Wednesday, January 29, 2003

Better cancer diagnosis, treatment options

Emory now has Georgia's first PET/CT scanner

Patients at Emory University Hospital now have access to the latest development in medical imaging technology with the installation of a PET/CT. The state-of-the-art scanner helps doctors see and treat cancer and deliver better cancer care from diagnosis to follow-up.

The $2 million scanner combines positron emission tomography and high-speed, multi-slice computerized tomography imaging. Although PET/CT is recognized as one of the most effective technologies for diagnosing certain cancers and staging malignant diseases, until now it was not available in Georgia. Access to this technology is very limited in the United States.

"This is the first-of-its-kind technology in the Atlanta area," said David Schuster, MD, medical director of the PET Center at EUH. "The PET/CT allows physicians to determine areas of abnormality precisely in the body so we can treat it as quickly and effectively as possible."

A PET scan detects changes in cellular function how cells are utilizing nutrients like sugar and oxygen. Areas with a high degree of metabolic activity have a greater chance of being cancerous. A CT scan allows doctors to see the internal structures within the human body. Together a PET/CT scan allows doctors to view metabolic activity and pinpoint where abnormal lesions are located so that they can target the disease. "In other words, it allows us to superimpose the function of the body with the anatomy of the body," Dr. Schuster said.

The integrated PET/CT scanner joins the best of both imaging modalities in one system. A CT shows the anatomical location of the tumor. It relies on changes in anatomy that occur as tumors grow larger. PET sees small metabolic changes and can help physicians identify extremely small lesions or cancerous cells before there are any accompanying changes in the anatomy. PET, however, cannot provide the precise location of the tumor.

With this combined technology, doctors can now detect cancer in its earliest form, pinpoint the exact location and determine the best way to remove the tumor and treat the affected area.

Combining the strengths of PET and CT will allow physicians to diagnose and localize smaller tumors early and make more informed treatment decisions for their patients. The technology allows physicians to separate normal from abnormal structures in the body, thus cutting down on false positives. We are already seeing this at EUH, noted Dr. Schuster.

This new technology will reduce invasive procedures in patients, such as biopsies and unnecessary surgeries. It also will reduce examination and imaging time.

Susan Burrows knows first-hand the importance these machines have in detecting cancer. After being diagnosed with ovarian cancer in 1998, Burrows underwent regular treatments of chemotherapy and was enjoying a remission.

Burrows had regular check-ups during the next two years. Her exams, which included CT scans, did not indicate anything abnormal. But blood tests put up a red flag with her physicians.

"The CA125 levels in my blood were slightly going up," Burrows explained. "The CA125 test looks for a 'tumor marker' for ovarian cancer. Even though the CT scans were normal, the blood tests caused some concern with my physicians so they ordered a PET scan."

She was scheduled for her first PET in March, 2001. This 40-minute scan came back with abnormal results. "The PET picked up what my regular exams missed," she said. "This test let me know at a much earlier stage that the cancer was back, and its giving me a chance to fight it."

After undergoing chemotherapy for more than a year, Burrows was scanned for the first time with EUHs new PET/CT on Sept. 30. "The new PET/CT showed progressive disease," she said. The results of the scan let Burrows physicians know how well the chemotherapy was working and allowed them the insight needed in their continued treatment plans.

The PET/CT scanner has the potential to provide increased diagnostic confidence for patients suspected of having cancer and for those who already have been diagnosed with the disease. It should mean peace of mind for patients and their families, knowing that this scanner provides comprehensive and accurate information regarding cancer detection and staging, said Schuster.

"The regular PET scans are good, but the new PET/CT is better. It is more anatomically detailed and accurate for staging and restaging ovarian cancer," Burrows noted. "For me, this accuracy is very important, since none of the other tests or scans detected the cancer was back."

"The PET/CT is a much quicker scan than traditional PET scanners. The PET/CT is cutting our examination times in half," said Michael L. White, PET imaging technologist. "Normally, a PET scan can take up to 50 minutes, but with this new technology, scan times are now 20 to 25 minutes. Our patients have been extremely pleased they don't have to spend an hour in the scanner."

"This is so true," added Burrows. "Even though this is a non-invasive procedure, its still a scary thing to go through. There's no-one going through this scan who is not facing a possible life-changing diagnosis. The decreased scan time makes the whole experience easier.

"Plus," she added, "the staff at the PET Center are very experienced and go the extra mile to make sure your experience is as pleasant as possible. They even warmed my feet while I was being scanned. Its small things like that that make a difference when you are facing a difficult diagnosis."

Burrows is still undergoing chemotherapy and is optimistic about beating cancer. "It's just a matter of time. It looks like my (CA125) numbers are going down. For me, the PET scans have provided a more accurate diagnosis and better information related to the effectiveness of treatment."