Another 1 cm nodule story

[RickinFla]

If I may, I would like to weigh on this topic with my own question. Please bear with me as there is some necessary backstory, although I will try to keep it short. I'm a five-year Stage IV colon cancer survivor so I have regular PET and CT scans and I've been NED for four years now. On 9/7/2016 I had a PET scan. There were no abnormalities noted in the report, but because of some equivocal results in my abdomen, we decided to redo the scan "in a few months." We did another scan on Feb. 23, 2017 and resolved the equivocal results in my abdomen and once more there was nothing reported in my lung. Because I complained of some chronic pain in my abdomen, the onc. decided to do another scan which was done last Thursday June 29. Again, there was no report of problems in my abdomen.

And, now we come to why I'm here. The radiologist referring to my lungs reported, "Stable irregular 1.0 cm nodule in the posterior right upper lobe is minimally metabolic with SUV max 1.6 with no additional nodules, infiltrates, effusions or metabolic lung findings." I haven't spoken with my oncologist yet, because the results are posted online in a "medical chart software program" that patients can access.

I'm wondering what your reaction to this finding of a "Stable irregular 1.0 cm nodule in the posterior right upper lobe is minimally metabolic with SUV max 1.6 with no additional nodules, infiltrates, effusions or metabolic lung findings" might be. I'm also wondering whether you all know if a radiologist can determine if a new finding, remember no nodules have ever been previously reported in my lung, is stable with just one data point. If, in fact, there was no nodule in my previous PET of Feb. 23 that means the nodule grew from 0 to 1 cm in four months which seems fast to me. Also, it's metabolically active but only minimally. I've read they really can't biopsy something so small safely and we might have to wait a while to see if it grows. Again, I would appreciate your thoughts in general and specifically whether we need to move fast to biopsy this nodule remembering it was found on PET with minimal FDG Avidity of SUV max of 1.6.

Also, I would appreciate any information on lung cancer survivorship that is more up-to-date than the published stats.

[LexieCat]

HI, Rick, I see you started your own thread!  I'm sure someone(s) with helpful info for you will be along soon.

And I, too, would be interested to know how that could be considered "stable."  I have a few lung nodules, which were observed over a year ago, stable on a three-month re-scan, and then on the last screening scan one had increased 2-3 mm since last year.  I have surgery scheduled a week from Monday.  The other nodules I have are still considered "stable" but that's because there's something to compare them to.  

[BridgetO]

 Hi Rick,  I too am mystified about how something could be found "stable" with only one data point. When my small nodule was found by the radiologist, the pulmonogist looked back at my prior scans. (I also get regular scans due to another cancer.) She said that knowing where it was, she could look back and see  that it had started growing earlier, but that it was so small and indistinct that it only was recognizable in retrospect, so to speak. So your situation could be something like that, perhaps. Your oncologist should be able to help you clarify this, and you might want to also see a pulmonologist.

Best of luck to you.

Bridget

 

[Tom Galli]

Rick,

Welcome here. So, lets move to your first question -- my reaction to a stable irregular 1 cm nodule with a SUV of 1.6.  It could be anything but not cancer with the very low SUV uptake.  It could be an early find, just starting to be metastatic disease but that is unlikely.  An SUV of 1.6 is a very very low response to a PET.  SUVs of 5 or 6 start the concern rate; 8 and higher is metastatic cancer.  Here is my go to resource on lung nodules.  Many things can cause them and some of them have appeared and disappeared in my many scans. So yes a radiologist might in fact have discovered a new nodule but a 1 cm nodule is very small and certainly capable of forming in the span of 4 months.

It is generally very hard to biopsy nodules the size of 1 cm.  We are dealing with less than a 1/2 inch mass in diffuse lung tissue.  It has been done but most doctors will advise a watch and weight strategy.  If it doubles in size 2 months from now, it will still be an early find, easily biopsied and easily treated.  So I wouldn't worry.

I think your delving into survivor statistics is premature at this stage of the game.  But, we all do it and Google returns scare us to death.  Here is an essay I wrote on Survival Statistics that may be of interest. Medical statistics and projections are very imprecise.  For additional insight, I strongly suggest listening to the Stephen Jay Gould essay link in the blog.  That gives a more scholarly view on predictive statistics.

Stay the course.

Tom

[RickinFla]

Thanks to everyone who posted. I see my pulmonologist Wednesday morning and my oncologist that afternoon to discuss these findings as well as some additional, but equally equivocal findings in my gut from that PET scan. BTW, I've had my pulmonologist for 14 years now after Lupus (SLE) went after my lungs so it was easy to get in with him and it's not like it's my first rodeo with the "lung doctor." Hopefully, we'll develop a reasonable course of action for both issues. Tom, thank you for the informative links and we'll have to see how this whole thing plays out. .

Rick