Re: James: mom's PET results, tumor still there

 I have a few questions regarding this scan:

1. Why do you think that a height measurement was not included in this scan?

It really should have been in there.  But the only reason I can think of that it may have not been put in there is simply it was done elsewhere and whoever went over the scan does not make a habit of including all the dimensions.

2. How reliable of an indicator are the SUV readings?

They are not going to be 100% accurate, and I am not convinced that the mass is malignant.  Note that the size is relatively close to the previous measurements, but the SUV dropped nearly in half.  If the entire mass was malignant then I would expect the SUV to be near the same or higher, not much lower.  What they need to keep in mind and seem to be overlooking is the fact that injured tissues being repaired also have a higher glucose uptake, but not as high as malignant cells.  For example, if you sprain your wrist hormones called prostaglandins will dilate the blood vessels in the area to bring in more oxygen and nutrients for the healing process such as glucose.  And since we are again are talking about increased cellular division, although in this case for healing, we can also expect increased glucose uptake by the cells.  This does not make them malignant though.

3. Why are the right axillary lymph nodes called "nonenlarged" in the impression? It was 14mm in the first scan and called "enlarged," and 12mm in the latest and called "nonenlarged."

Neither reading is enlarged.  Normal sizes for lymph nodes vary from 0.05cm (.5mm) to 2 cm (20mm).  Maybe on the first reading someone mistook mm for cm.

4. What do you make of the lytic lesions mentioned in the report? They suggest "Findings compatible with bony metastases," but at the same time, that "There is increased glucose metabolism in the right glenohumeral joint which is thought to be degenerative-arthritic." Are lytic lesions also caused by arthritis?

Lytic lesions refer to bone destruction from a variety of causes including cancer, bone cysts, infections, etc.  And yes, this can also be associated with arthritis.  They are assuming it has something to do with cancer since there is a history of cancer.  But there are various factors that have to be taken in to consideration including location and even appearance of the lesions.

As I pointed out earlier, the process of healing also increases glucose uptake.  This cold simply be a case of arthritis in the neck where the glucose uptake is being increased as part of the healing process.

Also keep in mind that cancer cells can replace healthy cells.  If the cancer cells are then killed (lyzed) then the tissue will still display lytic lesions despite there being no cancer cells.  As a related example, I had a friend who had a large (about the size of a half dollar) malignant tumor on her skin.  When the tumor was scratched open and 35% peroxide applied the tumor was destroyed, including portions below the skin where it had replaced healthy tissue.  Therefore, what was left was  very large crater where the healthy tissue had been replaced with malignant cells, then the malignant cells occupying that space destroyed.  So based on the limited amount of information it is impossible for them to state is the lytic lesions are from existent or previously existent cancer cells or something else such as pre-existing arthritis.

Her calcium levels are normal, I believe, from a blood test taken about a month ago, but that was a whole month ago. Are elevated calcium levels always present for cancer that spreads to the bones?

The serum calcium should be elevated if the cancer spread to the bone since the bone destruction would lead to calcium release.

Also, the first PET said that "bones are normal," while this last one shows deterioration in multiple spots. And her bones do hurt, as you already know.

Problem is that many things can lead to bone loss, including stress and even steroidal and non-steroidal pain relievers.

5. Due to the hypermetabolism in the rib area, elevated SUV levels, and the soft-tissue component found there, do you think that the cancer is spreading there? If not, what do all of these components mean?

The first part they are calling "hypermetabolic" is more of a concern considering how high the SUV is.  But the "skin thickening" part is not as much of a concern as infection and inflammation also increase SUV.  But also keep in mind that the SUV of the main mass is down nearly half and the size of the thickened area has not grown at all.  So the later could simply be scar tissue, which is why they are watching this.

6. Can the pleural effusion account for some of her pain? What does it mean? Can it be the pus that is now trapped because her wounds are healed? Does this relate to the pleural effusion in the left part of her chest?

Pleural effusion is a build up of fluid between the chest wall and the lung.  The pain it would cause would be chest pain that increases with a deep breath or cough.

7. What is the highest dosage of ozone a person can tolerate 3x day? My mom has been doing 35 u/g, but my brother has said that he read about people doing 47-50 u/g.

It is generally advised to use 35ug/ml, but higher concentrations re used in some cases such as bleeding in which about 80ug/ml is used.  But this helps to stop bleeding by hemolyzing red blood cells, which is why I don't recommend such high doses through insufflation.  The max I would recommend would be 50ug/ml.

Another option is to increase the number of treatments to 4 times a day.  Since the colon has accustomed to the concentration and it sounds like the uric acid levels have dropped drastically she should be able to tolerate 4 times daily very well  Just remind her to drink plenty of water throughout the day.

8. What do you recommend at this point? Should she go ahead with ozone injections in the chest?

If you can find someone that can do it and knows what they are doing then I would recommend the injection in to the main mass to deliver a concentrated amount to the site and surrounding tissues just in case there are any malignant cells present.

Please let us know anything else that we may have missed and that you have read from this PET/CT. What is your general impression based on the report? We should get the disc mailed out to us soon and my brother will provide you with the images, if necessary.