Ovarian Cancer PET into 2009: Very Promising Technology
Monday December 29, 2008
The PET scan for ovarian cancer, in my opinion, is a misunderstood test. Because of it's expense and "lack of data" and lack of approval leads payers to deny coverage often. Why is that? It's just a test. It will not lead to someone living longer by itself, just like CT or MRI scans and CA125 or other tumor markers. But if you take that position, may as well not pay for anything. Any test or procedure in the care of ovarian cancer, or any medical condition, can be misapplied.
With regard to the role of PET scanning in ovarian carcinoma, it appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Is this always helpful additional information? No! If the plan is not going to change much, for example chemo vs. no chemo, then finding the details of where the cancer might be located is not too helpful. That may only shift the date of chemo by weeks or months, without helping you live any longer. On the other hand, if the location of disease and number of areas involved will help make the decision of surgery vs. no surgery, then it can be crucial. There is no point in operating with suboptimal information only to find out during surgery that the surgical plan was a bad idea (e.g. "cancer all over the place and not removable"). The point is that deciding whether or not to perform a test, including the PET, is a multifactorial rather than a knee-jerk decision. In the right decision-making "hands", proper selection of testing can make the difference between avoiding unnecessary surgery (or not) and sometimes the difference between life and death.
From a purely technical standpoint the data is growing and the role of fluoro-D-deoxyglucose (FDG)-PET along with CT for the detection of recurrent ovarian cancer appears very promising. This a test which melds detection of abnormal anatomy and physiology very well. The devil is in the decision details as to when to use what and, more importantly, what difference it can make. If denied, go over these details with your trusted physician.
With regard to the role of PET scanning in ovarian carcinoma, it appears to be particularly useful for the diagnosis of recurrence when CA125 levels are rising and conventional imaging is inconclusive or negative. Is this always helpful additional information? No! If the plan is not going to change much, for example chemo vs. no chemo, then finding the details of where the cancer might be located is not too helpful. That may only shift the date of chemo by weeks or months, without helping you live any longer. On the other hand, if the location of disease and number of areas involved will help make the decision of surgery vs. no surgery, then it can be crucial. There is no point in operating with suboptimal information only to find out during surgery that the surgical plan was a bad idea (e.g. "cancer all over the place and not removable"). The point is that deciding whether or not to perform a test, including the PET, is a multifactorial rather than a knee-jerk decision. In the right decision-making "hands", proper selection of testing can make the difference between avoiding unnecessary surgery (or not) and sometimes the difference between life and death.
From a purely technical standpoint the data is growing and the role of fluoro-D-deoxyglucose (FDG)-PET along with CT for the detection of recurrent ovarian cancer appears very promising. This a test which melds detection of abnormal anatomy and physiology very well. The devil is in the decision details as to when to use what and, more importantly, what difference it can make. If denied, go over these details with your trusted physician.