Finding The Needle in the Haystack
PET Scans Revolutionizing Early Detection, Staging of Cancer

By Tony Glenn - Blue Ridge HealthCare

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SPECIAL TO THE NEWS HERALD

In the summer of 2004, O’Clair Alexander seemed cautiously optimistic that the worst of the battles against stage-three Hodgkin’s disease were behind her - but still mentally prepared to accept more adversity

Today, she seems stronger, more hopeful. More at peace and reflective. “I’m doing really well now,” O’Clair said. “My scans have been clear. I’ve gotten more and more energy back. Overall I’m in good spirits.”

Running her fingers through strands of blond hair that didn’t exist a year ago, O’Clair talked about the cancer and how it has changed her.

“When you have cancer, you end up paying some really heavy dues to be in a club that you just don’t want to join. It changes you - makes you become very still and think about the things that are really important,” she said.

“Once you’re part of that group - the people that have dealt with and overcome cancer - there’s a camaraderie and understanding that you share. You have a different appreciation for life. I’ve come to realize that my purpose here is to be appreciative of life - to live life, and live it with joy.”

In 2004, O’Clair was one of the first patients to be scanned in Blue Ridge HealthCare’s mobile Positron Emission Tomography (PET) unit which is giving doctors an enormous advantage in their hunt for early stages of cancer.

For decades detecting cancer in its earliest stages involved a lot of educated guesswork. Finding and assessing an already established tumor wasn’t so difficult, but to catch cancer in its infancy - when most treatable - was a daunting task. Detecting the smallest beginnings of the disease was like finding a needle in a haystack.

But now PET scanning, available at Blue Ridge HealthCare’s Grace and Valdese hospitals since April 2004, allows physicians to identify minute cancerous abnormalities with precision unheard of only a few years ago.

PET scanners monitor suspect anatomical activities at the most basic biochemical level. The scan is a non-invasive test that traces glucose (sugar) to where it is consumed by an abnormal growth. Because cancers metabolize glucose as a source of energy when they are growing, PET finds this abnormal uptake with sophisticated cameras and computers, so physicians can determine if cancer is present, and to what extent it has spread. PET images can also be “fused” or overlaid with CT and MRI data to reveal extraordinary detail of a malignant tumor’s location and size.

“PET technology has proven to be an effective diagnostic tool,” said Ivan Vinueza, director of radiology at Blue Ridge HealthCare. “This technology gives better information to physicians and consequently allows patients to be treated earlier with the most appropriate therapies. It also can reduce or eliminate the need for painful invasive tissue sampling, which often takes place when diagnosing cancer.”

Carolyn Mook, MD, medical oncologist, uses the PET technology to gauge the effectiveness of treatments for cancer patients under her care. For example, a patient could be undergoing chemotherapy for breast cancer, and after as little as one month of treatments, a PET scan could be used to evaluate progress. PET scan results allow an oncologist like Dr. Mook to fine-tune adjustments in treatments to optimize their success.

“The PET Scanner has really revolutionized the way we do many things,” said Dr. Mook. “It certainly promotes both proper staging (how far a cancer has spread on a scale of 1-4) and treatment. We adjust our treatment significantly because of the information it provides.”

When O’Clair, a Burke County resident and artist, was diagnosed with stage-three Hodgkin’s disease, PET scans proved invaluable in helping Dr. Mook with her treatment strategy. “In the middle of my treatment, I underwent a PET scan to determine how well it was working,” said O’Clair. “At the end of the treatment cycle I had another PET scan. One spot was showing up - all the others had cleared. This was not a spot that had shown up before.”

Because the spot was unexpected and in a new place, Dr. Mook decided O’Clair should have another scan. “We waited about four weeks and did the PET scan,” O’Clair said. “The cancerous spot was still there.”

Dr. Mook told O’Clair that she wanted to be aggressive in the treatment, and recommended another round of chemotherapy and a stem cell transplant. O’Clair had the transplant in June 2004 at Wake Forest University Baptist Medical Center. The process used O’Clair’s own healthy stem cells to replace cells that were killed by high-dose chemotherapy.

Subsequent PET scans came back clean. O’Clair thinks the PET scans gave her a jump-start in fighting the disease - especially when the spot showed up. “It could have been months before that spot was detected,” she said. Dr. Mook agreed, saying “We probably wouldn’t have detected the recurrence for some time with traditional scanning procedures.”

Dr. Mook continues to use PET technology to help diagnose and treat cancer patients, often doing pre-treatment, mid-cycle and post-treatment scans. “If the post-treatment scan shows no evidence of cancer activity then we monitor the patient and repeat the scan about every three months,” she said.

Another advantage of PET is that it surveys the whole body for potential spread of the cancer; particularly useful when a patient has had an aggressive variety of the disease.

The radiology departments at BRHC hospitals have been using state-of-the-art technology like multi-detector CT and high-field MRI scanners for some time. These devices show highly detailed anatomical images but can’t confirm whether a suspicious growth is cancerous or not.

“Now you can do PET scanning and see if it’s active or not,” said Dr. Mook. “There are a lot of ways that PET saves patients from having to have additional CT or MRI scans. You can accurately say whether they are in a state of remission or whether we need to proceed with further treatment.”

With the technologies being complementary, doctors will correlate the PET results with a CT or MRI. “If you see something on the PET scan, you can fuse it with a CT scan and it’s very helpful,” Dr. Mook said. “But if you’re treating a patient with breast cancer and you want to know how they are doing, one PET scan can often give you the information you need better than all the other scans put together.”

for information on PET Services, call the Blue Ridge HealthCare Imaging Centers at 580-6920 or 879-7611.

TONY GLENN is writer/graphic artist in the Marketing and Public Relations at Blue Ridge HealthCare.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.