肺腺癌患者術後追蹤與治療進展-腫瘤科

肺腺癌追蹤？

陳醫師好：本人是肺腺癌患者，今年05.21（5月21日）開刀切除右上肺葉惡性腫瘤(2.2cm)和同側下肺葉結節。
右下肺葉結節惡性切片亦為惡性。
06.10正子造影無發現轉移，醫師建議做基因檢測是否適合標靶治療，否則定期追蹤即可。
06.17開始服用Iressa (Gefitinib)，09.03腫瘤標記檢查高於標準(CEA: 9.94 ng/mL)，醫師換藥改服Giotrif (Afatinib)，並依序安排系列檢查，其部分結果節錄如下：(A) Exam: CT of the brain neck chest abdomen pelvis with/without contrast enhancement on 108.09.18. COMPARISON: 2019/8/1 CT.FINDINGS:- Lungs and pleura: -- Post-operative change of right lung with parenchymal bands. -- several stable nodules at RUL and LUL sized up to 7mm (coronal view ) at RUL (SE/IM: 8/26 12/45). -- other minor or non-specific lung parenchymal change.- Right renal stones and suspected old insult.- Bones: Degenerative change of the spine with marginal spurs formation. A 1.8cm oval lesion with sclerotic rim at right ilium favored non-aggressive lesion.(B) NUCLEAR MEDICINE STUDY:Whole body FDG PET on 108.10.11PET INDICATION: r/o recurrence.SCINTIGRAPHIC FINDINGS: Whole body PET from vertex of the skull to mid thighs was performed 60 minutes after intravenous injection of FDG. The computer reconstructed coronal and sagittal images disclosed: Compared to prior study 2019/6/10, * Near complete resolution of prior lesions with residual mild hypermetabolism near surgical materials at right lung (SUVmax=1.8), favour postoperative changes. * Persistent mild hot spot at right posterior iliac bone (SUVmax=3.3). * No definite abnormal increased metabolism noted at liver, adrenal glands, spleen or pancreas. * SUV: standard uptake value(C) EXAMINATION: MRI scan without and with Gadolinium contrast of the pelvis on 108.11.18.FINDINGS:Bone(s):> Pelvic bones: A nodular marrow-replacing lesion(s) with hypointensity on T2WI and peripheral hyperintensity on fat-suppressed T2WI and fat-supressed post-enhanced T1WI at the right iliac bone.Joint(s):Others: > Several nonspecific lymph nodes at the bilateral inguinal regions.以上MRI的檢查需待下次回診才有機會請醫師說明。
因此，本人先先就下述問題請教你的專業意見：(1) 從MRI報吿中，可以了解到其所指的”A nodular marrow-replacing lesion”是良性或惡性嗎？
它有可能是早期存在的舊傷嗎？
本人因前曾從高處落地跌坐地上而受傷，近十年來在該處(Iliac bone)常覺不適而就醫治療。
(2) 下次回診預約在12月中，我是否應該及早回診治療？
有必要會診其他專科嗎(例如，腫瘤或骨科)？
以上請教。
謝謝！