I have had HL stage 1A in 2009 Oct. My 12 cycles ABVD completed in 2010 April. I noticed recently there are two small lumps under my chins have grew up, is this a worry sign? Pet scan done May 10 and Oct 11 shown no trace of cancer.

Not sure exactly where you are referring to as to the location of these lumps, but this doesn't really sound like an area that HL would commonly affect. If you think these are swollen lymph nodes, look at the human anatomy and see if there are lymph nodes in that spot.

Thank you for your reply, Ross.

I cannot express clearly in wording where the lumps are, however, it should be about 1cm on both side of the Mylohyoidues (According to the picture from this link: http://en.wikipedia.org/wiki/File:Gray1195.png).

The doctor told me that PET SCAN shown the two lumps have increased in side compare to the previous scan, however, he believes they are unlikely assoicated with HL. He suggests these maybe caused by infection from the mouth.

I would like to know how accurate is PET SCAN diagnosis in cancer? Are two PET SCAN good enough after 1.5 years from my final treatment? I have to do a blood test every 6 months, is this good enough for the doctor to monitor if cancer is striking me again?

Thank you.

Actually while the blood test does tell the doc certain things about your health and about your bone marrow function (i.e. blood counts showing a healthy number of lymphocytes, RBCs etc), and while a couple of blood tests pertain to Hodgkin's (I can't think of them offhand, LDH levels I think is one), or rather to cancer in general, blood tests can't right now say with any certainty whether or not you have cancer. Instead, they can be indirect signals to the doc to look deeper. For instance, when LDH levels are elevated, it suggests that there is inflammation going on in the body. This could be from many things, but when cancer is suspected, then this elevated level may indicate the inflammation surrounding a tumor. So the blood tests are there to serve look-outs on less visible fronts.

First off, PET scans don't actually diagnose cancer, they only show doctors whether or not it is there. but they do that well. You're injected with a substance that will be processed by all the cells in your body- some form of sugar, I'm having a bad memory day - but it will be processed with considerable speed by cancer cells, causing these spots to light up. This is in its simplest form how the scan works. Thus it can detect very small cancer cell gatherings. It is not 100%-- if stray cancer cells are still hanging around trying to get the party started again, PET won't find them. Nothing can until they're detectable.

That said, false positive PET scans following first-line HL treatment are hardly uncommon, which is why they tend to be somewhat discounted. Those bumps could be inflammation, reactive to an infection, they could be swelling for no good reason, plus Hodgkin's is a pretty reliable disease, it doesn't often return in places it hadn't been before, at least not at the outset.

I would bet there are hundreds of HL survivors out there who can attest to the false-positive roller coaster of the post-treatment PET scan, as well as the false alarms, and more. It's impossible to tell you not to worry about this, you will anyway, but if you trust your doc go with him or her on this one.

You were dx'ed IA right? You no doubt know the odds of cure at that stage, so really, in several factors, the odds are heavily in your favor here.

Hi Ross,

My doctor also told me in similar with what you have said. I can't help to dig deeper because a friend of mine who has completed same treatment for her HL 1B has got it back after a few months. I can't control when cancer will strike, but I always believe early detection is vital.

Thank you for your answer once again, Ross.

No one could blame you for digging deeper and being concerned. I get the feeling though that you understand the somewhat significant difference between IA and IB. Yours is a so-called 'favorable' diagnosis. Your friends' is 'unfavorable.' Either stage is curable but when you add the B symptoms, it's more difficult. The odds go down. Granted IB is very early, but those B symptoms are a bitch in terms of prognosis.