5 years after colorectal cancer....lung nodule

[DanInMN]

I had my 5 year follow-up with my oncologist for my colorectal cancer yesterday. My treatment was by the book, with most everything going the way you hope. Surgery went well. Got through chemo. No evidence of disease since the surgery.

I've also had a few nodules in my lungs there were there from the beginning. They did not show up on the PET scan, did not react to the chemo, and were stable. Then, a year ago, the CT showed one of them grew a little (4 mm to 6 mm). Six months after that, still at 6 mm. Another 6 months, it is 9 mm.  So it went from 4 to 6 mm in a year, and from 4 to 9 mm in 2 years, with an uneven growth rate.

Because these nodules existed before the colorectal cancer was detected, and did not react to chemo, my oncologist says they are unlikely related to the colorectal cancer. She also says the odds of it being cancer are low. But I don't feel reassured, and it is so disappointing to get 5 years out and suddenly need a biopsy. I know there is nothing magical about 5 years, and there never are guarantees, but I think it would have been a relief to get the all-clear regardless. 

I thought maybe this lung forum might have some insights while I wait to get my biopsy.

Thanks.

[Tom Galli]

Dan,

Insights in waiting for a biopsy?  Well you are of course acquainted with waiting for test results during your colorectal treatment.  We informally use the term scanziety (actually most spell it with an "x" in place of the "z" but I coined the "z" definition).

You are right, there is nothing magic about 5 years or what was once commonly referred to as a cure.  Also, I think your doctor's conclusion about the change in size and origin of the lung nodules is correct.  They could be nothing or something or lung cancer but they are not likely colorectal mets. Thankfully, life insurance companies haven't picked up on the fact that cancer frequently recurs after 5 years, at least lung cancer does.  But, the lung cancer medical community now uses the words no evidence of disease or NED to characterize being free of disease.

We have a very helpful resource at the Lungevity webpage: Lung Cancer 101.  This might build insight.  I'd start my reading there and get to know the beast all the while hoping the biopsy shows nothing or something that is not lung cancer.

Stay the course.

Tom

[DanInMN]

Thanks for the fast response, Tom.  I had actually gotten used to not having "scanziety".  Great term.

NED seems to be the common phraseology, even if it is hard to explain to the general public.  I do appreciate your insights into possible causes of the node growth.  I was convinced it was nothing until I consulted Dr. Google and found the rate in the middle of the typical range for malignancy.  I don't know how/if the can tell if something like this was a met or a new primary if it does turn out to be cancer.

I guess it is just a matter of a week of being scared until I know whether to be really scared or not.

[BridgetO]

Hi Dan,

I see some similarities (but also some differences) with my situation. I was 5 years out and NED from the end of my treatment for a stage 3 grade 3 cervical cancer. In my routine followup CTs, they found a slow growing nodule in my right lung. It didn't light up on the PET scan. The various doctors agreed that it didn't look like a metastasis, whcih apparenlly would have been rounder, not so spread out. It was possible that it was some kind of infection or inflammation. . Unfortunately, It was in a location that couldn't be biopsied without taking it out, and it couldn't be taken out without taking out the whole lobe. So in November  I had a VATs (laparoscopic) lobectomy. It did turn out to be an adenocarcinoma. The surgery was easier than I expected and my recovery was prety fast. I'm not needing any additional treatment at this time, but I will have close CT surveillance to watch for possible recurrence.

I've learned a lot about lung cancer since November. I hope that what you have turns out to be benign. Once cancer per per person is MORE than enough. This site is a greap place to get information and support, so keep in touch and hang in there! Best of luck!

[DanInMN]

Thanks Bridget,

Sorry to hear you needed the lobectomy, and happy to hear you got it and things have been going well.  Thank goodness you went ahead with the procedure given the uncertainty of the situation!

I wish I knew more about what my nodule looks like.  I have the report, and saw the images, but I lack the knowledge for what to look for or to ask about.  The CT report calls it a "pleural-based nodule that has shown interval growth".  My oncologist suggested a biopsy, but also offered waiting for another CT.  I'm not good at the waiting thing.  I asked for the biopsy, and the hospital called me within a couple hours to set up toe procedure for this coming Wednesday.  That's good, because I'd like to move quickly.  It's bad because I'm not as informed as I should be.  Plus, I went to my appointment with a terrible cold, so was not thinking straight.  And my wife, who is most of the brains in our family, could not come with.

Folks in my colorectal forum have mentioned the danger of seeding during biopsies.  What little research I've done suggests this is a very rare issue.  I may try to get a hold of my oncologist again before my biopsy to see if I can't get some more information.  

[Tom Galli]

Dan,

There may be all kinds of danger from any medical procedure but the only way to identify these nodules is a pathology examination from a nodule sample.  There are limited ways to get a sample and a biopsy appears to be the best way.

Many years ago, when I was on the typing and staging trail, I read of many "myth-like" dangers associated with lung cancer procedures.  Seeding with a biopsy needle was one; rapid metastasis when a tumor is exposed to oxygen during surgery was another. I think you'll find the folks that do this very professional.  All things are possible but I believe seeding other metastasis from a needle biopsy is very improbable.  If it even had a low probability, needle biopsies would not be performed.  Your 9 mm tumor is large enough to be a good target.

Stay the course.

Tom

[DanInMN]

It was a met.  I'm devastated.  

[BridgetO]

I'm sorry to hear your diagnosis. What's your next step? Or do you know yet? Hang in there, Dan. You can find lots of support on this forun.

[DanInMN]

I don't know anything other than it is the colon cancer.  They are still doing some test to help determine treatment.  I'm trying to get an appointment for add early next week as possible.

[Tom Galli]

Dan,

Typing on one of those impossibly small IPhone keyboards so I be brief: met sucks!  

Well you have cancer in the lung and that qualifies for membership. We may struggle with chemistry but we can google. Hope radiation both conventional and stereotactic is being considered. 

Stay the course.

Tom

[DanInMN]

Thanks Tom.  I've been a reasonably active member in a colorectal cancer forum.  I'm talking there about treatments and such (as much as one can when one has very little information).  I may poke around here for information about lobectomies, etc, if it comes to that.  Thanks for the support!  I genuinely appreciate the welcome and knowledge I've received here.