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PET and Its Role in Routine Clinical Care: The Oncologist s Perspective

PET Imaging. PET provides images of tumor and tissue metabolism.PET images complement anatomic images obtained with CT and MRI.Routine imaging with PET uses a radioactive form of a sugar analog (FDG- Fluorodeoxyglucose).FDG uptake is used to measure tumor energy use.. PET Imaging. A tumor is

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PET and Its Role in Routine Clinical Care: The Oncologist s Perspective

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    1. PET and Its Role in Routine Clinical Care: The Oncologist’s Perspective Anthony F. Shields, M.D., Ph.D. Karmanos Cancer Institute Wayne State University, Detroit, Michigan

    2. PET Imaging PET provides images of tumor and tissue metabolism. PET images complement anatomic images obtained with CT and MRI. Routine imaging with PET uses a radioactive form of a sugar analog (FDG- Fluorodeoxyglucose). FDG uptake is used to measure tumor energy use.

    3. PET Imaging A tumor is just a lump and may represent cancer, injury, infection etc. Increased energy use is seen in most cancers and can be detected by PET. Normal energy use is also seen in the heart and brain.

    4. Assessment of Cancer What is the role of PET? Diagnosis Staging Response to Therapy Documenting Recurrence & Re-staging

    5. Assessment of Cancer Approved for use in the following cancers: Lung (Non-small Cell) Head and Neck Colon Esophagus Lymphoma Melanoma Breast Thyroid

    6. Assessment of Cancer Approved Pending for use in the following cancers: Brain Tumors Cervical Small Cell Lung Testicular Pancreas Gastrointestinal Stromal Prostate Multiple Myeloma When will it be approved for stomach, biliary, small bowel, ampullary, renal, unknown primary, adrenal, sarcoma,thymoma, mesothelioma ...

    7. PET

    8. PET Scans Have Limited Use in Some Situations

    10. Assessment of Cancer What is the role of PET? Diagnosis Can PET help us detect cancer?

    16. PET Scans Can Detect Multiple Cancers

    17. No Test is Perfect

    18. Assessment of Cancer What is the role of PET? Staging Staging: It the determination of how far a tumor has spread. Knowing the stage is important in deciding what treatment is needed (surgery, radiation, chemotherapy).

    20. Lymph Node Staging In Patients with Lung Cancer

    21. Dutch Trial of Standard Work-Up without and with FDG PET in Lung Cancer

    22. Costs (societal perspective, $ US)

    23. PET Limitations

    24. Assessment of Cancer What is the role of PET? Response to Therapy After treatment we measure the change in tumor size with CT or MR.

    25. Assessment of Cancer Treatment Cancer can take weeks to months to change size after treatment. Even when a tumor shrinks, what is left may be “healthy” and grow back. A tumor that does not shrink may be “dead” and mostly scar tissue.

    26. Assessment of Cancer Response to Therapy When to image depends on… Tumor type Treatment used When you need the answer

    28. Lung Cancer Response to ChemoRT: PET and CT

    29. Imaging Becomes More Important as the Number of Therapeutic Choices Increases

    30. Ineffective Chemotherapy Is Very Expensive

    31. Pancreas Cancer Therapy

    33. Assessment of Cancer What is the role of PET? Documenting Recurrence & Re-staging

    34. Recurrent/ Metastatic Colon Cancer

    35. Recurrent/ Metastatic Colon Cancer

    36. CT and separate FDG PET had been read as negative. The FDG PET showed a small area of increased uptake in the mid-abdomen, but one could not say if this represented recurrence. The combined images show that the FDG lesion is within the nodes and likely to be recurrence. Surgery is planned.CT and separate FDG PET had been read as negative. The FDG PET showed a small area of increased uptake in the mid-abdomen, but one could not say if this represented recurrence. The combined images show that the FDG lesion is within the nodes and likely to be recurrence. Surgery is planned.

    37. CT and separate FDG PET had been read as negative. The FDG PET showed a small area of increased uptake in the mid-abdomen, but one could not say if this represented recurrence. The combined images show that the FDG lesion is within the nodes and likely to be recurrence. Surgery is planned.CT and separate FDG PET had been read as negative. The FDG PET showed a small area of increased uptake in the mid-abdomen, but one could not say if this represented recurrence. The combined images show that the FDG lesion is within the nodes and likely to be recurrence. Surgery is planned.

    38. When to order PET?

    39. PET Imaging in Oncology Conclusions

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