There are many many types of scan you may have once you meet your oncologist and she/he sends you off to the various departments. I’ll start with the easy ones and work my way through the others for you.
When an abnormality is present the first scan you will have is probably going to be an x-ray. Images of areas inside the body help the doctor tell whether a tumor is present. These images can be made in several ways. In many cases, a special dye is used so that certain organs show up better on film. The dye may be swallowed or put into the body through a needle or a tube.
X-rays are the most common way doctors make pictures of the inside of the body.
What happens during an X-ray test?
The X-rays are produced by an electrical machine and the patient stands between the machine and a special screen used for obtaining the image. You will be asked to remove jewellery or watches as they may appear on the x-ray and cause confusion!
You will need to keep as still as possible for each picture taken. It is entirely painless and there are no side effects. Once the radiographer has checked that the x-ray is OK quality wise you are free to leave. The radiologist will then report on the findings to your oncologist.
For more complex examinations this process may take a few hours so the official result of the test is not usually available immediately.
Is X-ray radiation dangerous?
It is one of the ironies of radiological practice that X-rays can both cause cancer and be used to treat it. Nowadays, with the use of very small doses of radiation to produce high quality X-ray images, the risk of cancer after properly supervised X-ray examinations is extremely small.
Staff in the x-ray department are exposed to x-rays allt he time so that is why they go behind a screen when the beam is switched on. The cumulative effect would be more significant for them than someone who is a patient for example.
I have had these several times now. Once I was already radioactive after being told it was OK to have two tests in one day and was sent home immediately through another set of doors and outside the hospital after being told not to talk to pregnant women or children. How scary is that?!?!?
Anyway this is a more sensitive test than an x-ray and shows up any abnormal areas of bone more clearly. You have a small amount of mildly radioactive substance injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as hot spots. This is not dangerous to you and is similar to that from an x-ray.
What happens during an Isotope Bone Scan?
There is generally a wait of approximately 3-4 hours between having the injection and the scan itself, so I’d advise you to take a good book and have a supply of drink nearby as well as somewhere to sit that is comfortable. The scans will be taken with a ‘Gamma Camera’ and you may sit on a chair or lie down on a bed which is attached to a big machine. You do not normally undress and it does not involve pain (some people who do not like injections will not like the insertion of the radioactive substance as it uses a needle the same as a blood test!).
Even if an abnormality is detected on the bone scan, it is not always clear whether it is caused by cancer or by another condition such as arthritis. Sometimes a CT or MRI scan may help the doctors to decide whether the changes seen on a bone scan are caused by secondary bone cancer or another condition.
You will probably be asked to drink lots of fluid to ‘flush’ the radioactivity out of your body afterwards but nothing else needs to be done and you can continue your normal day.
The results are not available immediately but will be sent to your oncologist to discuss with you at the next oncology clinic appointment.
MRI means Magnetic Resonance Imaging scan. This test uses magnetic fields to build up a series of cross-sectional pictures of the body, a bit like slices of swiss roll.
You have to lie very still on a couch inside a metal cylinder (the polo mint image that everyone has of an MRI scanner!) which is open at both ends. The time taken for the scan will vary with which part of the body (and how many parts of it!) they are scanning. The machine is very noisy and you can have earphones on with music playing (sometimes hospitals give you a list to chose from). Just make sure it’s nothing too foot tapping though as you need to stay still throughout the whole scan. It is not a continuous scan but a series of smaller ones taking anything from a few minutes to a lot longer (I’ve had loads of these and you do get used to them).
The cylinder is actually an extremely powerful magnet, so before entering the room you will need to remove anything metal i.e. earrings, necklace etc. Also watch out if you have a walking frame or walking stick like me. They get you to the machine and then take it away. Imagine the problems that could cause once the machine starts! If you have any metal inside your body, for example, a heart monitor, pacemaker, surgical clips, or bone pins you should tell your doctor. You might not be able to have an MRI because of the magnetic fields. Normal dental fillings are normally OK but check if you are concerned.
Some people feel claustrophobic inside the cylinder. Mention it to the radiographer if you are not keen on enclosed spaces. You will always have a ‘panic button’ in your hand if you encounter problems and they will stop the scan and come in to you. They are very good with extra support for people who are nervous.
Sometimes your consultant can ask for you to have an injection, unluckily for me, I was always asked to have one and you know what my veins are like. It is a contrast dye so that they can see things more clearly. It doesn’t normally cause any discomfort (apart from the initial injection if these are not your favourite things!).
Once the scan is completed you are free to go and the results will be sent to your consultant and you will need a follow up appointment to see him (or her).
CT means Computerised Tomography scan. A CT scanner takes a series of xrays which builds up in to a three dimensional (3D) picture of the inside of the body. The scan is painless and takes longer than an x-ray (from 10-30 minutes).
You may be asked not to eat or drink for a few hours before the scan. Sometimes you may be asked to have a gloopy type of drink or an injection prior to your scan. It takes a long time to drink the liquid as it has to be taken over a certain timescale. Again, similar to the MRI scan this is so that certain areas show up better on the scans. If you are really lucky (NOT) then you will be asked to have both items, this was me on more than one occasion. Lucky me huh!
When you are in the scanner (again it is like a tube) you may feel hot all over and sometimes it feels like you need to desperately go to the toilet. Don’t worry nothing happens it just feels like it. The first time I had one of these I wasn’t told about that part so as you can imagine that was fun!
If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection. You should tell your doctor beforehand of any allergies in case there could be a reaction.
As soon as the scan is over you will be allowed to go home again.
A PET is a Positron Emission Tomography scan, first developed in the 1970’s. It uses low dose radioactive sugar to measure the activity of cells in different parts of the body and is extremely good at picking up Lymphomas. They can also detect cancers at a very early stage and they can be used for staging (showing if cancer has spread to other parts of the body).
The scan is usually done on an outpatient bases in the x-ray (Nuclear Medicine) department of the hospital. A PET scan takes longer than other scans normally and if you need it they can give you a sedative to calm you down. At mine, the nurse said to me “you don’t need that do you?” and she was so right! I was very calm.
Tiny particles called positrons are given off by a slightly radioactive sugar, and are detected by the scan to form a picture called a tomogram. A very small amount of a mildly radioactive substance (this is the sugar, and is called FDG-18) is injected into a vein, usually in your arm. It takes around 30-90 minutes to travel through the body and then the Doctor can see this in more detail. You will wait in a quiet area whilst this goes around your body. This is a fairly new type of scan and I had to go to Harley Street in London to have mine – hence it had a separate quiet room, soft music and oils burning to calm you down. Although it is getting more common and several hospitals have them now too – there are still only around 12 PET scanners in England and Wales, one in Scotland and one in Northern Ireland. (At the time of writing April 2008).
The machine is similar in looks to the CT/MRI scanner in that it is a large machine with a hole in the centre through which you pass on a moving couch as the image is taken. The test is painless but you can feel claustrophobic so it is worth mentioning this if you feel it is something that might affect you.
Any areas of cancer are usually more active than surrounding tissue and show up on the scan.
PET scans are not often necessary or taken for patients, but you can discuss with your doctor whether they think one would be useful in your case. The use of PET scans to diagnose secondary cancer in the bone is still being researched, but it is thought that these scans can help to show whether the bones are affected by other (non-cancerous) conditions or by cancer.
Very occasionally, after scans, the doctors may still not be certain of the cause of the abnormality in the bone and you may need to have a small sample of cells taken from the affected area of bone (a biopsy). Lucky old me, I had the full set of scans and the bone biopsy as well.
A biopsy can be carried out in different ways depending on what the consultant requires to diagnose your cancer.
A needle biopsy involves taking a sample of bone and examining it to see if it contains cancer cells. The needle is passed through the skin into the bone, and a small piece of the bone is taken. This is examined under a microscope.
As this part of the test can be painful a local anaesthetic is injected to numb the area. If you are feeling very anxious, a sedative injection may also be given.
The test does not take very long and you may have it as an outpatient. The results of the needle biopsy will take longer, normally 10-14 days to come through. Again you will have a follow up appointment made and your consultant will speak to you then.
It is not uncommon to have some discomfort for a few days after the test. Your doctor will prescribe painkillers for you.
For this test, a small piece of bone is removed while you are under a general anaesthetic. Bone is extremely hard, and the piece that has been removed has to be softened so that it can be examined under a microscope. The softening process takes several days, and means you may have to wait 10-14 days for the results of the biopsy.
A bone marrow biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow). A bone marrow aspiration removes only the marrow. They are often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow.
I had a nasty experience with this test in that they had a blunt batch of needles and it was almost postponed as they couldn’t get in to the bone. It was very painful and I was bruised for weeks not days. I hope that I won’t have to have another of these but they did say it may be a possibility in the future……fingers crossed everyone!
If you would like explanations of further tests, please let me know.