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Monitoring for lung mets with chest X-ray
Pinto
65 Posts
Hi everyone,

Questions about surveillance for mets.

First, my story is kind of unique in that I was diagnosed with stage 4 colon cancer with one small liver met but said met has never shown on scans. It was discovered by my general surgeon during my colon resection, NOT resected but biopsied, and photographed. The surgeon said it was plain as day, located in segment 5. I had a post-surgical CT and then a PET/CT which both showed nothing, so the tumour board discussed and declined surgery since it wasn’t showing on scans. I’ve since done 6 months of CAPOX which I finished last June. All scans since (CT, MRI and chest X-ray) have been showing NED.

Currently, I’m being monitored with MRI for liver and chest X-ray for lungs, every 6 mos. My oncologist said she doesn’t want to expose me to more radiation than necessary (I was almost 43 at dx, 44 now), she feels chest X-ray is sufficient and that it picks up more than people think.

Is anyone else being monitored with chest X-ray instead of CT scan? Thoughts on this approach?

If you’ve had chest X-ray, did it ever pick up lung mets? If so, how large were they at that point?

Thanks in advance!

2 Replies
ACH2015
2050 Posts

Hi @Pinto

I saw your post and thought I'd offer you what I could.

I was diagnosed with Stage IV unknown primary cancer (left inguinal / groin region) in 2016. I underwent multiple PET CT / CT / MRI / and x rays before during and after two years of treatments.

I have always been monitored with CT scans myself. Every CT scan shows spots on both of my lungs, that remain stable and under 10mm in size. I just recently went from 3 month CT's to 4 month CT's. And this is after 5 years.

I looked up some information and found that LDCT (Low Dose CT) is the preferred means of monitoring for lung cancer over x rays. The information comes from the American Cancer Society, but also, if you look up BC Cancer - you will find information about LDCT being used to monitor cancer patients. Perhaps ask if LDCT is offered as an alternative for you. LDCT is a lower level of radiation than regular CT scans.

As with your situation, I am in a position to be constantly monitored for any potential recurrences, and I know I have far exceeded the radiation limits long ago. But it is a necessary evil if you are to keep on top of any potential recurrence or new cancer. The other question I'd ask is how much forewarning bloodwork gives toward prevention and surveillance.

Its always a toss up with radiation - and in the end, I trust my instincts and comfort level after doing the required research.

Hope this helps.

ACH2015

@Pinto

Interesting question. I'm in a somewhat similar situation to @ACH2015 except I have Stage 4 adenocarcinoma NSCLC. My oncologist is moving to the four month scan mode as well. we've had a few scares and moved back to three months but the last two times we have been in four month mode. So the first time at the two month mark he sent me for an Xray and labs. “Just to check.” But the last time around it was just labs. And when I asked him about it, his response was “It's really hard to pick up any progression on an Xray.” This is a doc that spends day in day out looking at lung CTs and Xrays. I would be wary of someone who says they can spot tumours on an Xray.

The question of lifetime radiation is also an interesting one and is part of the driver for moving to four month scans, cost and scheduling being two other reasons. When I was discussing radiation for my male breast cancer (yeah double winner here) we decided to leave the radiation “room” for aggressive treatment of future lung cancer tumours. Not sure if that would be the decision today, given the tendency to higher short doses and some other technologies but that was the decision then.

Angus

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