请教：是先做PET-Tumor-Total Body还是先看肿瘤医生？

家母(78岁)CT结果显示有Colon Cancer，因为也怀疑有淋巴和肺部转移，家庭医生安排了PET-Tumor-Total Body。如果已经转移到淋巴和肺部的话，一般不建议手术。家母比较抵抗外科手术。

肠镜医生建议先看肿瘤医生，PET可以延后，听肿瘤医生安排，因为肺部结果可能是年轻时肺结核遗留的。

到底应该先做PET-Tumor-Total Body还是先看肿瘤医生？

多谢！

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Conlonnoscopy results: 

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We performed your procedure due to an indication of:

Colonic mass - K63.89 

Elevated CEA: 795.81 - R97.0

Hematochezia: 578.1 -K92.1

Protruding Lesions

A large fungating mass of malignant appearance was found in the rectosigmoid junction at 10 cm from the anus.

The mass caused a complete obstruction. The scope could not traverse the lesion and the exam could not be finished. Cold forceps biopsies were performed. 4mL of SPOT ink injections were successfully applied for tattooing at 2 opposite walls just distal to the mass. Medium grade/stage lI internal hemorrhoids were noted.

 

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CT results:

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FINDINGS:

CHEST:

Thyroid gland: Homogenous.

Lymphadenopathy: None. Calcified mediastinal and hilar nodes related to old granulomatous disease. Heart: Normal in size.

Aorta and pulmonary artery trunk: Dilated pulmonary artery trunk measuring up to 4.4 cm suggestive of underlying pulmonary artery hypertension. Ascending thoracic aorta is also aneurysmal measuring up to 5.2 cm. Aortic arch and descending thoracic aorta are normal in diameter. No aortic dissection or central or segmental pulmonary embolism.

Tracheobronchial tree: Patent.

Lungs and pleural: Large 5x4 cm right upper lobe calcified granulomas with associated pulmonary distortion. Scattered smaller calcified granulomas are also present. There are several bilateral pulmonary micronodules measuring up to 5 mm in the left lower lobe.

 

ABDOMEN & PELVIS: Liver: Unremarkable.

Gallbladder: Cholecystectomy. 

Pancreas: Unremarkable.

Spleen: Unremarkable.

Adrenal Glands: Unremarkable.

Kidneys and ureters: No nephrolithiasis or hydroureteronephrosis. 

Bladder: Unremarkable.

 

Gastrointestinal tract: Long segment circumferential thickening of the rectosigmoid consistent with malignancy. This is insuperable from posterior uterine serosa. There is nodal metastasis to the sigmoid mesocolon nodes which measure up to 1cm.

Reproductive organs: Fibroid uterus. No adnexal mass. Aorta: Atherosclerotic changes without aneurysmal dilatation.

Lymphadenopathy: No retroperitoneal lymphadenopathy.

Bones: Multilevel degenerative changes. No acute fracture or suspicious lesions. Extraabdominal soft tissues: Unremarkable.

 

Unless otherwise recommended, any incidental findings identified above require no follow up imaging based on consensus recommendations. Fleischner 2017 criteria utilized when applicable for pulmonary nodule follow-up.

IMPRESSION:

1 Long segment circumferential thickening of the rectosigmoid consistent with malignancy. This is inseparable from posterior uterine serosa. There is nodal metastasis to the sigmoid mesocolon nodes which measure up to 1cm. No liver metastasis or retroperitoneal nodal metastasis.

2. Several bilateral pulmonary micronodules are present and could be related to metastasis or benign.