Ask the Doctor Question:
I am a 59-year-old male and recently diagnosed with CLL (11/2020). In 12/2020 I had a CT scan that confirmed I have extensive adenopathy in the chest, abdomen, and pelvis with lymphoproliferative disorder such as lymphoma. I feel great and have a follow-up visit with my oncologist later this month – the doctor has asked that I have another CT scan. After reading the CLL society article about CT scans, I’m not so sure I need a CT scan. I feel good and have noticed no changes to size of lymph nodes in neck. Can you please provide your advice on getting this second CT scan in a six-month period?
Answer: We have a lot of information on our website pertaining to CT scans. They should not be routine or done out of curiosity, as it sounds like you are already aware that we recommend reducing radiation exposure over your lifetime as much as possible. The biggest question to ask is WHY he thinks this is necessary. What we do want to avoid is performing one out of curiosity and not because there is a diagnostic or clinical reason. There is a case to be made for a CT scan when there is the discovery of biomarkers that suggest a patient may be at risk for transforming to Richter’s. These include TP53, NOTCH1 activation, and disruption of CDKN2A/B – along with rapid node growth and rising lactate dehydrogenase (LDH).
The CT scan is a useful tool but needs to be used judiciously and appropriately. If your doctor offers you a convincing reason for a CT scan, then go for it. Just don’t passively accept it because it is ordered for you without being given a convincing rationale.
You mentioned you had read some things on the website, but we’re not sure which ones. Here are a few really good resources we would encourage you to read up on before having the conversation with your physician: