lobectomy for lung nodule 12mm x 15mm - update

[littlemissbags55]

Hi everyone, 

  Just to quickly summarize, I posted awhile ago about my mother (63 yrs old now)  who had a Ct scan while she was in the hospital for an upper respiratory infection dec 2018.  On the ct scan a 12mm x 15 mm lung part solid, ground glass nodule was found  in her upper left lobe along with smaller nodules surrounding it which have remained unchanged.  The hospital sent her home to follow up with a pulmonologist in which she has had a PET/CT scan - clear, and has since had 4 CT scans and a broncoscopy. The broncoscopy was clear and her doctor performed a new technique to essentially dust her airways to determine whether or not she was more or less susceptible to cancer and that came back negative.  So heres the timeline.  December 2018 - lung nodule found , CT Scan June 2019 - nodule increased in density not size, everything else unchanged.  July 2019- PET/CT Scan- negative & broncoscopy - negative.  December 2019 - CT scan - lung nodule unchanged.  August 2020 - CT Scan - radiologist noted that the density has changed (become more solid) since her 2018 Scan, everything else remained unchanged.  My mother had a tele call with her thoracic surgeon yesterday and he said that he would like to see her in person to discuss her options moving forward based on him knowing the radiologist who wrote the report.  He has not seen the images yet, we will bring them to the appointment this Friday (14th)   The guidance we received prior to this was that he would not operate on a nodule of this size and because of the size and the placement a lobectomy would be the only option. Now it appears because he is familiar with this radiologist and the radiologist noted that a "surgical resection is recommended" which we know cannot be done, that surgery is somehow back on the table for discussion.  What strikes me as odd is that the radiologist referenced it increasing in density as compared to her 2018 scan which is not the most recent scan.  She has had 2 scans in between in which one showed an increase in density and the other remained unchanged and stable(most recent).  Does surgery seem like the next logical step based on a lung nodule that has never been proven as adenocarcinoma and has remained unchanged in size for a year and 8 months?  Our family was quite taken a back after we received this phone call and I want to make sure im adequately prepared for our appointment on Friday.  Any information or suggestions would be greatly appreciated!  

 

**Update** We met with my moms thorasic surgeon yesterday and it appears that because it is becoming for more solid he suggests meeting with a radiation oncologist and gave us a few names of doctors that he has personally worked with.  He believes that a few short appointments later and we can get this thing zapped right on out of there!  Phew!  Although the ideal situation would be that it hasnt changed and there are no concerns this seems like the best alternative seeing as though now there is something we can actually do to potentially get rid of it... hopefully for good!  Thank you for everyones continued good wishes as we move on to the next step.

[LexieCat]

You seem to be thinking "resection" is different from a lobectomy. Resection just means removing the potentially cancerous nodule. You can have a "resection" by lobectomy--in fact, lobectomy is preferred when lung capacity permits, as it provides a greater chance of removing all the cancer (assuming it is cancer). 

And I'm in the diagnostic process of a recurrence (I had lobectomy 3 years ago) that started off as an increase in density. All the scans are relevant. Often the angle of the "slices" of a specific CT will give a slightly different picture of what's in the lung.

I think those are all good questions for your surgeon, but what they are talking about does not sound out of line to me.

[littlemissbags55]

what i meant by lobectomy would be she would have to have the whole lobe removed not just a section. just seemed like an extreme next step based on a nodule that hadnt changed in size only density once and that was over a year ago.  thanks for your input very much appreciated! 

[LexieCat]

No, I know what you meant, but "resection" includes lobectomy. It's not an extreme step--I had absolutely no problems after my lobectomy. No loss of breathing capacity, was out with friends and back at work 2 weeks after my VATS lobectomy (which is a laparoscopic procedure--very simple). My doctor explained they do the partial resections (i.e., less than the whole lobe) ONLY when someone can't tolerate the more-complete lobectomy surgery (e.g., COPD or other issue affecting breathing capacity).

[LexieCat]

BTW, when I had my lobectomy, the doctor first performed a "wedge resection" (the partial removal of lung tissue you're thinking of) and the lab did a preliminary examination to see if it appeared to be cancerous before proceeding to remove the lobe. In my case, it wasn't clear whether it was cancerous, so he went ahead anyway and removed the lobe. The pathology afterward proved it was cancer--adenocarcinoma. 

 

[littlemissbags55]

if you dont mind me asking what size was the nodule that they removed?  

[LexieCat]

Mine? I believe it was 1.5  cm when they removed it--I think it was 9 mm on the scan.

 

[Tom Galli]

Uncertainty about thoracic surgery is always there. Unfortunately, because of the nature of our disease and of lung tissue, all scans show an incomplete and perhaps inconsistent picture of the actual state. The value of the surgeon is actual "eyes on the problem."

It is good your mom's surgeon and radiologist have a working relationship. Reading scans is like spy photo interpretation. There is a lot of science involved, but the best radiologists are artists. There is a knack to creating a mental picture of an amorphous nodule among amorphous tissue.

Has a biopsy been suggested as a way forward? I assume the bronchoscopy in July 2019 obtained a nodule sample for a biopsy. Either way, the only way we can diagnose lung cancer is with a biopsy. That said, some tumors or nodules are in difficult orientations making a needle biopsy or bronchoscopy biopsy difficult. I'd ask about a biopsy before discussing surgical resection by any means.

As you move forward on the diagnostic trail, you might give some thought to a consultation with a medical oncologist and a radiation oncologist. These disciplines treat lung cancer when surgery is not a possible treatment modality.

Last, surgery for Stages less than and including stage IIIA is the best form of treatment for lung cancer.

Stay the course.

Tom

[ChiMama]

Hi, uncertainty is the hardest part of the medical journey!

My story: A ground glass nodule in the upper left lobe was discovered in scans 4 years ago incidental to my colon cancer journey. It was originally measured at 9mm and was put on the "watch list" in my every 6 month scans.

Over the four years, it was measured from 8mm to 10mm to 9mm to "up to 1cm."  Different every time.  Sometimes they listed a "9mm x 6mm" type measurement but usually not.  It was also referred to in several scans as a "stable nodule."  Apparently there can be a little variance in the measurements.

Then in April it read as 1.1cm and my pulmonologist sent me for a biopsy.  It came back adenocarcinoma non small cell primary lung cancer, obviously slow growing.  My first PET in 2016 showed minimal uptake in the nodule, and although not much bigger in size, it lit up in the PET I had in May.

So I had a lobectomy 4 weeks ago.  The entire upper left lobe was removed.  There were a couple other small spots in the lobe, one that was benign calcification and the other they called "a 4mm tumorlet."  It's still a little difficult for me to accept emotionally, especially as I'm still in the healing process, but the removal of the lobe is the standard to make sure they get it all.

Hope the appointment goes well and you get the answers you need.  (PS I'm the same age as your mom 💜)