3 month checkup: X-ray v CT

[1980Andy]

Hi all - looking for some advice. My mum just had her first checkup, five months after a pneumonectomy (and 3 months after she had postoperative scans). As a standard procedure, the oncologist ordered an X ray and blood test. Both came back clear and he said everything is fine and he'll be in touch again in another 3 months. Does anyone know why he would have ordered an X-ray and not a CT scan? Just concerned the X-ray might miss something and that a CT would have been preferable. Am I right, or should I just take the oncologists word for it that the X-ray is sufficient?

Thanks for any advice.

[RoyCastleHelpline Partner Ask the Nurse Roy Castle]

Dear 1980Andy

Welcome to the forum and hope your Mum has recovered well from her pneumonectomy.

You mentioned she had a scan at 2 months after her operation and 3 months after that had her chest x-ray. It can depend on hospital policy, but usually CT scans are recommended at 6 monthly intervals for the first 2-4 years.

You could check with her lung cancer nurse specialist, as some checks are done 3 monthly for the first year in some hospitals. A chest x-ray would show up any abnormality that would warrant further investigation or any change in symptoms may require an additional scan check.

It is very encouraging that both the x-ray and bloods came back clear, if you are still concerned you could discuss with either your Mum's GP or the Oncologist, you can contact them through their secretary.

Wishing your Mum the very best.

Kind regards

The Roy Castle Support Team

[1980Andy in reply to RoyCastleHelpline]

Thanks for your kind words and advice!

[JanetteR57]

Try not to worry - there is a risk with having too many scans as radiation can contribute to cancer development. As I understand it not all hospitals have newer lower dose ones so the standard of care is chest x-ray. Some Trusts use CT more frequently. I had my lobectomy in Dec 2010 and in jan 2011 when diagnosed was told my follow up treatment would be 'surveillance' 'the surgeon when asked what that meant, he said regular check ups and a chest x-ray. I responded well to treatment and quickly moved into an annual check up with a chest x-ray before seeing the surgeon. I've had a few CT scans since when infections resulting in me being hospitalised and not clearing up prompted them. There are NICE guidelines for lung cancer treatment and BTS guidelines (for nodule follow up) and a national optimum lung cancer pathway but not everywhere has the same equipment, clinical nurse specialists, same day testing, hot reporting etc. Clinicians have to follow various guidelines in treating and following up lung cancer. The national lung cancer audit shows regional variation in terms of how long they might follow up and how some go beyond recommended 5 years and Covid 19 has impacted on many areas differently. Since 2014 I've been involved in cancer research on various committees. A UK focus has been on earlier detection resulting in national screening pilot projects called 'targeted lung health checks'. The lung cancer research world has been waiting years for a major clinical trial in the Netherlands and Belgium outcome to determine the benefits and potential harms of regular CT screening for those at highest risk of lung cancer. The UK lung health checks aim to use a lower dose than that used for diagnostics due to the risk of radiation harm. hope this reassures you - although it's easy for us to think all are ravaging our body, many are relatively slow growing - I was told my 7cm tumour probably took years to reach that size and I couldn't remember having had a chest x-ray for years until I went to A&E and it was found 10 years ago. Many Trusts use the lung nurse specialists to follow their protocols for follow up so she could speak to the nurse or oncologist if concerned. good luck.

[1980Andy in reply to JanetteR57]

Thanks for the advice Janette. It helps me understand the process and I really appreciate it.