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6 mm growing lung nodule in Right Upper Lung Lobe


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My Disease History

Name : Swapon Kumar

Age : 29 Years 

Marital Status : Married

I Share  my health conditions. At Mar 2015 , I experienced some burning and localized type chest pain in left chest area .After taking several investigation like Ecocaridography and Nuclear stress test  it was confirm that it was not from Heart .Doctor told me to GERD ,musculoskeletal or something like that .Also perform upper gastro endoscopy in May which came back normal. But in Jun 2016 I found my left Supra Clavicle  region slightly higher than right .After that one doctor recommend me to perform MRI. Findings of MRI Shows no Lymph node .Only 3 mm thickness in transverse process muscle body in Brachial Plexus region Higher than Right area.

After that because of chest pain I take another opinion who recommend  me to perform CT and after performing that with 5mm thickness pre and post contrast IV  findings are  multinodular  densities shows in both lung field at October 13,2016.One Subcentrimetric  Sizable nodule in left lower lobe at Lateral Basal Segment .(Not mentioned Size )

In November 2016 I have some cough with blood sputum in morning . So Perform Skin tuberculin test which come back +8 mm and Two Consecutive acid first Bacillii (AFB ) Test show negative result .Then perform another IV contrast CT with 2.5 mm MPR Images Result Shows :

(21 st November 2016 CT Date ) : CT-1 (Findings )

Right Lung :  

-small round 3.6 mm nodule seen in the peripheral part ,anterior segment of the right upper lobe with smooth well defined margin with surrounding  lung parenchyma.

-4 small irregular shaped nodules ranging from 3-4 mm seen in posterior basal segment ,located adjacent to each other surrounding lung parenchyma .

Left Lung :

-solitary, round 9.4mm sub pleural nodule is seen at the lateral basal segment of the left lower lobe ,well defined margin surrounding  lung parenchyma.

(12th  February  2017 CT Date ) : CT-2 (Findings )

 No appreciable interval changes as compared to the previous study, the previously seen nodules shows no change in size nor in number or location.

After another six month follow up I take appointment in another ct. In the mean time I experience several symptoms like Bad headache, serious Back pain , some swelling in LUQ area but Performing ultrasound ,no organomegaly  or abnormal pathology seen.

(24th  July  2017 CT Date ) : CT-3 (Findings )

Scan through the chest shows a well defined nodule in the anterior segment of the right upper lobe.No intralesional calcification or cavitation noted. It measures about 6mm.Another pleural based nodule noted in the left lower lobe along the postero lateral chest wall. It contain foci of calcification and measures about 9mm in size.

Bilateral lung nodule,one in the right upper lobe and another one in the left lower lobe as described.Further workup advised.
In comparison with the last CT dated 12/02/17,the size of the right upper lobe nodule shows increase in size. However, the nodules noted in the right lower lobe as mentioned in the previous report are not visualized in the current study.

Blood Profile Count History :

All other parameter of total biochemistry remain normal except uric acid shows high maximum time. I also perform RF Factor which came back normal.

My lymphocyte count maximum time in near the top and some times higher than range .But RBC ,WBC ,Haemoglobulin within normal range .

Dated

Differential

Range

Absolute

Range ×1000

03-01-17

34.07%

20 %-50 %

2.4×1000

2.0-4.0

10-01-17

45.2 %

20.5 %-51.1 %

3.5×1000

1.20-3.40

22-01-17

42.7%

19.4%-44.9 %

2.56×1000

1.30-3.5

05-02-17

33.66%

20 %-50 %

2.5×1000

2.0-4.0

23-04-17

46.8 %

20 %-50 %

2.8×1000

2.0-4.0

07-05-17

44.6 %

20 %-50 %

3.23×1000

2.0-4.0

21-06-17

30.6 %

20 %-50 %

2.0 ×1000

2.0-4.0

22-07-17

52.4 %

20 %-50 %

3.43×1000

1.0-4.0 (Low Neu)

30-07-17

46.3%

20 %-50 %

3.2×1000

2.0-4.0

This is my disease history. But I am now very much concerned regarding experiencing some during pressing at toilet .some pain in right upper rib cage sternum area when bent and a point near right breast pain and swelling a little.. And also increase Size of Right upper lung nodule.

What should be the next point now this stage what should I do from my view point ????

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Swapon,

Welcome here and thank you for the very detailed summary of your medical history.

Please keep in mind I am not a doctor so do not consider my opinion as medical advice or guidance.  If it were me, the results of the July 24 CT scan would prompt me to consult with a medical oncologist.  There are many things that can cause lung nodules that are not cancer but the repeat finding in the upper right lobe and the size increase would be of concern.

In any event, have a look around our site and read this material to acquaint yourself with information about lung cancer, should you have it.

Stay the course.

Tom

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Dear Tom,

I am very much glad that you give response on that regards. I take an appointment with a pulmnologist. After observing the ct report he recommend to perform another ct after 6 month. But after googling i found every where recommend further workup approach. Is it wise to wait another 6 or three month because i experience some symptoms like pain below sternum and throat mucus.But after consulting pulmnologist , he told it is so small to biopsy or other procedure. and My Age and smoking history not support to do that. I need to take referral from pulmnologist to take appointment to medical oncologist. What can i do on that situation ?

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Swapon,

It is hard for me to answer because I do not know the medical system in India.

Pain from small nodules in the lung is an uncommon symptom.  Pain even from large nodules in the lung is uncommon.  That is why lung cancer is so dangerous.  It often presents with no physical symptoms.  At age 29 and with no smoking history, it would be improbable to presume lung cancer, but it cannot be ruled out either.  True, small nodules are difficult to biopsy and yours are indeed small. There is another scan that is used to assess metastatic disease -- a PET scan.  But, it can also have questionable results, particularly with very small tumors.

If your medical system requires pulmonology approval before consulting with a medical oncologist, then I suppose you have to wait.  I wouldn't wait but I am biased because I've had the disease.

I'd press the pulmonologist for an answer to your pain symptom.  Sorry I can't be of more help.

Stay the course.

Tom

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Dear Mr. Tom,

Thanks a lot for your kind reply. I will insist to take appointment in medical  oncologist  Within one month if possible. But I want to give another information that now i am in Kuwait  as a Captain in Bangladesh army as a pharmacist . So need some approval from the authority as well as health insurance concern on that regards.In last appointment with my pulmnologist may be MD or FCCP in Respiratory medicine insist to take an recommendation to do PET scan ( FDG -uptake ) Initial staging he marks on the serial. But he told to done that one in next February  or like that . I am a middle class family person and only earning  person of the family with old father and mother with newly married one. So take everything on consideration. Is it best to do PET Scan within one month or then take appointment with medical oncologist or  done that one after appointment with him her , which one logical ?  I find a way or some light at the end of the tube experienced friend like you . I get real assurance from you my friend .Expect your reply on that regards.
 

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Swapon,

Again, I'm not a doctor, so I can't begin to give you advice. 

The problem is a very small nodule. Six millimeters is a little larger than an eraser on a pencile. A biopsy is the only way I know to confirm the nodule is cancer. At this small size, a doctor will be reluctant to order a biopsy. The most common way to biopsy lung nodules is with a needle and a nodule this small is hard to hit.  Even if it is, the sample may not be good enough to examine. And, without a biopsy a medical oncologist will not be able to treat you. 

A PET scan can, with larger tumors, indicate cancer but is not reliable on small tumors and it cannot identify a type of cancer.  Not knowing the type will make treatment difficult.  

So you may need to wait till the nodule gets bigger. It could disappear.  I hope it does. 

Stay the course. 

Tom

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