u/begjster

Hi everyone,

I am sharing the official English translation of a recent F-18 FDG PET-CT scan (dated June 23, 2026). The clinical indication was initially listed as "Carcinoma of Unknown Primary" (CUP), but the PET-CT has now identified a primary lung lesion along with nodal and distant bone involvement.

Here is the translation of the findings:

**Protocol & Clinical Info:**
Fasting Blood Glucose: 130 mg/dL. Whole-body images from vertex to mid-thigh were acquired 1 hour after IV administration of 11.4 mCi F-18 FDG. Evaluation performed alongside co-registered CT slices.
Clinical Info: Carcinoma of Unknown Primary (CUP), Diagnosis and Staging.

**FINDINGS:**
- HEAD AND NECK: Normal appearance, physiological metabolic activity. No pathologically active or enlarged lymph nodes.
- THORAX: Pathological FDG uptake is observed in an irregularly bordered nodular lesion measuring 1.3 x 0.9 cm in the apicoposterior segment of the left lung upper lobe (SUVmax: 5.9). Pathological FDG uptake is observed in a 1.4 cm short-axis aortopulmonary window lymph node (SUVmax: 6.9). Mediastinal main vascular structures and pleura are normal.
- ABDOMEN AND PELVIS: Diffuse increased FDG uptake in the gastric mucosa (consistent with gastritis). Mild hypodense liver parenchyma secondary to fatty infiltration. Cortical cyst in the left kidney. Spleen, adrenal glands, and pancreas are normal in size and activity. No free or loculated fluid.
- MUSCULOSKELETAL: Pathological FDG uptake is observed in a lytic lesion in the sacrum (SUVmax: 17.5). Degenerative changes in the vertebral column. Other bone structures and soft tissues are within physiological limits.

**CONCLUSION:**

1. Hypermetabolic nodular lesion in the apicoposterior segment of the left lung upper lobe (lung ca).
2. Aortopulmonary hypermetabolic metastatic lymph node.
3. Hypermetabolic metastatic lytic lesion in the sacrum.

***

We are currently waiting for our first official appointment with a Medical Oncologist.

What should we expect next?

Realistically, how aggressive is this presentation (Lung primary with a solitary sacral metastasis)?

Can a lung lesion of this size (1.3 x 0.9 cm) typically be removed surgically when there is already known distant bone metastasis, or does treatment shift entirely to systemic therapy (chemo, immunotherapy, targeted therapy)?

How are lytic sacral metastases usually treated or stabilized? Can bone lesions of this type achieve complete metabolic remission or "heal" with systemic and localized treatments (like radiation or bone-protecting agents)?

Any guidance on what crucial questions we should ask the oncologist during our first visit would be immensely appreciated. Thank you so much.

Hi everyone,

I am sharing the official English translation of a recent F-18 FDG PET-CT scan (dated June 23, 2026). The clinical indication was initially listed as "Carcinoma of Unknown Primary" (CUP), but the PET-CT has now identified a primary lung lesion along with nodal and distant bone involvement.

Here is the translation of the findings:

**Protocol & Clinical Info:**
Fasting Blood Glucose: 130 mg/dL. Whole-body images from vertex to mid-thigh were acquired 1 hour after IV administration of 11.4 mCi F-18 FDG. Evaluation performed alongside co-registered CT slices.
Clinical Info: Carcinoma of Unknown Primary (CUP), Diagnosis and Staging.

**FINDINGS:**
- HEAD AND NECK: Normal appearance, physiological metabolic activity. No pathologically active or enlarged lymph nodes.
- THORAX: Pathological FDG uptake is observed in an irregularly bordered nodular lesion measuring 1.3 x 0.9 cm in the apicoposterior segment of the left lung upper lobe (SUVmax: 5.9). Pathological FDG uptake is observed in a 1.4 cm short-axis aortopulmonary window lymph node (SUVmax: 6.9). Mediastinal main vascular structures and pleura are normal.
- ABDOMEN AND PELVIS: Diffuse increased FDG uptake in the gastric mucosa (consistent with gastritis). Mild hypodense liver parenchyma secondary to fatty infiltration. Cortical cyst in the left kidney. Spleen, adrenal glands, and pancreas are normal in size and activity. No free or loculated fluid.
- MUSCULOSKELETAL: Pathological FDG uptake is observed in a lytic lesion in the sacrum (SUVmax: 17.5). Degenerative changes in the vertebral column. Other bone structures and soft tissues are within physiological limits.

**CONCLUSION:**

1. Hypermetabolic nodular lesion in the apicoposterior segment of the left lung upper lobe (lung ca).
2. Aortopulmonary hypermetabolic metastatic lymph node.
3. Hypermetabolic metastatic lytic lesion in the sacrum.

***

We are currently waiting for our first official appointment with a Medical Oncologist.

What should we expect next? Will they prefer a biopsy of the lung nodule or the sacrum bone to determine the exact histopathology and driver mutations (like EGFR, ALK, PD-L1)? Also, what are the standard palliative or targeted approaches usually considered for the active sacral lesion to prevent bone pain/instability?

Any guidance on what crucial questions we should ask the oncologist during our first visit would be immensely appreciated. Thank you so much.

Hi everyone,
We recently received the pathology report for my uncle (55M), and I wanted to get some insights from this community on what to expect next and what questions we should ask the oncologists.
Here is what we know so far based on the biopsy/pathology report:
The surgery: He underwent a partial resection of a sacrum (spine) tumor.
The pathology result: The report clearly states a "carcinoma metastasis to bone and soft tissue."
The suspected source: Immunohistochemical stains came back positive for CK7, TTF-1, and p63, while negative for CK20, NKX3.1, and CDX2. The pathologist noted that these findings are highly consistent with Lung Adenocarcinoma metastasis.
We are currently waiting to see a Medical Oncologist to plan the next steps. We know we will likely need further imaging (like a chest CT or PET scan) to fully evaluate the lungs and look for the primary source, as well as genetic mutation testing (EGFR, ALK, ROS1, etc.) to see if targeted therapy is an option.
Since we are at the very beginning of this journey, I would highly appreciate any honest advice and realistic expectations:

1. How serious is this situation, and what should we realistically expect? For those who had a similar diagnosis (Stage 4 with bone/spine involvement), what was your reality at the beginning versus months/years down the line?
2. What specific questions should we ask the medical and radiation oncologists during our first appointments to get a clear picture of the prognosis?
3. For those with bone metastases in the spine/sacrum area, what did your initial treatment plan look like (radiation, surgery, systemic treatment)? How did it affect your pain and mobility?
4. How long did it usually take for your genetic mutation test results to come back so you could start targeted treatments or chemo?
   Thank you so much in advance for your support, honesty, and stories. It really helps to not feel alone in this.