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This question was answered on Sun 11, Jan 2009 11:27am by Dr Heinrik M, MD

Lab and Bone Scan Results


    
Asked by shybird (Female; 53 ) on Sun 11, Jan 2009 04:49am

Hello Dr. Heinrik, I just want you to know that I am so thankful that you take the time to be truthful and honest with me. That is why I email you so often with questions. In my first visit with my oncologist, after having all the Staging tests completed, I still remember her words to me "All your tests are okay. There's a tiny cyst on your liver and kidney, but have probably been there since you've been born". The findings from the Nuclear Bone Scan on my Kidney reads: The right kidney appears diminshed in size compared to the left. The presence of a chronic obstructive process with parenchymal loss should be considered. Slight prominence of the right intrarenal collecting system. Follow-up with ultrasound of CT would be helpful. I had a kidney infection when I was pregnant in 1975, but no other issues in that area. I don't understand why my oncologist isn't pursuing this further, if that is the recommendations after the testing, and why she presumed I've had this since birth, like nothing is or could be wrong. Why wouldn't a physician tell me, the patient, what is really said? As with my Lab results, the A/G ratio is in the high range (2.4). Normal range is listed as 1.1-1.8. What is this, Dr. Heinrik? I have had weight loss (10 pounds)about a year before finding out about my breast cancer.(which makes me underweight). I know that breast cancer would not cause the weight issue, and that is why I have been so paranoid with all my questions about getting/having DM cancer, or my risks with getting it down the road. I know that I am obsessive with all that I have continually put before you, Dr. Heinrik. Cancer is just a scary thing for me.
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Answer by Dr Heinrik M, MD  on Sun 11, Jan 2009 11:27am:

Hi Shybird, On Cysts: These usually aren’t problematic for as long as function of the liver and kidney are adequate (function is usually established via blood and urine tests. On the right kidney: This may be worth investigating as it may mean damage on that kidney. A single infection is unlikely as a cause- but repeated infections may be contributory. As kidney function is also assessed with blood tests – your doctor may prefer to have the imaging done if the blood seems problematic. The contrast material used for the CT would also have its deleterious effects, so the follow-up would be weighed against this risk. The ultrasound though, would not pose this concern of possibly adding damage to the kidney. It would be best to talk it over with the doctor. This report does not make mention of the cyst. So this may not be the test your doctor was referring to. Could it be possible that you had an ultrasound or CT involving the abdomen? And it is from this other imaging test – that the doctor mentioned you had cysts? On the A/G ratio: This test looks at proteins in the blood. Generally, the more critical result is a reversal – meaning there is more G (globulin) than A (albumin) making the result less than one. If the value is high and you have lost weight – then this may simply imply a dietary cause, probably your body is under-producing globulins. Stay positive.

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Follow up:

Clarification by shybird on Mon 12, Jan 2009 06:25am: 
Dr. Heinrik,

You are just TOO smart. Glad you are using your talents wisely in the field of medicine.

I did find the CT for the Thorax, Abdomen, and Pelvis area.

FINDINGS:  

LUNG:  5 mm hypdensity having well defined borders in the subcapsular protion of the lateral segameent left
lobe liver. Likely a cyst.

KIDNEY:  There is a small hypodensity in the cortex and anterior mid pole of the right kidney, likely a cyst.

So a CT is more accurate than a nuclear bone scan?

Comments:

Comment by Dr Heinrik M, MD on Mon 19, Jan 2009 08:21am: The answer depends on what is under investigation. If the question is to rule out bone metastases, then the bone scan would be superior. For masses in the liver, kidney, or other vital solid organs – a CT scan would generally be better.

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