Questions about NSCLC and possible recurrance

[Cathy's daughter]

My mom, age 57, was diagnosed last July with Stage IA Squamous cell, tumor size 1.6 cm. She had a left lower lobectcomy and has done well. No oncology consult, no chemo/radiation. She had a chronic cough which led the surgeon to order a CT scan in January which showed a 4 mm mass. He did a follow-up CT 12 weeks later (end of April) which showed change to 6-mm, no big deal, but showed "multiple new areas on left, 1-cm in diameter in size and smaller, worrisome for metastatic disease." Her surgeon said too small for PET, wait and do another CT in 10 weeks.

My aunt is a chemo nurse and said no way, and the oncologist she works for agreed, and has ordered a PET on May 18 and he will see mom on May 29.

Also, the cough is better, they took her off her ACE inhibitor and that seems to have worked.

Anyone have experience with 1 cm being too small for PET? Her surgeon said that even if the PET was positive, he would be hesitant to go back in with surgery at 1cm. He is taking a very conservative approach, and the oncologist seems to be very aggressive. I'm at a loss for who is right?

Any and all advice appreciated.

Lisa

[recce101]

Hi, Lisa, and welcome to the LCSC!

This is a perfect question for Dr. West at onctalk.com. He's especially good at answering this type of question, about the pros and cons of various approaches. Browse his site for a while and you'll see what I mean.

Best wishes and Aloha,

Ned

[ernrol]

Lisa,

I think the PET scan will pick up things that may not be seen on a CT scan. I have a spot that shows on the PET scan and they did not even see it at first on the CT scan. Then they came back and said that it shows as a subtle lesion. The only thing that I have heard is some say that there is no since doing the PET scan because they still have to wait till it gets larger to do a biopsy.

Stay positive,

Ernie

[Don M]

I had my second cancer cut out at 1.4 cm in size. I don't think it is very uncommon to have surgery or biopsies for 1 cm suspected lesions. Anything smaller than that, usually falls into the wait and see category.

Don m

[Welthy]

PET scans picked up 1 cm tumors in my husband's lungs. Granted it was pretty clear that he had lung cancer, but actually having a PET isn't overly aggressive at all. It is the next logical step, especially since you indicated other smaller spots were detected on the CAT.

Best of luck to your Mom!

[Cathy's daughter]

Thank you all for your responses. I was just shocked at the 2 totally different responses by the doctors, one seemed so laid back and the other had a sense of urgency. The deciding factor for us was that my mom cannot wait 2-1/2 more months mentally or emotionally to see what this spot does. Your reassurance helps so much. Thanks again, and I did find Dr. West's site and post there as well.

Thanks,

Lisa

[tnmynatt]

I like the aggressive doctor. IMO, you can't be too aggressive with LC. Praying for a good PET!

[alexan]

Please do the PET scan, they found my recurrence very early thanks to that. he sooner the better.

They are very small, much easier to kill them.

Buest of luck, hugs & prayers

bucky

[Andrea]

Aggressive is the way to go. My dad's was 1cm and the PET was inconclusive.

[kbroo2]

At the risk of doing a me too - aggressive for me. I had the lobectomy, left also and asked for the oncol. I am doing the chemo even though my PCP and surgem were on the fence. At least I know I have done all I can to kill it. PET is not to aggressive - I would pay out of pocket for the info - best of luck -

Kevin

[pammie]

Get rid of the cancer pronto. Sooner the better. Cancer spreads. Be agressive. Praying. pammie.

[RandyW]

Not the best time to be laid Back. Be aggresive. better now than Later. Saying a Prayer for you and family.

[DrWest]

This was my response, which I posted at OncTalk, but other people may be interested:

It's true that small nodules are less likely to show up on PET, but the newer machines can often detect nodules as small as 6-8 mm. There is a risk with PET scans for small lesions that they will be false negatives, in other words that they won't be detected on PET but will actually be cancer. There is always some risk of false positives, that PET-positive nodules will turn out to be inflammation or infection, but that's quite unlikely in this setting.

For multiple nodules, if they are showing up on PET, this would be considered metastatic disease if there is disease on the left and right. Treatment wouldn't be different whether they are new or related to the prior cancer, although to me it's hard to imagine that the appearance of multiple lung nodules a year after a prior resection is not all the same process.

Overall, I'd be highly inclined to recommend a PET for this type of situation, as the oncologist has suggested.

-Dr. West

[Cathy's daughter]

Thank you all so much. She has the PET this Friday. Praying for a clear PET. Oncologist meeting is the Tuesday after Memorial day. Thanks again!

Lisa

[Don M]

Good luck for you mom Lisa.

Don M

[fillise]

Praying for a good scan result!

Susan