Each year about 11 000 people in Latvia hear for the first time the frightening diagnosis – cancer. Their lives are turned upside down – what to do, what treatment to choose, will I survive?
Everyone affected by this disease knows the importance of early diagnostics and efficient treatment. However, the situation in the country is absurd – there is never enough money for medicine and up-to-date treatment with efficient medications is at the patient’s expense or depends on the availability of public donations, whereby high technology diagnostics are mainly available in private medical institutions.
Notwithstanding availability of examination method allowing for fast, early and precise diagnostics of a tumour, doctors do not rush to prescribe it to their patients and continue sending them abroad. Why is that?
More than half of oncology patients who have had PET/CT examination have found us by themselves, and each of them has his own story of how he got here. We have summed up the most frequently asked questions, references and myths from our patients.
Vija: I have once conquered breast cancer, 7 years ago. Currently the oncomarker has increased and I am very frightened that I might have cancer again. I read an article about PET/CT that this examination allows finding cancer cells at early stage. I went to my oncologist with the magazine. But the doctor talked me out, persuading to save money and sent me to computed tomography, convincing me that it shows as much as PET/CT. But the article said that PET/CT is more efficient than computed tomography. Who is right?
Vija acted right when asking her doctor about the necessity of PET/CT. Unfortunately, when sending her to computed tomography the doctor brought her life under a great risk. Why? Frequently in case the tumour or metastases are disclosed by computed tomography, it has progressed so far that efficient treatment can be difficult. If the oncomarker increases and there are concerns about cancer recurrence, you should not wait – it is the right time to have a whole-body PET/CT examination to discover the tumour at an early stage and start treatment as soon as possible. Each of these examinations shows human body completely differently. Computed tomography shows human body’s anatomy – bones, tissues, organs and when seeing changes in their form or structure the doctor might have suspicion of a cancer, while PET shows changes a lot earlier, already at the level of cells. Cancer cells grow rapidly, their metabolism is more active, and therefore they intensely accumulate the radiopharmaceutical preparation used in PET examinations that brightly visualises aggregation of malignant cells against the background of healthy tissues. Thanks to the specifics of the examination, PET allows early diagnostics of tiny cancer focal points that are not yet visible at computed tomography.
JĀNIS: I had a Hodgkin lymphoma and had to undergo PET for several times. Previously I underwent it in Estonia. The attitude of doctors of the Oncology Centre of Latvia is strange. When I returned with my PET results from Estonia they did not accept them and sent me to Russia to have a repeated examination. I served at the National Guard and therefore I was prohibited to go to Russia. I was very grateful that I had the opportunity to undergo PET/CT here in Latvia, and it was cheaper than elsewhere in Europe.
Quality of PET/CT examination in Latvia is equal to the quality of this examination at the leading European PET centres. We are proud of our proficient doctors, experienced nuclear medicine specialists, who have studied and have had in-service training in Germany, Finland, Lithuania, Estonia and elsewhere. Patients, who previously went abroad to undergo PET/CT examination, admit that the work quality of “Nuclear Medicine Clinic” does not differ from the best European clinics.
Here is a reference from another patient: “We have just returned from the Berlin Charite Hospital with good news. Examinations of my husband were reviewed by several German doctors and their conclusion matched with yours. It really is a benign formation and there is no need for surgery. We are so grateful to you!!! The doctor complimented the high quality of PET in Riga!”
Patients with malignant illnesses of blood and haematogenous organs, like Hodgkin lymphoma, Non-Hodgkin lymphoma and leucosis most probably know about the importance of PET/CT the best, as these tumours primarily are systemic disorders not a single focus disease as, for example, breast cancer, therefore they have to undergo this examination more than once. For lymphoma patients PET/CT examination is the most efficient way to obtain complete information about spread of the disease, its development and treatment efficiency. If the treating physician knows which lymphatic tissues contain cancer cells it is much easier to choose most appropriate form of treatment.
DANA: PET examination was a great (!) help to me! It was like a small revolution. I had undergone computed tomography and magnetic resonance examinations, which did not confirm progression of the tumour. I wanted to be sure, therefore I underwent PET scan and it revealed two metastases. I faced difficulties – council of doctors did not believe in the results of PET/CT examination and prescribed me a repeated chemotherapy. I did not give up and together with my doctor we decided to plan further treatment on the basis of PET results. I had a bronchoscopy and a surgery that confirmed the existence of the metastases showed by PET. I underwent surgery and no chemotherapy was needed.
SKAIDRĪTE: I am so happy about the availability of PET/CT method. It is a great time-saver for a cancer patient. Doctors did not give me information, I had to find everything myself, you know. I am lucky that my sister is a doctor, who knew about the method. I would have wasted so much time going through all the unpleasant examinations – colonoscopy under anaesthesia, gynaecology, liver biopsy… instead I came to have a single examination that gave precise answers – I had tumours here and here, and I did not have to have other examinations, I could start treatment at once.
INTA: PET helped me a lot. Actually, all subsequent therapy was based on PET results. When the doctor took biopsy, and confirmed that I have breast cancer, we had to understand the spread of it that was determined by PET examination. I had chemotherapy following which the ultrasound examination revealed two active lymph nodes. To be sure I underwent a PET scan. It was followed by a surgery and radiation therapy. Now I have regular control examinations by ultrasound and computed tomography. But once there will be any uncertainties I will undergo repeated PET. It is hard to be in a total information vacuum – doctors do not provide information, I found everything myself. Now, when I will take all the check-ups for the third time already, I know whom to ask and where to go. You have all my support, as I understand how important PET is.
These cases confirm that patient’s involvement and initiative during the treatment process, instead of silent consent to the path chosen by the doctor is of vital importance. PET/CT is not a novelty in the world - it is evidence-based, well-approbated method of diagnosis that has arrived to Latvia in a well-prepared environment. The doctors should understand that and use it, not deny it. PET/CT examination is irreplaceable in case of treatment of many diagnoses and situations! Moreover, it allows for a whole body examination by a single PET/CT scan to obtain necessary information about bones, soft tissues and organs. Thus, the patient is saved from the necessity to undergo a range of other examinations, for example, ultrasound, roentgenography, scintigraphy, computed tomography, magnetic resonance … running out of time, frequently being left without precise diagnosis and therewith delaying commencement of treatment. Considering the high sensibility of PET/CT method it is possible to carry out very precise and early diagnostics of very small focal points of cancer, to determine the stage (spread) of the disease, to see all metastases, to assess whether the applied therapy has been efficient, whether the cancer has not returned and examine other substantial factors.
At the moment, there is no competitor to PET/CT examination that could be able to diagnose tumours with similar precision. Efficiency of PET/CT is confirmed by the fact that after this examination the treatment tactics of every third patient is changed – cancelled surgery, changed medicine or other substantial corrections introduced.
ANITA: When the doctor took biopsy and confirmed breast cancer, we had to understand the spread of it. I wanted to have PET/CT examination, but the doctor frightened me with radiation caused during the examination saying it might cause further development of the cancer.
It is a myth. PET examination is a low-risk procedure. The radiopharmaceutical substance injected intravenously is tolerated easily – allergic reaction, fever, sickness or vomiting are rare side-effects, moreover the preparation leaves the body within a few hours after the procedure. There is no scientific substantiation for the rooted fear. Most experimental and epidemiological studies show the opposite – radioactivity in small doses (including PET) stimulates protective reactions of the body. The Life Span research studying people survived after explosion of a nuclear bomb stated that the received radioactive radiation below ~ 200 milisievert (mSv) did not cause cancerous risk. In comparison, an effective dose received by a patient during a standard computed tomography examination is equal to 10 mSv, during a PET/CT examination of head – 5-7 mSv, during 18F-FDG PET/CT whole body scan – 12-15 mSv. Thus, neither grownups nor kids should avoid the examination or reduce the dose of radiation to a worthless image due to radiophobia. Radiological diagnostics used in medicine is safe and saves lives.
DIĀNA: The treating physician sends me to have PET/CT examination, saying that it is the only way to obtain precise diagnosis, but I cannot afford it and I do not have time to save up the sum…
In Europe, including Lithuania and Estonia, PET/CT examination is on the list of state funded services, while in Latvia patients have to pay themselves. Although we offer small discounts and the possibility to pay by instalments, not all people can afford that. We hope that the situation will change soon – we are eagerly waiting for the state’s decision to co-finance PET/CT examinations for cancer patients and we have commenced cooperation with the charity fund “O Fonds”, the aim of which is to help low income patients to undergo examination for diagnosis of cancer and to commence timely treatment.