient studies. For recurrence: an estimated 33% change was noted in management effect, based on 15% patient studies. Because management effect for both diagnosis/staging and recurrence is based upon the same single study of 15 patients, results should be interpreted with caution


Breast Cancer :Breast Cancer Disease Background In the Untied States, breast cancer is currently second only to lung cancer as the leading cancer causing death in women. It is the most common single cause of death for women ages 35-50 years old. Cure can be achieved with early diagnosis and treatment, but a multidisciplinary approach is required.


Breast Cancer :Breast Cancer Disease Background Treatment includes surgery, which become progressively less radical, together with chemotherapy. Hormones and radiation therapy also are used therapeutically. Imaging is an important part of detection, staging and management of most breast cancer patients.


Case Example :Case Example A 61 year old woman with breast cancer showed several foci of tumor involvement in the chest and spine on her initial FDG PET scan. After chemotherapy, an FDG PET study was requested to look for tumor response to chmeotherapy. The small foci of FDG accumulation seen throughout the chest and spine clearly had resolved.


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Why did FDG PET Help? :Why did FDG PET Help? FDG PET showed that the chemotherapy was working and that this patient's breast cancer had responded to this particular type of chemotherapy. Key Management Issuse Determining if a breast mass is bengin or malignant Staging of axillary and internal mammary lymph nodes Detecting metastatic disease Detecting local or distant recurrence Assessing the response of the tumor to treatment


Summary of Evidence for FDG PET in Breast Cancer :Summary of Evidence for FDG PET in Breast Cancer For diagnosis: and estimated 100% change was noted in management effect, based on six patient studies. For staging: an estimated 24% change in management effect, based on 111 patient studies. For recurrence: an estimated 40% change in management effect, based on 23 patient sutdies.


Brain Tumors :Brain Tumors Disease Background The incidence of primary brain tumors in the population is 11 in 100,000, with overall metastatic brain disease being more common. Space occupying lesions are caused by primary tumors, with >50% of patients presenting with some from of epilepsy. New treatment are being introduced, including guided biopsy and surgery, targeted radiation, chemotherapy, and radioactive seed implantation. Outlook remains poor, with survival <1 year for patients with high grade tumors. The preferred treatment for brain tumors is surgical removal. FDG PET scans are useful for evaluating the efficacy of surgical procedures.


Case Example :Case Example A 64 year old woman with a diagnosis of glioblastoma multiforme (aggressive brain tumor) was operated on to remove the tumor and was treated with radiation. MRI suggested possible tumor recurrence. Noted the area of contrast accumulation near the surgical region.


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Why did FDG PET Help? :Why did FDG PET Help? FDG PET helped by showing that an inconclusive finding on MRI was, in fact, the result of radiation and not residual tumor. This patient did not need medical or surgical intervention Key Management Issue Initial managment Diagnosing and grading the malignancy Determining the extent for treatment planning Directing biopsy Determining prognosis


Key Management :Key Management Post management Differential diagnosis between recurrence and radition necrosis Directing biopsy Determining the estent of tumor in treatment planning Monitoring response to treatment


Summary of Evidence for FDG PET in Brain Tumors :Summary of Evidence for FDG PET in Brain Tumors For recurrence: an estimated 31% change was noted in management effect, based on 89% patient studies.


Ovarian, Cervical, and Uterine Cancer :Ovarian, Cervical, and Uterine Cancer Disease Background Ovarian cancer is the fifth leading cause of cancer death in women in the United States, with 14,500 deaths and 25,400 new cases diagnosed each year. Approximately one-third of all new cases will have metastatic disease at the time of diagnosis, with another third developing clinical metastases during the first year after surgical resection. Early stage ovarian cancer, accurate diagnosis is very difficult.


Ovarian, Cervical, and Uterine Cancer :Ovarian, Cervical, and Uterine Cancer Disease Background Cancer of the endometrium, a common type of cancer in women, is a disease in which cancer cells are found in the lining of the uterus. It is high curable tumor


Case Example :Case Example A 50 year old woman with a history of ovarian cancer showed rising tumor markers in an annual blood test that looked for possible tumor recurrence. A follow up CT scan was unable to find the source of the recurrence. FDG PET study showed that the tumor had metastasized to the right lobe of the liver. No other areas of metastasis were seen.


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Why did FDG PET Help? :Why did FDG PET Help? FDG PET showed that the blood study was correct( it was not falsely elevated) and that the source of recurrence was the liver. Key Management Issue Staging lymph nodes Identifying recurrent disease after surgery and radiation Assessing response to treatment


Summary of Evidence for FDG PET in Ovarian, Uterine and Cervical Cancer :Summary of Evidence for FDG PET in Ovarian, Uterine and Cervical Cancer For recurrence: an estimated 17% change was noted in management effect, based on 30 patient studies.


Bladder Cancer :Bladder Cancer Disease Background Bladder cancer is a disease in which cancer cells originate from the bladder wall. Approximately 70%- 80% of patients with newly diagnosed bladder cancer will present with superficial bladder tumors. Those tumors that are noninvasive are often curable, and those that are deeply invasive are sometimes cured by surgery, irradiation, or a combination of modalities that includes chemotherapy. Transurethral surgery, intravesical medications, and Bladder removal have been used in the management of patients with superifcal tumors and are all assoctiated with 5 year survival rate for 55%-80% of patients treated.


Case Example :Case Example A patient with cancer of the bladder was scanned for staging purposes. Focal FDG uptake was seen within the posterior aspect of the bladder, indicating primary disease only. Mild accumltaionof FDG also was seen around the right total hip replacement possibly indicating active inflammation or infection


Bladder Cancer :Bladder Cancer


Why did FDG PET Help? :Why did FDG PET Help? FDG PET helped by showing no evidence of cancer spread beyond the bladder, so that local treatment, likely would benefit the patient Key Management Issues Primary nodal staging Systemic metastases staging


Summary of Evidence for FDG PET in Bladder Cancer :Summary of Evidence for FDG PET in Bladder Cancer For staging : an estimated 17% change was noted in management effect, based on 12 patient studies. For recurrence: an estimated 17% change was noted in management effect, based on 12 patient studies.


Gastroesophageal Cancer :Gastroesophageal Cancer Disease Background Cancer of the stomach, also called gastric cancer, is a disease in which cancer cells originate form the tissues of the stomach. Cancer in the distal half of the stomach has been decreasing in the United States since the 1930s. In the last two decades the incidence of cancer of the cardia and gastroesophageal junction has been rising rapidly. Due to gastric reflux acid fro stomach


Gastroesophageal Cancer :Gastroesophageal Cancer Disease Background Radical surgery represents the standard form of therapy with curative intent. Lesser surgical procedures also may play important roles in palliative therapy for patients with gastric cancer. Primary treatment modalities include surgery alone or chemotherapy with radiation therapy, or combination of the three.


Case Example :Case Example Gastric Cancer A 35 year old patient underwent surgery for gastric cancer. At the time of surgery, a portion of the stomach was removed around the tumor site. Lymph nodes near the stomach also were involved. Patient underwent chemotherapy to treat for spread of the gastric cancer. FDG PET confirmed 6 months later recurrence of tumor. Esophageal Cancer A 59 year old man with known esophageal cancer was referred for FDG PET before surgery. PET showed uptake in the primary tumor and lymph node near the trachea. The esophageal cancer had spread beyond the esophagus


Slide 60:Gastric Cancer Esophageal Cancer


How did FDG PET Help? :How did FDG PET Help? FDG PET confirmed that questionable findings on CT scan, in fact, were likely to be tumor. Showed that the cancer had spread beyond the esophagus. Key Management Issues Staging for possible spread of tumor Assessing or recurrence


Summary of Evidence for FDG PET in Gastroesophageal Cancer :Summary of Evidence for FDG PET in Gastroesophageal Cancer For diagnosis: an estimated 14% change was noted in management effect, based on 99 patient studies with 276 lesion sites. For staging: an estimated 20% change was noted in management effect, based on 229 patient studies. For diagnosis/staging: an estimated 14% change was noted in management effect, based on 109 patient studies.


Hepatocellular Cancer :Hepatocellular Cancer Disease Background Adult primary liver cancer is a disease in which cancer start to grow in the tissues of the liver. People who have hepatitis B or C or cirrhosis, a disease of the liver, are more likely than other people to get adult primary liver cancer Hepatocellular cancinoma is a relatively uncommon tumor in the United States. Potentially curable by surgical resection, but surgery is the treatment of choice for only the small fraction of patients with localized disease. Hepatocellular carcinma is associated with cirrhosis in 50%-80% of patients.


Hepatocellular Cancer :Hepatocellular Cancer Disease Background Childhood liver cancer also called hepatoma, is a rare disease in which cancer cells are found in the tissures of a child’s liver. Hepatoblastoma and hepatocelluar cancer are the two types. Hepatoblastoma is more common in children younger that 3 years old and may have genetic cause.


Case Example :Case Example A patient presented to his doctor with vague abdominal symptoms. The work-up which eventually included a CT scan, revealed that the patient had enlarged lymph nodes near the portal region of the liver. FDG PET scan was ordered to further evaluate for tumor. Revealed uptake of FDG within a foci were present,indicating tumor was confirmed. Patient underwent surgery


Hepatocellular Cancer :Hepatocellular Cancer


How did FDG PET Help? :How did FDG PET Help? FDG PET indicated that the tumor was localized and that the patient was a candidate for surgery. Key Management Issues Distinguishing between cirrhosis and hepatoma Assessing response to treatment and differentiating tumor for necrosis, edema, and scarring Identifying multifocal lesions


Summary of Evidence for FDG PET in Hepatocellular :Summary of Evidence for FDG PET in Hepatocellular For staging: an estimated 60% change was noted in management effect, based on 20 patient studies.


Muscle and Connective Tissue Tumor :Muscle and Connective Tissue Tumor Disease Background Adult soft tissue sarcoma is a disease in which cancer cells are found in the soft tissue of part of the body. Soft tissue includes muscles, connective tissues, vessels that carry blood or lymph, joints and fat. Low grade tumors usually are curiable by surgery alone, higher grade sarcomas are associated with higher local treatment failure rates and increased metastatic potential.


Case Example :Case Example A 41 year old man had surgery and radiotherapy first for a liposarcoma in the right thigh and 3 month later for a solitary metastasis in the abdomen. FDG PET scan showed focal increased metabolism within the right thigh, indicative of recurrent of disease


Muscle and Connective Tissue Tumor :Muscle and Connective Tissue Tumor


How did FDG PET Help? :How did FDG PET Help? The FDG PET scan indicated lung and mediastinal metastases, in addition to local disease in the thigh. Key Management Issues Following up sarcoma treatment Grading sarcoma Separating benign form malignant masses Assessing extent of sarcomas


Summary of Evidence for FDG PET in Muscle and Connective Tissue Tumors :Summary of Evidence for FDG PET in Muscle and Connective Tissue Tumors Management change data for diagnosis and staging and other applications are not directly avaiable from the literature.


Pancreatic Cancer :Pancreatic Cancer Disease Background Most common in the United States, with approximately 30,000 patients each year diagnosed with pancreatic adenocarcinomas. PET greatest role may prove to be in helping to characterize masses appearing in the pancreas, as opposed to more general tumor staging.


Case Example :Case Example A 52 year old woman with a calcified pacreatic mass on CT was referred for FDG PET scanning because of rising blood tumor markers. No uptake of FDG was seen with in the mass. Patient was treate conservatively, under the assumption that she had inflammation of the pancreas. Follow up scan over 2 years confirmed no tumor present


Pancreatic Cancer :Pancreatic Cancer


Why did FDG PET Help? :Why did FDG PET Help? Demonstrated that there was no pancreatic tumor, sparing the patient pancreatic surgery Key Management Issues Differentiating chronic pancreatic masses from cancer Staging nodal and liver metastases Assessing response to chemotherapy


Summary of Evidence for FDG PET in Pancreatic Cancer :Summary of Evidence for FDG PET in Pancreatic Cancer For Diagnosis: an estimated 50% changed was noted in management effect, based on 26 patient studies. For diagnosis/staging: an estimated 43% change was noted in management effect, based on 65 patient studies. For staging: an estimated 36% changed was noted in management effect,based 33 patient studies. For recurrence: an estimated 53% change was noted in management effect, based on 19 patient studies. For monitoring response: an estimated 16% change was noted in mangement effect, based on 19 patient studies.


Prostate Cancer :Prostate Cancer Disease Background Prostate cancer continues to be the most frequently occurring malignancy representing 29% of all new cancer cases in American men. One out of every six men is at lifetime resk for prostate cancer. Approximatedly every 13 minutes a life is lost to prostate caner in the United States. African American have the highest prostate cancer incidence rates in the world.


Case Example :Case Example A 75year old man, who was diagnosed with prostate cancer was followed by blood levels for prostate specific antigen PSA. A rising PSA ws followed up with a CT scan which revealed lymph node involvement in the pelvis near the removed prostate.. FDG PET scan confirmed what was seen on CT and in addition, showed spread of cancer in to the abdomen and chest.


Prostate Cancer :Prostate Cancer


Why did FDG PET Help? :Why did FDG PET Help? Helped because it showed that the cancer had spread to distant sites and that local radiation to the pelvis alone was not likely to benefit the patient. Key Management Issues Further evaluation of equivocal bone lesions found with conventional imaging Differentiating bengin from malignant lesions in bone Assessing treatment response when lesion is imaged Initially Identifying metastatic disease in soft tissue


Summary of Evidence for FDG PET in Prostate Cancer :Summary of Evidence for FDG PET in Prostate Cancer Management change data for staging patients are not directly avaiable from the literature.


Renal Cell Cancer :Renal Cell Cancer Disease Background Renal cell cancer can often be cured if diagnosed and treated when still localize to the kidney and to immediately surrounding tissue. The probability of cure is directly related to the stage or degree of tumor dissemination. Surgical resection is the mainstay of treatment of this disease. Systemic therapy has demonstrated onlly limited effectiveness.


Case Example :Case Example A 59 year old man with a history of metatastic renal cell cancer and left kidney removal developed left sided flank pain. Abdominal pelvic Ct was negative. FDG PET revealed a focus in the apex of the right lung and in the left flank. Biopsy revealed metastasis from renal cell cancer.


Renal Cancer :Renal Cancer


Why did FDG PET Help? :Why did FDG PET Help? Showed a lesion missed on Ct and also showed that the renal cell cancer had spread to the lungs. Key Management Issues Detecting metastatic disease Assessing response of metastases to chemotherapy Determining nature of renal masses


Summary of Evidence for FDG PET in Renal Cell Cancer :Summary of Evidence for FDG PET in Renal Cell Cancer Management change data for diagnosis and staging and other applications are not directly avaiable form the literature


Testicular Cancer :Testicular Cancer Disease Background Rare type of cancer, is a disease in which cancer cell are found in the tissue of on or both of a man’s testicles. Men who have undescended testicle are at higher risk of developing cancer of the testicle.


Case Example :Case Example A 27 year old man with testicular cancer had his left testicle removed. An abdominal CT scan indicated an enlarged lymph node in the lower abdomen. Biopsy was performed and no cancer. FDG PET scan showed a focus of activity in the abdominal lymph node . Tumor in abdominal lymph node


Testicular Cancer :Testicular Cancer


Why did FDG PET Help? :Why did FDG PET Help? Showed that the biopsy was wrong, tumor ws present in the abdomen. Key Management Issue Monitioring response to treatment Staging of primary disease Assessing residual mass Further evaluating raised markers


Summary of Evidence for FDG PET in Testicular Cancer :Summary of Evidence for FDG PET in Testicular Cancer For staging: an estimated 22% change was noted in management effect, based on 27 patient studies. For recurrence: and estimated 51% change was noted in management effect, based on 53 patient studies.


Thyroid Cancer :Thyroid Cancer Disease Background Cancer of the thyroid is a disease in which cancer cells are found in the tissue of the thyroid gland. People who have been exposed to large amonts of radiation or who have had radiation treatment for medical problems in the head and neck have a higher risk of getting thyroid cancer. The four main cancers are papillary, follicular, medullary , and anaplastic.


Case Example :Case Example A 62 year old patient underwent surgery of the left thyroid for cancer. Routine yearly monitoring revealed elevated blood levels of calcitonin. A CT was normal. FDG PET scan revealed increased FDG uptake in the neck which was confirmed by biopsy to be residual thyroid cancer.


Thyroid Cancer :Thyroid Cancer


Why did FDG PET Help? :Why did FDG PET Help? Identified the source of the rising tumor marker and thereby allowed removal of residual thyroid cancer. Key Management Issues Further evaluation when whole body I 131 scan is negative but TG levels are rising in a patient. Further evaluation for medullary thyroid


Summary of Evidence for FDG PET in Thyroid Cancer :Summary of Evidence for FDG PET in Thyroid Cancer For staging: an estimated 22% change was noted in management effecct, based on 60 patient studies. For diagnosis/staging: an estimated 9% change was noted in management effect, based on 58 patient studies. For recurrence and estimated 53% change was noted in management effect, based on 21 patient studies.