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[sandy4468]

Hello, I am new here. 50 year old female.  2 months ago I had a CT scan and this is what they found:There is a non calcified 6 mm pleural-based pulmonary nodule in the right apex (image 44 series 7). There is a 4 mm non calcified pulmonary nodule in the posterior segment of the right upper lobe (image 54 series 7). No airspace infiltrates are found..

My family Dr. would like to take the "wait and watch" approach.  I have always had problems with my respiratory system.  Pneumonia, chronic bronchitis, asthma, COPD, second hand smoke and smoking the last 15 years myself.  (I have recently quit).  

How can anyone sit and wait?  What are some other options?  I would like to see a specialist for further testing, but do not know which.  Oncology, Respiratory, GP, etc. but unsure which one. It's so stressful waiting.  

Can someone give me suggestions?

Thank you so much.

 

 

[LexieCat]

Hi, Sandy, and welcome!  I understand your wanting to know NOW what's going on, but the vast majority of nodules are not cancer, and waiting and watching is usually what's recommended.  Yours are so small they probably cannot be biopsied.  The good news is, since they ARE so small, keeping an eye on them will mean any changes or growth will be observed before it gets out of control.  

I did have a nodule that went "bad" and resulted in removal of a lobe of my lung, but I have several other nodules the docs continue to monitor but are not especially concerned about.  The fact that you had other lung issues suggests yours are more than likely scar tissue or inflammation from one of those other conditions.  

[LexieCat]

Oh, one thought.  I think I would suggest seeing a pulmonologist and having that person monitor your nodules.  Pulmonologists have a lot more expertise when it comes to noticing suspicious changes in nodules.  

[Susan Cornett]

Hi, Sandy.  The wait and watch approach stinks but sometimes that's our only option.  CT in January showed a small nodule in my left lung, but it was very small - couldn't be biopsied.  CT in April showed it was a little bigger, but still too small to do anything about.  Finally in August the decision was made to treat it with SBRT - I didn't have a biopsy because, with my history, we knew what it was.  The January CT measured it in mm, and we didn't do anything until we could measure it in cm.  Don't know if that helps.

Lexie is right - a pulmonologist is the way to go here.

[BridgetO]

Hi Sandy,

I did "watch and wait". My nodule was discovered in a routine CT scan done to watch for possible metastases from a prior non-lung cancer. The nodule was very small and I was "yellow tagged" by the radiologist to be scanned again in 3 months. At that time the nodule had grown a tiny bit and looked suspicious primary lung cancer, more so than a metastasis.   So they began doing other tests such as lung capacity and a PET.-- it didn't register at all, apparently because the thing was so small and slow growing.  They couldn't biopsy without surgery because of the location, so I was scheduled for a lobectomy.  Actually, I asked if it could wait until I took a scheduled vacation and they agreed that it would be fine because this thing wasn't doing anything fast.

I felt OK about the delay. My experience with my prior cancer (gynecologic) was very different. It was found to be large and aggressive and they got me into surgery within a week, so I figured these doctors knew when it was necessary to move fast. My lung nodule was removed by a VATS lobectomy and it was Adenocarcinoma Stage 1A, so they were right.

In any event, cancer is a big drag!

Best wishes.

Bridget O

[ColleenRae]

Hi Sandy!

You've come to a great place to get support and answers or at least hear about other people's experiences! 

Completely understand your anxiety and questioning the "watch & wait" decision. 

Like the other commenters here, I, too, was in a watch and wait.  I had a Lung CT in Dec 2016.  Several nodules were discovered, all quite small and at the time, none appeared to be cancerous. I was told we'd be in a watch 'n wait pattern with regular CT's.  Three CT's later - July 2018 I was told that one nodule had grown slightly but the concerning issue was that it had become more dense. The clinic I was being monitored at now felt confident in saying they suspected adenocarcinoma, probably Stage 1a, but due to the size and the location, a biopsy would be extremely challenging to do successfully. So they are not 100% sure this is cancer, but believe it is likely. 

So, after waiting for over a year and a half, we finally got to the next step of this process.  Patience is NOT my greatest virtue. I cannot say I have done well with this "watch and wait" pattern, but there wasn't much else I could do.  I was told I had some time to "play with" if I wanted to get some other opinions and that is what I have been doing since July 2018.  I did not want to just jump into surgery (I'd been referred for a lobectomy of my right upper lobe to remove the suspicious tumor - they will biopsy it then). In the meantime, I completed a lung function test and I had a PET Scan. The PET Scan did light up the tumor, but does not indicate cancer elsewhere, so that is at least some good news! (I hope).  Lungs are functioning "near normal" so they anticipate I will handle the surgery well and not have breathing problems even though 1/3 of my right lung will be removed.  I also spent the time since July meeting with two different pulmonologists (DEFINITELY get yourself attached to a good pulmonologist - that has been  most helpful for me. The one I have is a great resource. I feel he is looking after my best interest. He is not a surgeon or a radiologist, so he can be a bit more impartial regarding his views and treatment). I met with a radiologist - he would not touch this tumor unless he knew it was definitely cancer and recommended I have an interventional radiologist do a biopsy.  I did some research and while I'd love to have a biopsy  to give us an actual diagnosis of this tumor (is it cancer or not?!), the biopsy would probably be inconclusive due to location/size and I just don't think it's worth the risks involved. I decided I might as well just go ahead with the surgery. I met with three different surgeons - which I found very helpful. All three were very different from one another, had different levels of experience, "bedside" manner, communication skills, opinions re: this tumor, etc.  I chose the 3rd surgeon I met with - I felt the most comfortable with his explanations, experience and personality.  That is helping me enormously in moving forward with surgery.  I will have the lobectomy on October 1st... I could have had it this month, but I, too, asked if I had time to plan a mini vacation. Part of me is stalling on surgery, but the Dr. did not seem concerned about waiting another 3 weeks.  I just felt I wanted / needed one small trip with my son before this is done. Hoping for some peace, quiet and hiking in one of our favorite state parks . 

 

I don't know if sharing my experiences so far will help you, but want you to know that you are not alone.  I had a very difficult time waiting and watching. I found things got much better when I aligned myself with a pulmonologist. He was able to refer me for additional testing and providers. He has been the one who took the time to review each of my scans and give me his opinion on where things stood. He helped me stay calm (well, at least calmer than I would have been on my own!) in this process. 

Keep coming back here - there are a lot of experienced and knowledgeable people here who really care and can offer you support and hopefully answers.  They've been a big help to me so far in this journey!  Good luck.

[Shelkay1]

I did a wait & watch for 17 years on some small ones similar to yours; they called them granulomas, thought to be scaring from histoplasmosis. I had a CT done every year. Sometime there was a little growth, usually they stayed the same. They had considered a needle biopsy a couple of times but never did one die to the small size, minimal growth & closeness to my heart. Along with this I had a severe chronic cough, bad enough to crack ribs a few times. I was eventually put on gabapentin & it was beneficial in helping calm it. The CT I had this year showed the largest nodule tripled in size. It now was a much bigger concern. I had a biopsy that confirmed adinocarcinoma; followed by a PET, broncospy & a medianoscopy. It appears to all be contained in the left lower lobe. I'm having VATS surgery this morning for a lobectomy at Hershey Penn State Mecical/Cancer Center. I will then have  follow up chemo to make sure no more cells are lurking behind. They've not staged mine yet, waiting till it's out & have the full pathology repory.

Best wishes to you all, I'll be updating my experience and results on my surgery page afterwards when I know more.

[sandy4468]

Thank you all for all of your stories, suggestions and help.  Wishing everyone well on whatever journey you may be on.  I do have a pulmonary doctors appointment the beginning of October.  I would like to get him the actual images from CT (if possible) so he can further explain this and give his opinion an how or if to move forward for more testing.  You are all so very helpful and have given me a lot of food for thought and questions to ask.  Your recommendations are so very helpful because I am blank in regards to what to do.  Waiting is not one of my strong points.  I want things now always.  Keeping busy and my mind off of things is helping.  I do work at a Holistic Healing and Empowerment Center as a "mascot".  I am not a practitioner but do have unlimited access to the women an practices the center offers.  But along with my lack of patience, I have a lack of commitment when attempting something new.  So with that, I guess for now its wait for pulmonologist appointment and go from there.  Thank you all so very much again.  

[BridgetO]

Yes! Be sure that your pulmonologist sees the  actual CT images.My pulmonologist was able to tell me a lot from looking at the images taken over time. She pointed stuff out to me on the actual images, which helped me understand what she told me. If your CTS were done in an office or practice different from the pulmonologists, you might want to call the pulmo office and ask if you need to do something to get the images sent there. They may already have done it.

Bridget O

[Tom Galli]

Sandy,

As many have suggested, go see a pulmonologist and bring both your CT written report and the actual images.  That discipline will be helpful in treating your COPD and hopefully keep you from having it morph to pneumonia as winter comes.

Like everyone on this thread, I've watched and waited a number of times.  It seems to be the lung cancer trudge.  Scan, wait, report, wait, consult, wait -- everything waits but the bills.  They fly in!

Your report is using the term "nodules".  Lung nodules come in all types and flavors.  Here is my go to resource explaining what they are and why they happen, besides cancer.

Stay the course.

Tom