How our PET-CT scans are turning fear into hope for patients
Lung cancer has long been one of the toughest cancers to treat, but things are changing fast—and imaging is at the heart of that transformation. At Paul Strickland Scanner Centre (PSSC), advanced PET-CT scans are helping doctors diagnose lung cancer earlier, plan more precise treatments, and monitor patients more effectively than ever before. Dr James Diss, Consultant Radionuclide Radiologist At Paul Strickland Scanner Centre, said: “Ten years ago, hardly anyone with lung cancer had a PET-CT scan. Now, 95% of cases we discuss in the lung cancer multidisciplinary team (MDT) meetings include FDG PET-CT imaging. It’s become absolutely central to the diagnostic process.”
Why PET imaging matters
FDG PET-CT scans use a small amount of radioactive glucose to highlight areas of high metabolic activity in the body — often a sign of cancer. While the principle sounds simple, interpreting these scans is anything but. “Specialist knowledge of this imaging is vital.
Many other processes that are not malignant, like infection or inflammation, also result in increased glucose uptake and many cancer subtypes don’t rely heavily on sugar-based metabolism for growth.” PET-CT scans are often performed at specialist centres, so in many hospitals the MDT doesn’t have PET imaging specialists in attendance. “You don’t get that extra level of scrutiny. My role in our MDT meeting is to provide specialist input that means we can make better decisions—whether that’s confirming a diagnosis, deciding where to biopsy, or helping in decisions about planning treatment and assessing treatment response.”
This expertise is vital because lung cancer care is becoming more complex. “Instead of patients receiving treatment for one cancer in their lifetime, an increasing number of people are surviving one type of cancer and subsequently, often years later, developing another completely unrelated cancer type. In these cases, specialist knowledge is needed to advise clinicians on patients’ synchronous cancers and help determine what treatments may need to be added or changed.”
Early detection game changer
One of the biggest shifts in recent years is the introduction of a National Lung Cancer Screening Programme. “Since 2019, nearly three million people at risk have had low-dose CT scans. Instead of most patients presenting with latestage cancer, we’re now diagnosing mainly early-stage cancers. That’s game changing.”
Early detection means treatment can be far more effective, but it also creates challenges. “We’ve got many more people coming through the system and less time to do things for them. PET-CT scans give us that extra information to decide: is this something we can just monitor, or do we need to biopsy and get a molecular profile?”
From one-size-fits-all to tailored therapy
The molecular profile of a tumour now guides treatment in ways that were unimaginable a decade ago. “If you’ve got a cancer with an appropriate molecular profile, the outcomes of new immunotherapies can be spectacular so that even stage 4 cancers can be manageable – not necessarily definitively cured but controlled, similar to diabetes management.”
This shift means imaging isn’t just about spotting cancer—it’s about steering personalised care. “We now rely a great deal on scoring models that calculate a percentage probability that the abnormal scan finding is a cancer. Clinicians can then make diagnostic management decisions based on clear evidence-based guidelines about how best to proceed based on that score.”
Looking ahead
The future promises even more innovation. “We’re going to see new radiotracers beyond those based on glucose, AI to help us better and more reliably interpret scans, and much much more cancer screening. Everything will be quicker, but also even more complex. That’s why specialist input will matter more than ever.” For patients, these changes mean hope.
“When I first started working in cancer imaging, I thought it would ultimately inevitably involve mainly tragic outcomes for our patients but I truly feel that with the amazing new innovations of the last few years, and those just around the corner, the narrative has now turned spectacularly and definitively the other way.”
