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Snickpea

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Hi, my mom just had a Ct scan last night. We went to the doc this morning. He said she had 1 mass and 3 nodules on right lung. I asked for a copy of the report. It seems very concerning. I was wondering if you guys could have a look and let me know what exactly it all is.

 

she has a pet scan scheduled for Monday.

thanks

lung parenchyma: There is a large mass centered in the left hilum. It measures 5.5 cm at the level of the carina transversely. It extends superiority and inferior you. There is a 2nd contiguous mass seen inferiority. It is uncertain as to whether this is mediastinal parenchyma. It measures 4cm transversely. This large lobulated contiguous mass narrows the posterior inferior left pulmonary vein and the lower lobe pulmonary artery on the left. This is highly suspicious for neoplasm. Tissue sampling is suggested. The left lower lobe bronchus is also affected. There is a left lower lobe consolidation possibly representing postobstructive atelectasis. The right lung demonstrates three nodular densities. There is a 6mm nodular density seen in the right lower lobe on image 66 of series A2. Two ovoid nodular densities are seen measuring 6 and 4mm on image 65 within the right major fissure probably representing intrapulmonary lymph nodes.

Mesiastinium: The paranchymal mass described above extends superiorly almost to the thoracic inlet lying to the left of the trachea and anterior to the esophagus. There is also a subcarinal extension of the mass. These finding may represent contiguous adenopathy.

 

Hila: See above the mass described involves the left hilum. There is a 6mm right hilar lymph node.

 

Abdomen: There is a left para-aortic node measuring 1.2 x 1.1cm seen on image of series A1.

IMPRESSION: Large left hilar/mediastinal/infrahilar mass as described above. Findings are highly suspicious for malignancy.

PET scanning to determine extent of disease and tissue sampling are suggested.

 

Thank you for any help you can give.

 

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Snickpea,

I am not a doctor but the the IMPRESSION of the report tells the whole story -- the scan reveals tissue growth that is "highly suspicious for malignancy."  The recommendation for a PET scan or tissue sample confirms suspicion for malignancy.  My reading of the report suggests growths in both the left (2 large) and right (3 nodules) lungs.

Her PET scan will confirm malignancy in the lung and check for malignancy elsewhere.  If the nodules in her right lung are confirmed as malignant, then your mom will likely be diagnosed with Stage IV lung cancer.  You can read about lung cancer staging here.  If the nodules in her right lung are deemed not malignant, then she may be diagnosed as Stage III lung cancer.  So the PET will tell some of the story but not enough to treat her.

Before a treatment plan can be devised, your mom will need to have a pathology examination of the tissue that constitutes the reported masses and perhaps nodules.  There are a number of ways this tissue sample can be obtained but I'd guess a needle biopsy is the likely vehicle.  The pathology examination will yield the type of lung cancer.  You can read about lung cancer types here.

You had a really quick turn around from CT to results revealed.  You'll likely know by the middle of next week the extent of metastatic activity.  Then your mom will likely be scheduled for a biopsy.  This is a non complicated surgical procedure done with very low risk.  It is performed normally by thoracic surgeons or interventional radiologists.  Here is relevant information on how biopsies are performed.

So, where do you go from here.  You are in the portion of treatment we informally call the typing and staging trail.  Your mom will undergo tests and results will trickle in.  The waiting can be maddening. So, I'd suggest she use the time to read about lung cancer.  Like most patients or family members, the first bit of reading will be on survival statistics.  Before you Google them, read this.  Many of us here have what we call late stage diagnosis -- Stage III or IV -- and we are still here.  If we can live, so can your mom.  How does one survive?  Here are my suggestions.

You'll have many more questions.  It is good you are being proactive and helping your mother understand.  You are fulfilling a vital role of caretaker and that role will expand and become vastly more important as your mom progresses through treatment.  My best recommendation is have your mom join us here on the forum.  Some however are reluctant and I completely understand why so perhaps you can read into the disease and tell your mom what you've learned.  One final bit of advice.  When the typing and staging trail ends, there will be a very important consultation with a medical oncologist. Ensure someone attends that session with your mother.  My lung cancer diagnosis was a frightening experience and my wife asked the questions while I watched the office wall clock.

Stay the course.

Tom

 

 

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Tom, Thanks so much for your help. It does not sound good at all. It says there is a left para-aortic node in abdomen. Does this mean there is a nodule or mass in her abdomen. If that's the case, is it spread.

Thank you

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Snickpea,

I saw the para-aortic node comment and took it to mean an enlargement of one of the para-aortic lymph nodes located in the abdomen.  Cancer could cause such an enlargement but so could many other things.  More commonly in lung cancer, lymph nodes near the lungs display signs of cancer (enlargement) and the CT scan didn't report on any of them. It would be unusual, but not impossible, to have a para-aortic lymph node metastasis without lymph nodes near the lungs being similarly affected.  But, recall I'm not a doctor.

The IMPRESSION statement is focused at only the left lung.  The nodules in the right lung and the para-aortic lymph node are anatomical reports but note they are not included in the impression statement.  Monday's PET scan will answer the uncertainty.

Stay the course.

Tom 

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Hi Tom, my mom got the results of pet scan. I am trying to figure it out. Dr didn't say much only she needed a biopsy.

can you have a look at it.

Thank you

Neck: hypermetabolic activity along the right lateral aspect of the larynx with suv max 8.9 with no identifiable mass by CT. This is non specific. Correlate clinically.

THORAX: Background mediastinal activity is SUV max 2.2

Large hypermetabolic left hilar/mediastinal mass with SUV max 23.9. The epicenter of the mass is at the left hilum, measuring at least 6cm transverse, with extension superiorly along the mediastinum to the thoracic inlet. There is adjacent hypermetabolic left lower lobe infiltrate and pleural thickening, which could be neoplactic and/or inflammatory.

There is a 2nd 4.0cm hypermetabolic mass more inferiorly abutting the lateral aspect of the descending aorta with SUV max 10.0, extending inferiorly to the level of the diaphragm along the posteromedial mediastinum. This could be a 2nd adjacent mass, or a bilobed component of the left perihilar mass.

Two hypermetabolic mediastinal nodes, measuring 1.5cm posterior to the carina SUV max 6.5, and 1.2 cm between the aorta and esophagus with SUV max 2.7.

Numerous hypermetabolic hepatic lesions, too numerous to count, with a representative right lobe lesion measuring 2.2cm on image #139 SUV max 8.8 and 1.7cm in the left lobe on image #135 SUV max 8.6.

MUSCULOSKELETAL: hypermetabolic osseous Foci compatible with metastatic disease,located in the anterior arch of C1, T6, and the proximal left femoral diaphysis.

Low dose CT images: Scattered subcentimeter mediastinal nodes are present in the prevascular space, not hypermetabolic. Several additional parenchymal nodules are present, not hypermetabolic as follows: 4mm right medial apex #53, 2 and 3mm in the anterior right upper lobe on #75 and #78, 7mm right lower lobe on #94,3mm pleural-based left lower lobe #91. The cervix is prominent, however not hypermetabolic, therefore likely within the range of normal.

IMPRESSION:

1. Large hypermetabolic left hilar/mediastinal mass with a bilobed component or immediately adjacent 2nd mass just inferior. These masses extend along the entire mediastinum, from the thoracic inlet to the diaphragm. Hypermetabolic mediastinal adenopathy.

2. Hypermetabolic left lower lobe infiltrate with pleural thickening, possibly postobstructive, with known neoplasm not excluded.

3. Extensive hypermetabolic hepatic metastatic disease

4. Hypermetabolic osseous metastatic disease

5. Additional subcentimeter parenchymal nodules as delineated above.

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Snickpea,

Again recall I am not a doctor.  This is her first PET scan and everyone metabolizes differently.  But in the impressions, anywhere you see the word hypermetabolic, there is a high probability of metastatic cancer.  From this report, I would conclude she has metastatic cancer in both lungs, two places in her spine and her femur. 

The next step is a pathology determination of the type of cancer so a treatment plan can be organized.  The test sample or samples will likely require a biopsy.  So, if you are looking for good news, you'll not find it in this report.

But, I've read my PET reports with the same kind of language (except for bone involvement) and I'm still here.  I had one of the first PET scans administered in the Dallas metroplex and my oncologist and I read the report together because it was new technology.  I saw a lot of references to hypermetabolic and that is how I discovered what the term meant.  Once we get the biopsy results, we'll know a lot more about the road ahead.

Stay the course.

Tom

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Thank you for replying Tom.  Family dr said next step is to biopsy the large mass. We are not sure if we need a pulmonary dr or ENT dr to do the biopsy. We are still waiting to find out what kind of dr.  We hope the biopsy will be done asap and get results soon.

Thanks so much for your help these past few days.

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