Cervical Cancer Blog Eight aka Diagnostic Imaging

“Gosh, you know, I would just LOVE to stay completely motionless for twenty to thirty minutes whilst being held inside a long, noisy tube as it scans for me the spread of the cancer I have just been diagnosed with. Even better if I get to do it twice in one week!”

Said absolutely no one in the history of humankind, EVER.

Welcome to Diagnostic Imaging week!

Four days after my diagnosis I received a call from my Clinical Nurse Specialist (CNS) to explain that I would be booked in for the following procedures: –

• PET-CT scan
• MRI scan
• Pelvic examination under anaesthetic

The ones I was most nervous about were the first two – for the third I knew I would be out like a light so wasn’t particularly bothered when she announced it – but the first two? Holy hell.

There is so much pressure about having to hold yourself, incredibly still, for a lengthy period of time so that the medical people can get those pictures they desperately need. Oh, and they have to have them now so that they can proceed with your treatment plan in accordance to their timetable. So, if you screw up and move during imaging then those pictures are useless and you have to do it all over again. You’re letting them down, you’re letting your team down and you’re letting yourself down, plus you’re costing the NHS money for each time they use the machine on you.

I thought I felt pressure when taking selfies with friends but this was a whole new level. By the way did I mention my slight claustrophobia?

You know what? It wasn’t fun but it was fine. If I, the biggest panicky wuss in the world, can do it then so can you. Let me take you through ‘Gerry’s Guide to Diagnostic Imaging’ and reassure you that things are going to go ok.

Disclaimer – for one of them I was helped by my new friend diazepam. Sometimes you just can’t go it alone.

A few weeks back I wrote a post about staging and I mentioned things like lymph nodes and metastasis. The diagnostic imaging is what needs to happen to see what’s occurring inside your body and to see whether the above has happened and so they can officially confirm your staging.

One woman on the Jo’s Trust forum had been told by a friend that, because she had been booked in for the scans, this meant that her cancer had probably spread. Luckily the forum posters that replied to her called it the same thing that I am now. Bullshit. It’s bullshit.

They have to check. Even if they are 99.9% sure that there is no lymph node involvement and no spread they need to do these checks to make sure. Let me put it this way; I process payroll. As part of that payroll process there is a checking component. Even if I am 99.9% sure that I have input people’s payroll correctly, so certain in fact, that I feel like I don’t even need to check it – I will still check it. Why? Because I like accuracy and contrary to belief I do at least try to do my job properly.

If I missed a check and was in that 0.1% error margin than I have a bit of egg on my face. Someone’s pay is gonna be wrong. Then it becomes a lot of fixing and apologising and feeling like I’m shitty at my job. If the doctors missed their check and were in that 0.1% margin then the repercussions could be far more tragic.

Getting invited to these scans doesn’t mean anything other than the NHS are doing their job.

Seven days after diagnosis I was invited to my PET-CT. Here we go.

PET-CT Scan (Position Emission Tomography – Computed Tomography)

This does two things:

1. Takes a series of x-rays from all over your body
2. Shows up areas of your body where cells are more active or abnormal then usual (using an injected radioactive tracer.)

This is basically the posh scan of all scans.

If you could line up all types of scans in a row this is the one you would marry and bring home to your mum. It is, without a doubt, a very expensive piece of machinery. So expensive in fact, that they aren’t in every hospital and sometimes you have to travel to get to one of these. Lucky for me there was one in the Diagnostic Imaging Centre in the Royal Surrey County Hospital in Guildford. Convenient.

There is also a waiting list for these bad boys. As a cancer patient, you get bumped up the list first. Sorry back pain people, if this machine was a nightclub I would be a….

Here is a link to some wonderful information on PET-CT scans. If you’re ever invited to a PET-CT you should get a little booklet telling you how to prep. This mainly equates to when you need to stop eating food and whether you need to stop drinking. For PET-CT they encouraged me to drink a lot of water beforehand because it makes the radioactive trace go around your body faster.

You may be asked to change into a hospital gown (I wasn’t) but you will have to remove any clothes that contain metal. I managed to get away with removing my boots and my bra (it had metal clasps) and so I just let my boobs flop out. Under my dress of course. Get your minds from the gutter.

When I arrived, I explained to the nurse that I was nervous and claustrophobic and she did the most wonderful thing. She took me into the room so I could see the machine first. It looked like this: –

Ok that’s a lie. That’s from Stargate. Ok, it looked like this: –

The most awkward thing was hopping up onto the bloody scanning bed. I am a hobbit. They do not design these things with steps.

But I’m moving ahead too fast, before you get scanned the nurses need to prep you with the radioactive treatment. You get used to watching blood go out your arm and watching other substances go in and this is both quick and painless.

Now this isn’t an image of the actual PET-CT suite I was in but out of all that I Googled it is the most similar: –

As the PET-CT needs to view active and abnormal cells they need to inject you with a radioactive tracer that shows up these areas when they do the scan. This tracer is injected in a glucose solution for the primary reason that cancer cells love sugar. They love sugar like Cookie Monster loves Cookies.

Please don’t ask me if I think that sugar causes cancer. Probably. I don’t know. I have a diet that is higher in sugar then it has any right to be and when I think about whether I should change my lifestyle and diet to avoid ever having cancer again I take it seriously. And then I eat some serious cake.

You get put into a little room – check out the suite picture. There is a chair, a bed, a nice warm radiator and a blanket. They inject you and then you lie down for about an hour. Muscles use glucose for movement and so if you were to perform a lot of movement then all that sugary goodness goes straight to your muscles and not the areas of focus. This means that the imaging would be all wonky.

“But I can’t possibly just lie there for an entire hour!!!” Well you can get up and go to the loo, they just don’t want you doing star-jumps on route. As it turns out I fell asleep. Did I mention the radiator and blanket?

Then they wake you up and guide you in. As I sat in the waiting area I saw they had a whiteboard with a quote from one of our most profound philosophers; Winnie the Pooh.

It made me smile.

The scan took about 20 – 30 minutes and they had the radio on the entire time as they try their best to make it as relaxing and calm as possible. The room is quite cold and so they will wrap a blanket over you but my first main tip is get into a comfortable position because once you are ‘in hold’ so to speak you can’t move. My thoughts are with you if you get an itchy nose. Like I did.

The machine is not that bad. Look at the image again. The machine is like a doughnut – not too deep and with a large hole in the middle. This scan requires full body images so the bed passes your entire body through the hole head first. My other main tip – close your eyes.

My body was never fully in the machine at any point and I am a shorty! When my top half was in the machine, my legs from my knees down were outside of the hole. When they passed the rest of my body through then my arms were outside from elbows up.

The space of the hole is also surprisingly substantial with your face no way near the top of the machine so it doesn’t feel too enclosed. Not that you want to but if you find yourself panicking then you have plenty of space to wriggle your way out. But you won’t need to. Honestly, I was unexpectedly impressed.

Another plus is that the machine is very quiet. Aside from a hum there was no noise other than the radio and the radiographer talking over the intercom when they needed to.

Would I do it again? Well if I have too, yes. Obviously. Would I be worried about it again? No probably not. I’d be normal levels of nervous but this scan is marvellous.

I would have had images that looked a lot like this: –

These aren’t mine but these are images from someone with cervical cancer. You can see the cancer showing up due to the radioactive tracer in the glucose injection as a hot white blob.

I am sad to inform you that I have not gained radioactive powers and so I need to return the cape. And the sidekick. And the Germobile.

Two days after the PET-CT I attended my MRI.

MRI (Magnetic Resonance Imaging)

This uses magnetism and radio waves to get a different, yet similar, set of images of your body and apparently focuses on soft tissues like organs and lymph nodes.

If I’m honest I have no clue why two different scans need to be done especially as the PET-CT seems to show a lot of detail. But then as the PET-CT shows activity this may be needed to show a current overall picture. Still no clue though. Answers on a postcard please.

MRI’s are more common and can be found in pretty much every hospital.

This isn’t so much the scan you would marry and bring home to mum as much as the one that you date a few years before you find The One.

Here is a link to some more information.

Again, before you’re invited to a MRI you should get some information on what you need to do to prep usually around food/ drink intake. This machine definitely requires no significant amount of metal to be on your body as it operates based on magnetism.

Huh. It’s the machine equivalent of this dude.

I didn’t have to change into a gown for this scan either but again had to ensure that nothing I was wearing contained metal so I just got pretty comfortable with the idea of my unsupported boobs flopping about.

Now this is the MRI machine: –

It differs from the PET-CT in these three things: –

1. It is deeper
2. The hole is significantly smaller (ooh that’s what she said)
3. It’s noisy

I knew before I even had the MRI that I was going to struggle with it and the idea of having an MRI freaked me out. So here is a tip: –

Sedative. Get one.

If you are nervous about small and noisy spaces and think that your anxiety levels will shoot through the roof than make sure you head down to the GP and ask for a sedative because you’re due to have an MRI and are pantsing yourself.

This is not uncommon. MY GP prescribed me diazepam without a second thought and my CNS even suggested that I get a sedative when I said I was nervous. Remember last week’s mantra? Do what you need to do.

If you’re taking a sedative you will need to arrive at the hospital one hour before your allocated scan time. This is because they want a nurse to be with you whilst you take the sedative to make sure you’re following the instructions. Key thing with this is that you will need to find a lovely person to take you to the hospital and back as you won’t be able to drive or travel alone.

I took two 5mg diazepam, had my dye injected and during all this….

I was as doped as fuck.

It was beautiful.

My memory is hazy but the lovely radiographer – her name was Eileen – took me to have the MRI. I was wrapped up in a blanket and was given my emergency button to press if I needed to speak to someone. Then they put the cage on me.

Yeah that’s also how it differs from the PET-CT. Luckily, I was going in feet first as they didn’t need to take a lot of images of my body aside from the pelvis but they had to put a cage and some straps over my waist and legs. If I hadn’t had the sedative I would probably be doing this: –

As it stands I was blissed out on another planet so it didn’t bother me at all.

Because the machine is noisy they can’t play a radio like with the PET-CT however they do have headphones where they play music to you. Eileen promised me that she would try and get the CD working. She did.

Two things I didn’t know before I had my MRI: –

1. If you are very nervous and the person with you doesn’t have any metal on they can come into the MRI room with you. I know I was dopey and spaced out and all he could see was the top of my head but it was reassuring knowing that my partner was in the room with me. He gave me a comforting pat on the head every now and then just to let me he was still there and hadn’t done a runner with Eileen. To be honest I think I would have done a runner with Eileen.
2. The machine heats up around the area they are investigating. I was a little forewarned about this by a friend who mentioned that her friend didn’t know that when she had a MRI. I was extremely grateful for this information. The fact that I needed the bathroom 5 minutes towards the end of the 30-minute scan plus the fact that I was doped up plus the fact that the machine was heating up around my pelvis led me to believe, for a few seconds of time, that I, a grown woman had in fact had a wee in a hospital scanner. I hadn’t. That forewarning saved me some mild trauma so I will pay it forward.

Would I do it again? Well same as the PET-CT – if I had too then yes. Would I be worried about it again? Yes. Definitely. The MRI is no way as big and spacey as the PET-CT but that is ok. Because I have found the true loves of my life: –

And this guy of course…

Gosh I love R2.

Gerry’s Tips for diagnostic imaging: –

• Try and stay calm
• Listen to the music
• Close your eyes and think of lovely places
• Tell the nurses if are nervous, they will help
• Bring a trusted love one
• Think of the motivational words of that chubby little cubby all stuffed with fluff
• Take drugs

Next week’s post will be on meeting the person who will stare at your naked crotch with more intensity then anyone ever has in your life. Next week we shall meet the operating consultant.