Patient Summary

• Left composite resection + marginal mandibulectomy + left sentinel node biopsy with reconstruction (January 2025)
• Radiation therapy (April 2025)
• A prior PET-CT (January 2026) showed a new lesion along the right mandibular ramus and a spiculated lung opacity - confirmed right cheek lesion SCC on biopsy
• Has been on chemotherapy since then

Region-by-Region Findings

Brain

• Normal. No abnormal metabolic activity or lesions.

Head & Neck (Left Side - Operative Site)

• Good news on the left: The surgical flap reconstruction looks stable. No abnormal FDG uptake or enhancing lesions at the operative bed - no signs of local recurrence on the treated side.
• Left neck nodes: No significantly enlarged or FDG-avid nodes (no active nodal disease on the left).

Head & Neck (Right Side - Active Disease)

• There is a persistent soft tissue lesion along the right mandibular ramus, infiltrating the upper right masseter muscle.
• Size reduced: From 3.6 x 2.6 x 3.1 cm → now 3.2 x 2.3 x 2.6 cm
• SUVmax reduced: From 8.2 → now 7.1 (SUVmax reflects metabolic activity; lower = less active)
• The lesion still erodes the right zygomatic bone cranially, but no significant destruction of the mandibular ramus itself.
• It has effaced fat planes near the right parotid gland and infiltrates the subcutaneous space, but the overlying skin appears uninvolved.
• Small right neck level IB, II, and tiny level III nodes show low-grade FDG uptake - considered likely reactive (not malignant) and are stable.

Thorax (Lungs)

• A persistent spiculated opacity (irregular lung mass) in the right lung perihilar region, abutting the right pulmonary artery (middle/lower lobe branches).
• Size reduced: From 2.8 x 2.4 x 2.5 cm → now 2.3 x 1.6 x 2.5 cm
• SUVmax: 6.14 (previously 6.4) - marginally reduced metabolic activity
• Causing compression of right middle lobe bronchi with some distal collapse (atelectasis).
• No pleural effusion. No other lung lesions. No enlarged mediastinal or axillary nodes.

Abdomen & Pelvis

• Liver, spleen, gallbladder, pancreas, adrenals, left kidney: All normal.
• Tiny calcium deposit in the right kidney (incidental, likely benign).
• Prostate is mildly enlarged but shows no suspicious FDG uptake.
• No abnormal nodes in the abdomen or pelvis.

Musculoskeletal / Bones

• No FDG-avid lytic or sclerotic bone metastases anywhere in the body.

Overall Conclusion (Radiologist's Remarks)

"Overall scan findings are suggestive of partial response to treatment."

1. The right mandibular/masseter lesion has shrunk slightly and become slightly less metabolically active, but it is still present and still active (SUVmax 7.1 is significantly elevated).
2. The right lung lesion has also partially reduced in size but remains active.
3. The left-side surgical site is clean - no recurrence there.
4. No new metastatic sites have appeared anywhere in the body.

What "Partial Response" Means Clinically

• Complete response = no detectable disease
• Partial response = measurable reduction in tumor size/activity (typically >30% reduction in size), but disease is still present
• Stable disease = no significant change
• Progressive disease = tumor growth or new lesions

PAGE 1 — Complete Blood Count (CBC)

CBC Interpretation:

• Haemoglobin is low at 10.8 g/dL - this is mild anaemia in a 72-year-old woman (normal for females is ≥11.5 g/dL, WHO defines anaemia as <12 g/dL in women).
• The MCV (87.7 fL) is normal, meaning this is normocytic anaemia - the red cells are normal in size, not iron deficient (microcytic) or B12/folate deficient (macrocytic).
• RDW is normal, suggesting a relatively uniform red cell population.
• WBC differential, platelet count, and all absolute counts are entirely normal - no infection, no immune suppression, no bleeding tendency suggested.

PAGE 2 — Kidney Function, Uric Acid & Electrolytes

Kidney & Electrolyte Interpretation:

• Kidney function is normal - urea and creatinine are within range. However, note that in elderly women, serum creatinine can be deceptively normal even with reduced kidney function due to lower muscle mass. An eGFR (estimated GFR) calculation would give a more accurate picture.
• Sodium is 134.5 mmol/L - just marginally below the lower limit of 135. This is very mild hyponatraemia (low sodium). In isolation, this is often not clinically significant, but in an elderly person, even mild hyponatraemia can contribute to weakness, dizziness, or cognitive symptoms. Worth monitoring.
• Potassium and ionised calcium are normal.
• Uric acid is normal - no gout risk flagged.

PAGE 3 — Liver Function Tests (LFT) & Proteins

Liver Function Interpretation:

• Liver function is completely normal. SGPT, SGOT, and alkaline phosphatase are all well within range.
• Total protein, albumin, and globulin are normal - the liver is synthesising proteins well, and nutritional status is adequate.
• Total bilirubin at 0.96 is within the normal limit of 1.0 mg%. The conjugated fraction at 0.34 is very slightly elevated (normal upper limit is typically 0.25–0.3 mg%), but this is minimal and not clinically concerning in isolation - worth correlating if there are any symptoms like jaundice or dark urine.

Overall Summary

Key Points for the Doctor:

1. Mild anaemia (Hb 10.8 g/dL) in a 72-year-old woman needs to be investigated for cause - consider iron studies (serum ferritin, TIBC), B12/folate, ESR, and peripheral smear if not already done. Anaemia of chronic disease is the most common cause at this age.
2. Borderline low sodium (134.5 mmol/L) - mild and may be incidental, but in the elderly, this can affect energy, balance, and cognition. Monitor and assess for dietary causes, diuretic use, or hypothyroidism.
3. No evidence of kidney disease, liver disease, or electrolyte imbalance of concern.
4. All inflammatory/immune markers within the differential count are reassuringly normal.