PET scan

[GAYLEE53]

Hello everyone,

I had a PET/CT scan done. It was interpreted as "probably benign" but it's definitely there. The radiologist said it could be a "low uptake" tumor and that we should wait for 4 months and get another CT scan.

I want it taken out. Is that reasonable? I want to talk wit ha thoracic surgeon so I made an appointment at the Cleveland Clinic.

Would any of you wait? The nodule is 10mm.

[Don M]

Surgery is risky. It is not be worth it for something that is not cancer. I think it has a 50% chance of being cancer at this point. Waiting 4 months would probably not change the treatment.

You might find a surgeon who would be willing to do a wedge resection using video assisted thoracic surgery (VATS) which is minimally invasive and prbabaly less risky than conventional surgery. If they find cancer at the operating table, they will remove the rest of the lobe.

What would I do? I would wait.

Don M

[john]

Getting a 2nd opinion like you are doing is a good idea. If it is a low uptake tumor, then it should be not very aggressive.

There are bunch of factors that determine the percentage of being malignant versus benign. You could ask the Dr what the percent chance it is malignant. This may help your decision.

Good luck

[Bruce u]

I was being told the same thing after CT scans and the PET scan. They could not tell me with 100% certainty that is was not cancer so I asked to have the surgey. Even on the operating table the surgeon said he felt it wasn't cancer. When he did a wedge resection and checked it under the microscope, it looked suspicious so he removed the upper lobe. It was cancer. I had VATS and the recovery has been good. For me personaly, I am glad I had the surgery.

[john]

From a Dr on the web:

Decision about managing SPNs may be influenced by numerous factors including the probability that the nodule is malignant, risks or surgery accuracy of biopsy techniques, fear that delay in surgical resection may forfeit the possibility of cure and the patients attitudes toward alternative approaches[2]. The management options for SPN are either observation i.e. the "Wait and Watch" strategy[19] or immediate thoracotomy[20] or biopsy of the nodule based on which decision is taken. If biopsy findings are not specifically diagnostic of either malignant or benign disease then either surgery is carried out immediately or the patient is followed up conducting serial chest films to determine rate of growth of nodule[2].

The proponents of immediate surgery argue that if surgery is delayed, it allows time for growth of SPN and therapy reduces the chances of a 5 year survival. However, there are no studies demonstrating a decrease in survival when a patient is kept under observation for few months to assess the growth of nodule. Observation is advisable when the risk of malignancy is low, the risk of thoracotomy is high, or when the patient refuses further invasive procedures[7].

Cummings et al[21] proposed the use of decision analysis based on the probability that the nodule is malignant. Using Bayes Theorem and four variables i.e. age, history of cigarette smoking, diameter of nodule, and prevalence of malignancy is SPNs, an estimation of malignancy was calculated. The average life expectancy in years of various strategies was then compared. In patients with a calculated probability of malignancy greater than 75% to 80% early thoracotomy appeared slightly superior to the needle biopsy. In patients with probability of malignancy less than 75% to 80%, needle biopsy was slightly superior to immediate thoracotomy. Observation was suggested when the likelihood of malignancy was less than 5% or the risk of surgery was high. In most of the circumstances, the differences between strategies were so small that it was a "close call"[2].

If surgery is contraindicated because of poor lung functions, age or coexistent cardiovascular disease or results of CT scan, further management is influenced by symptoms and probability of malignant disease. Management of SPN is complex and should be individualised. The basic guidelines to be followed are presented as algorithm for management of SPN[19] in [Table - 3].

Finally, the role of the physician is crucial in the management of an SPN[22]. Informing the patient and family about each option and their uncertainties as well as about the immediate and long term risks and benefits of each step is extremely important. It is also important to assess and respect the patient’s anxiety, fears and attitude. Active patient participation in decision making allows these factors to be incorporated into the patients decision. Each patient must be dealt with on an individual basis. In short, we must treat the patient and not the SPN[22].

[Muriel]

Sorry I'm so dumb and maybe I just read John's 2nd response too fast. What are SPNs? Thanks

Muriel

[john]

Solitary pulmonary nodule. A nodule is less than 2cm (I believe). If it is greater than 2cm it is called a mass.

Most lung cancers are solitary nodules or masses. Multiple nodules are often (but not always) metastasis or something else and not a primary lung tumor

Sometimes a multiple nodules are lung cancer but I think it is less likely. If something is greater than 2-3 cm in the lung it is more likely to be cancer.

[Debi]

Gaylee,

When my nodule was first found, it was 10mm. Like you, I had the CT and then the PET done, and they could not find anything definitive. I had a CT done less than 3 months later and it had grown to 13mm and I was sent to a surgeon. He suggested to have it out, and I went to the operating room still unsure if it was cancer, I was told it was a 50/50 chance. It was cancer.

I would suggest a compromise - maybe ask the doctor if you can push the CT up a month or so and have it in 2 1/2 or 3 months instead of 4. I had had my first CT in February, and had the 2nd in April where it showed the growth.

[nonni]

Hi There...

I know this must be nerve wracking cause it was for me...I went to 3 different doctor's...another team of 8 doctors and none could tell me if my nodule was cancer...The CT showed a nodule...three months later it was unchanged...the PET showed 'inconclusive..but I knew I could not live with this cloud hanging over my head whether it was or wasn't...I opted for the surgery...It was cancer Stage 1...Had I waited?...who know's...I am now a 3+year LC survivor.Thank you Jesus

Get a second and even 3rd opinion...wouldn't hurt..

Best of luck..nonni

[StrahDawg]

I guess based on the opinion of the Radiologist to wait a few months I'm ok with but I think 4 months is a little long for me. I would push for the 2 1/2 to 3 months to get re-scanned. I am also a Cleveland Clinic patient and if you have to see a thoracic surgeon (hopefully not) mine was Dr. Mason who I really liked he was very straight forward, aggressive but also very caring.