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Worried about my dad.....


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My dad was recently admitted to the hospital for chest pain/shortness of breath. He is a smoker, and has been for over 40 years. He is 71. He has lost weight over the course of the year, along with his appetite. 

He has COPD and emphysema. While in the ER they did a CT of his chest/abd/pelvis. His results : "Suspicious for right hilar mass measuring up to 2cm without other mediastinal lymphadenopathy in the background of severe emphysema. Perhaps PET/CT would be appropriate for further evaluation."

Has anyone experienced the same or anything similar? I am just looking for direction. He has seen a pulmonologist recently (3 months ago) and they did a Chest x-ray (he has atrial fibrillation- and has had shortness of breath since his ablation/surgery this summer) it showed a small nodule, but they are stating this current one is new. My mom will call the pulmonologist to schedule an appointment on Monday. Any advice or similar stories would help my mind greatly. The good news is he has not touched a cigarette since. I pray this is easily treatable, and a wake up call for him to continue down the path of not smoking. 

Thank you so much for taking the time to read this.

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SDP,

Welcome here. I do hope your dad's diagnostic path remains short and concise. 

"Has anyone experience the same or anything similar." Yes, we all have. Lung cancer is unfortunately often a surprise diagnosis and the diagnostic path is filled with new terms and methods and uncertainty and fear. Reading the findings on your dad you provided, I agree a PET/CT should be next in line as a diagnostic method. Here is some information about the different types of medical imaging used in diagnosis of lung cancer.

As I understand the CT results, a single suspicious nodule in the right lung is the finding of concern. A PET/CT will determine if there are any other areas in the body that are metastatic. After the PET/CT, your dad should be given a stage. Here is information about lung cancer staging.

Staging generally determines if surgery can be a method of treatment. But your dad's entire medical situation must be considered in addition to diagnostic results for a surgical method. However, there are effective non surgical methods for treating lung cancer. I use the term precision radiation as a collective descriptor. Here is an explanation of these methods. 

Regardless, non surgical lung cancer treatment has vastly improved in the last 5 years. Your dad will likely have a biopsy to identify his type of cancer. Both a stage and a type of lung cancer need to be determined before a treatment plan can be devised. 

Advise? Do everything you can to condense his diagnostic path? Ask to be informed about cancelled appointments and prepare to attend diagnostic procedures on a short notice basis. Take time now to find a medical oncologist and perhaps a radiation oncologist while you are navigating the diagnostic process. Your dad's pulmonologist is a good resource for shepherding him through the diagnostic process, but the oncologist discipline establishes the treatment plan. I'd use this time on the diagnostic trail to find oncology practitioners your dad is comfortable with.

Pass this along to your mom and dad.

Stay the course.

Tom

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Hi and welcome to our group: First of all  COPD is an umbrella term used to describe other lung deceases among them emphysema. Hopefully your dad is on an inhaler and doing breathing exercises for both. If you are not aware of those , there are plenty of examples and instructions on Youtube.

Second the best advise to put your mind at rest is to go to a cancer center and let them do Pet scans and whatever they see necessary to diagnose your father. I was diagnosed in the ER and while they did a fine job, the cancer center was a lot better alternative. Good luck!

 

 

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Hi SDP and welcome.  It's alarming and disorienting to get this kind of news, for both the patient and his family. I want to add a couple of things to what Tom and Gary have written.  First, not all nodules are cancer, in fact most aren't. Of course,  your father has an increased risk due to  his smokiing history An experienced pulmonologist can often get a lot of information by looking at the CT images her/hiimself, rather than just relying on the radiologist's report.  Also,it's not surprising that a nodule didi't show up on an X-ray. A 2ssc cm nodule isn't small, but it's not very big, either,  CTs are a lot more sensitive. 

Second, about the PET?CT: This will show areas of high metabolic activity in the body. The higher the metabolic activity, the higher the PET score in a specific area  (the more it "lights up") Cancer generally has a high metabolic rate, so the more the nodule lights up on the PET, the more likely it is to be cancer. My small nodule didn't light up at all, as some small and slow growing cancers don't.  And some things like infections and inflammations can also light up. But the PET will give valuable info about the likelihood the nodule is cancer and if so, whether is has spread to other areas of the body.

Third, the only sure way to diagnose cancer is by a biopsy. Most suspicious nodules can be biopsied either by a needle from outside the chest, or by a bronchoscope which goes down the bronchial tube. Some nodules can't be biopsied in this way due to location and require a surgery for biopsy

I hope this isn't too much information! I guarantee that unless you're a medical professional or have other recent experinces with lung cancer, you'll be learning a lot of new things as your father goes through the diagnostic process. I say "recent experience" because  in the last few years there have been a lot of new lung cancer treatments and many more are in clinical trials.

So, have hope, keep us posted, ask whatever questions you have, and let us know how we can support you.

Bridget O

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I cannot thank all of you enough for taking the time to write me such lengthy & informative responses. 

For a little update: I was looking at my fathers My Chart which includes all of his test results. I was incorrect about the x-ray. He had a standard CT Scan without contrast done (routine from the pulmonologist), on 10/5/20, and had a 4 mm nodule in the posterior lateral left lower lobe that the radiologist noted was most likely benign nodule, but would do a repeat CT in 12 months. He did have numerous prominent, but non-enlarged, mediastinal lymph nodes. No enlarged hilar or axillary lymph nodes were present.

Fast forward to 12/31/20. He was having pain in his chest (a-fib), and they wanted to get a CT of the chest/abd/pelvis with and without contrast- which is where these results differ from the CT without contrast less than 3 months ago.

"Suspicious for right hilar mass measuring up to 2 cm without other
mediastinal lymphadenopathy in a background of emphysema.
Perhaps PET/CT would be appropriate for further evaluation"

I have been absolutely sick to my stomach since we found out about the new mass. My husband & my brother are both in the medical field, however, neither in pulmonology. Both emergency medicine. So while they have extensive knowledge, it is not helpful for this worried mind. They are very cut and dry. Basically, my husband has said he hopes this was just an early find, and my good friend "google" is terrifying me with SCLC. 

My dad has a virtual conference call with his pulmonologist tomorrow afternoon, and I know I need to calm myself down, for there is nothing I can do at this point. I'm just such a daddy's girl, and he is my whole world. I cannot shut my brain off.

My new question for any/all of you: Do you think it is possible that they might have missed the mass in the CT done on 10/5? My husband seems to think that would be a BIG MISS if that were the case. So, now I'm worried he has some aggressive form of lung cancer for a mass of that size. My husband gave me one of the books he had in medical school to look through (he knows I will not stop researching, and wanted to give me the best source of information aka NOT google, haha), and everything I've read is that lung masses, when it is NSCLC, usually take 3-6 months (or longer) to double in size. What concerns me is that  3 months ago nothing was noted on the CT or was present, & now for there to be a new mass & for it to already be 2cm 3 months later.. Does this even sound possible? ALSO... He had prominent lymph nodes on 10/5 and enlarged lymph nodes on 12/31... If the mass was not present on 10/5, why would he have prominent mediastinal lymph nodes??

Is this something that is common with lung cancer?  or have any of you had similar experiences? 

I hope that you do not think I'm crazy, and I cannot tell you how truly grateful I am for your feedback. I actually read all of your responses with tears in my eyes, but I've been doing that a lot these last few days. I know nothing will be known until a biopsy or the PET scan, bu I am just desperate for similar stories, or information.

 

Thank you from the bottom of my heart for taking the time, again, to read this!

 

Sarah

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I totally get trying to figure out what's going on based on these two scans, but honestly, I think you are just gonna make yourself nuts without really figuring anything out. The CT report says it's "suspicious" for a mass of up to 2 cm. That doesn't sound too definitive. Also, the term "mass" is usually limited to something 3 cm or larger--2 cm is usually referred to as a nodule.

Radiologists are not lung cancer experts. They just highlight things that look abnormal that might be of significance to a pulmonologist or oncologist. 

I'd suggest you try to sit tight and let the further imaging/testing take its course. I know it's frustrating and scary--it's honestly the worst part of an initial diagnosis for anyone. 

Hang in there.

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Sarah,

I had an x-ray in early January 2004 for suspected broken ribs. It was performed at my GP's office. A month later, I was in the hospital coughing up blood and an emergency room x-ray showed a very large tumor. Several days later, my first CT scan confirmed a tumor 7cm in length and 2.5cm in diameter completely filling the main stem bronchus of my right lung. My diagnosis was NSCLC with a subtype of squamous cell. Normally, these tumors do not grow quickly. I suppose I am abnormal.

My GP and I have often looked at that January 2004 x-ray together searching for indications of a tumor. There is nothing evident but two broken ribs, the complaint I presented with. In my nearly seventeen years of surviving this nastiness, I've learned that one can never associate the words "common or normal" with lung cancer. There are trends in terms of growth and metastasis but these are expressed as statistical means or medians. Recall, that in statistics, there are always outliers. Apparently I was one.

Lexie's suggestion is one I advocate. Allow the diagnostic process to proceed and focus on getting to a treatment plan. 

Stay the course.

Tom

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Sarah, sorry about your Dad, I hope you get some answers soon.

I am in no way a medical person, and I am not speculating on your father's condition,  but thought I should share with you my experience.

My husband @ 60 suffered a fall at work.  July 2019.  He was self employed so it's not like you can just STOP working.  When he wasn't getting better in 2 weeks his Doc ordered a CT of his head, which came up clear.  He then went on to get his normal CT lung scan (no contrast) and it showed pneumonia. Had short course antibiotics and a repeat CT lung w/contrast in 6 weeks.  Well, now we have a possible neoplasm and are referred to pulmonologist. Another month to wait, which he never made it, he landed in the ER with abdominal pain, was admitted, and biopsy was done there.  He went from nothing to full blown cancer in about 9-10 weeks.  It's insanely aggressive. However, a NP explained it best to me when it happened.  She simply said a lot of what shows up on these scans looks like an infection.  They can also show lymph nodes reacting to an infection as well.   I really hope that's the case, but you are also correct to stay on it, as pain, shortness of breath, and these latest results most definitely need follow up.

 

Good luck! 

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