Concerned Dad

[BBB123]

My son was recently injured in a fall. At the emergency room they gave him a CAT scan looking for any internal injuries. There were none and he just needed to have his head stitched up. The CAT scan, however, found the following:  multiple prominent and enlarged mediastinal lymph nodes measuring up to 1.1 cm, possible bilateral hilar adenopathy. Multiple pulmonary nodules measuring up to 6 mm. The emergency room had the scan results sent to my son's primary care doctor and told him to set-up an appointment to see him in a week. The report also indicated, in the case of the nodules, that a follow-up CT scan in 6-12 months is recommended for a low risk patient. My son is 34, a non-smoker, and in good health.

My son had his appointment with his primary care doctor yesterday and I was a bit surprised that he told my son that he was going to schedule him for a chest x-ray in 3-6 months. I guess that I was expecting more like a referral to a specialist and/or a biopsy for the lymph nodes.

I am a prostate cancer surviver and very familiar with the protocols for the disease, but this is very new ground for me. I know that the members of this site are not medical professionals, but I would appreciate any guidance you can give me. Just want to make sure that he is doing what is necessary at this point. Thanks for your help.

 

 

 

[LexieCat]

Hi, Dad, and welcome.

Your son may not be high-risk, but nobody knows why some seemingly low-risk people get lung cancer.  Not suggesting that's what your son likely has, just that followup is appropriate.  Nodules can be many things, and most of them are not cancer.

Chest x-rays aren't that good for visualizing nodules.  If I were your son, I'd want another CT scan in a few months, and to discuss the results with a pulmonologist.  Nodules 6 mm in size are very small, and most likely too small to biopsy.  The usual course with small nodules (unless they are especially suspicious in appearance) is to do a followup scan in a few months to look for any changes.  Whether they need to be followed after that is a call that a pulmonologist can make.

[Tom Galli]

Dad,

Welcome here.

Press your son and his doctor to have a low-dose CT scan.  This technology is far better at picking up potential tumors than a X-ray.  I was X-rayed about a month before being diagnosed with a 3" long 3/4" in diameter (700 mm X 200 mm) tumor that completely blocked the right main stem broncs. Either the X-ray missed the tumor or my cancer grew very quickly.  While you are right to be concerned because the only prerequisite to getting lung cancer is having lungs, there are many reason pulmonary nodules form and most are not cancer.  Here is my Cleveland Clinic primer on lung nodules.

But, try not to get too concerned about your son's very small nodules.  Six millimeters is very small, about the diameter of an eraser on a lead pencil. It is a hard target to hit with a needle biopsy and so if something shows on the scan or X-ray, the likely outcome will be watch and wait to see growth, especially given your son's non-smoking history.  Patients and peace of mind will be challenged during this waiting period.  I know, I've been there.  I call this waiting period Scanziety and it was so maddening for me I wrote a book about it. 

If you are concerned about the radiation dose from a low dose CT, here is some interesting data that might reduce your concern. 

So a CT scan is prudent to establish a size and shape baseline (to Lexi's suspicious appearance point).  That would be my best suggestion at this stage.

Stay the course.

Tom

[BridgetO]

I like Lexiecat's suggestion of a pulmonologist referral . I think this is a judgment call for a specialist. And I also concur with Lexicat's and Tom's recommnedation of a CT rather than an x-ray--it's a  much better diagnostic tool. I had one small nodule and had a 3-month re-scan. Turned out I had a very slow growing non-small-cell lung cancer. I'm a non-smoker with no known environmental exposures (other than second-hand smoke). Best wishes to your son and good for you for your active support.

Bridget O

[BBB123]

Lexie, Tom and Bridget, thank you for your comments and recommendations. I will make sure that my son gets a CT scan instead of an chest X-Ray after 3 months or so. Although I think that there is a possibility that he just mis-understood the doctor. I will also talk to him about a specialist. I am concerned about the enlarged lymph nodes. If it is unlikely that they are enlarged due to lung cancer if nodules are so small, perhaps something else is going on. His Doctor seemed to want to deal with them as one issue. Again, thanks for you help.

[LexieCat]

That's a good idea.  One of the typical causes of nodules is local inflammation.  It could be that he's got some kind of infection or something causing the lymph nodes to swell.  

Hopefully it turns out to be something minor and easily addressed--most of the time, that's how it turns out.