Radiation Oncologist Questions PET Scans

Is a whole body PET scan essential for diagnosing the spread of tongue cancer?

I was diagnosed with tongue cancer one year back, post which I underwent the chemotherapy and radiation therapy. Now that my treatment is complete, the doctor has recommended a PET scan for the entire body to diagnose if the cancer has spread to other parts of the body. Is it essential?

10 Answers

Based on the limited clinical information, I believe that a PET scan is useful for two reasons. It could detect subclinical tumor spread, which may be effectively treated as an oligo metastasis, and there is a significant chance of another subclinical cancer, e.g., lung cancer or another head and neck cancer.
A whole body Positron Emission Tomography (PET) can be very helpful to screen the body for increased hypermetabolic activity. When we see this it can indicate inflammatory conditions such as cancer. In addition, the scan uses CT scan imaging simultaneously to evaluate solid organs such as lungs, liver and so on as well. It is a very useful tool.
If your first PET/CT after treatment is negative (no residual disease), you don't need another PET/CT in follow-up. The doctor can see you every 4 months for the first 2 years, then every 6 months to year 5. He will order CT scan of head and neck if indicated.
PET scans are recommended as a follow-up exam to verify response to intitial treatment and are usually done at least 12 weeks after radiatioin has been completed. If you have had one done after the treatment was complete and it was negative then I would only recommend a PET scan if I was concerned about some symptoms that you are having
It is good to have it to monitor local recurrence because CT scan can not tell whether the change in the tumor bed is scar tissue or active tumor. For head and neck cancer, the first 2 years after treatment are critical because 90% of recurrence and distant metastasis happen in those 2 years.
It is a reasonable follow up test.
PET/CT scans are one of the best tests you can have to tell exactly where the cancer is & where it isn't. For most tumors, they are more accurate than MRIs or CT scans.
If it were me, I would want the PET. It is the best modality we currently have to evaluate the spread of certain cancers (head and neck cancers is in that group). The PET can detect cancer in a lymph node before it becomes enlarged and can detect the spread of cancer to other organs before these areas become symptomatic. The rationale for imaging close after treatment is that ~80% of head and neck cancers that do recur, recur within 2 years after treatment.
A CAT scan of the head and neck is the standard of care. However, a PET scan is helpful in finding out if you have a second malignancy in the lungs and elsewhere in the body.
Not absolutely essential, but very useful to look at local recurrence in tongue as well as the rest of the body. The best test we have for the purposes.