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Ask Daniel Sheibley, MD Your Own Question

Daniel Sheibley, MD
Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience:  MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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If a SUV uptake on a pet scan is low does this mean the cancer

Customer Question

If a SUV uptake on a pet scan is low does this mean the cancer is less aggressive ?
Submitted: 2 years ago.
Category: Medical
Expert:  Daniel Sheibley, MD replied 2 years ago.
Daniel Sheibley, MD :

Hello, yes that is generally true, however in some cases it can represent an early metastasis that is on its way to become more active or one that is dying and becoming less active. But on the whole, if you compare two metastases, the one with a lower SUV will be less "active"

Daniel Sheibley, MD :

Does that answer your question to satisfaction?

Customer:

ok. so if trearment like chemo started it's better right ?

Customer:

If a

Customer:

Person refuses chemo and he has a liver metastases, can he still

Customer:

Live a number of years?

Daniel Sheibley, MD :

That depends on the size and positioning of the metastases. But chemotherapy or other adjunctive treatments such as percutaneous ablation, chemoembolization and radioembolization do significantly add to survival times.

Customer:

It is 1.6 cm and peripheral met they said . What is that?

Daniel Sheibley, MD :

It is only 1.6cm in diameter and it is near the outer edge of the liver - that is a better area of it to be at.

Customer:

Without chemo and an ablation procedure only, approx how long would a person survive

Daniel Sheibley, MD :

That depends on cell-type of the tumor. Not all cancers are as active as others. Even the same type of cancer can vary person to person depending on the specific mutations causing the cancer.

Daniel Sheibley, MD :

If that is the only met in the person's body, an ablative procedure can be curative if the primary cancer has been removed.

Customer:

Primary removed already in march this year

Customer:

It's just that the side effects are not good like hair loss and appetite loss etc

Daniel Sheibley, MD :

So yes, if that is the only met at all in his body an ablative procedure can be curative, however if there is any other met, including just a single cell that his ended up elsewhere it would not have the potential to be curative

Customer:

That's the thing we don't know if any other mets in body. There could be but just not seen right at present

Daniel Sheibley, MD :

Yes. Even another single cell.

Customer:

Well in that way chemo is goo right and works thur the whole body and not a single area ?

Daniel Sheibley, MD :

That is why chemo (which can kill the unseen mets) is good in conjunction with ablative therapies to target the larger seen mets

Customer:

So a pet scan can only pick

Customer:

Up over 1cm?

Daniel Sheibley, MD :

A pet can only reliably pick up metastases that are over 7mm (0.7cm)

Customer:

How good is xeloda ? As he was on that after surgery but obviously it did not work right otherwise this met would not b here?

Customer:

Oh ok . Can a ct pick from 7 mm too ?

Daniel Sheibley, MD :

A ct won't give you any idea about activity of the metastasis. That is what a PET does. The PET-CT does both, using the CT anatomic data to correlate with the PET activity data.

Daniel Sheibley, MD :

a ct can pick up far smaller things than 7mm, down to mm but can't tell you if it is a metabolically active metastasis you need the pet to give you that info and the pet can only reliably resolved down to 7mm

Customer:

A scan in dec last year, feb this year and April this year - all were clear if mets . This was a ct. So I'm thinking why in April nothing small was seen in a ct?

Daniel Sheibley, MD :

If his metastasis burden has only increased since being on xeloda than another regimen of chemo would be a good thought to entertain

Daniel Sheibley, MD :

Metastases can be the same radiopacity as the normal liver surrounding them and therefore not seen.

Daniel Sheibley, MD :

Chemo + ablative therapy is the best choice for most all patients

Customer:

the thing is surgery was march , xeloda started late in June as he was reluctant to have it , few doses were missed too - could have affected the way it worked ?

Daniel Sheibley, MD :

Yes that can

Customer:

Ok. So would had have chances to survive , say, more than 3 years ?

Daniel Sheibley, MD :

That depends on cytologic factors (specific genetics of the cancer which differ from patient to patient) but yes that is a possibility

Customer:

Im

Customer:

I'm not sure if he's KRAS mutant or KRAS wild yet

Customer:

ok so I need to look into ablation . Someone mentioned nano knife to me is that worth considering ,?

Daniel Sheibley, MD :

Yes you do.

Daniel Sheibley, MD :

Percutaneous ablation can be also used with external beam radiation and chemotherapy all at the same time

Daniel Sheibley, MD :

and offer the best chance of controlling metastases

Customer:

Ok . I don't know why dr are not mentioning ablation

Customer:

But chemo does not work on some ppl right ?

Daniel Sheibley, MD :

You need to ask them about it and if they aren't familiary with it they need to send you for a second opinon elsewhere

Daniel Sheibley, MD :

yes certain chemotherapies alone do not work for all patient's cancers

Customer:

Yes exactly as we need to be proactive here right ? It's a matter of life

Customer:

The nhs may only suggest chemo but someone else may havev

Daniel Sheibley, MD :

I'd ask for a second opinion/referral somewhere where they offer those other therapies

Customer:

another option

Daniel Sheibley, MD :

here in the US those other therapies would have been discussed already

Customer:

Here in uk private hosp have these but nhs do not

Customer:

Can c

Daniel Sheibley, MD :

He'd need to go there then

Customer:

His cea is 9

Daniel Sheibley, MD :

That is elevated a bit. But still he needs to discuss those other treatments with another physician

Customer:

some ppl have cea in the 100's is that due to more of the disease ?

Daniel Sheibley, MD :

that tends to be the case.

Customer:

He is a smoker

Customer:

Should he refrain from alcohol as he would drink it whilst on xeloda ?

Daniel Sheibley, MD :

If he can not get those therapies then chemotherapy is at least doing something for him if they continue this or entertain the idea of changing his chemotherapy

Daniel Sheibley, MD :

Yes abstain from alcohol

Daniel Sheibley, MD :

Not a good idea in any patient on chemotherapy

Customer:

That's the problem he had it while on xeloda too . Can it affect way chemo works ?

Daniel Sheibley, MD :

Not generally but it is not a good idea to add alcohol (a toxic substance) on top of chemo - another toxic substance

Customer:

I see

Customer:

Thx for ur help

Daniel Sheibley, MD :

No worries. Best of wishes

Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience: MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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