Since esophageal cancer can later show up in the brain, shouldn’t follow-up PET scans include the head?

Why are they only from the neck down?

A PET scan showed a brain metastasis in a patient whose treatment for esophageal cancer had been deemed successful.

This was a post in an online forum dedicated to esophageal cancer.

The patient had been having neurological symptoms which lead to the brain scan.

However, at some point prior to that, he had undergone a follow-up PET scan as part of the routine treatment – but only from the neck down.

One has to wonder if, had that previous PET scan included the head, the metastasis may have been discovered – and smaller, of course – and perhaps more treatable.

But even if the prognosis had been the same with an earlier detection of the brain lesion, the patient and family certainly would’ve been agonizing over wondering if an earlier detection might’ve resulted in living a little longer. The patient died soon after.

Why don’t follow-up PET scans for esophageal cancer include the head?

“It is not standard or routine at this time,” begins Alex Little, MD, a thoracic surgeon with a special interest in esophageal and lung cancer.

“The likelihood of the physician, who is following the patient, getting any type of scan is dependent on the postoperative stage of the cancer.

“The more advanced the cancer — the worse the stage — the more likely are metastases to occur and therefore scans of any type to be obtained.

“Cancer recurrence is more likely to be in the chest, so the most frequently obtained scan would be a chest CT scan.

“I think most clinicians would not get other scans unless there were symptoms suggesting metastases.

“For example, we would get a brain scan if a patient had a new headache.”

But by the time a patient gets the new headache or other suspicious neurological symptom, wouldn’t the metastatic tumor’s size be a challenge to treat?

Why not just administer the head scans pre-emptively to catch a possible secondary brain tumor as early as possible?

“Two issues are worth considering,” says Dr. Little.

“First is the cost/benefit consideration of routinely getting multiple scans on asymptomatic patients, knowing most will be negative.

“There is also the legitimate consideration whether it is beneficial to the patient if a recurrence is discovered if they are asymptomatic.

“Cure is not a realistic goal, as the odds are overwhelming that the recurrence represents metastatic disease.

“Physicians might choose to reserve treatment until there are symptoms to palliate.”

In short, metastatic esophageal cancer to the brain is pretty much a terminal sentence, and any care at that point would be geared towards making the patient as comfortable as possible.

Esophageal cancer is just plain a wretched disease with a five-year survival rate of around 20 percent, according to the National Cancer Institute Surveillance and Epidemiology End Results Program.

However, of those who get past this point, there’s just over a 10 percent chance that they’ll be celebrating a 10-year survival.

Keep in mind that these survival rates include all stages of the disease taken as an average.

But for localized disease, the five-year survival rate is still pretty dismal, at 46 percent.

Furthermore, it’s very uncommon for esophageal cancer to be diagnosed when localized.

What can you do if you fear esophageal cancer?

First of all, if you have a history of GERD (gastroesophageal reflux disease) or issues with acid reflux, consult with a gastroenterologist about a screening upper endoscopy to see if your esophagus has sustained damage from long-term exposure to stomach acid.

Next, if you smoke, QUIT. Just QUIT. Smoking is a major risk factor.

So is drinking. If you drink, QUIT. Avoid alcohol.

Obesity is another risk factor that can be modified. Make every attempt to lose weight with sustainable lifestyle changes.

Worrying that you might have esophageal cancer that could spread to the brain is an awful way to exist.

Alex Little, MD, trained in general and thoracic surgery at the Johns Hopkins University School of Medicine; has been active in national thoracic surgical societies as a speaker and participant, and served as president of the American College of Chest Physicians. He’s the author of “Cracking Chests: How Thoracic Surgery Got from Rocks to Sticks,” available on Amazon.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.


Top image: Shutterstock/Duet PandG