6 month scan...possible recurrence

[Steph1235]

Hi...today was my 6 months scan.  It’s my 3rd scan since my RLL lobectomy in Sept. 2019.   I had stage 1a adenocarcinoma.   Today they told me there is a small spot on my right upper lung and they want me back in 4 months instead of 6 months.  I’m a little scared.  I just read the report and it says:

“Status post right lower lobectomy and mediastinal lymph node dissection with stable postsurgical changes. Mildly increased 1.3 x 0.9 cm, previously 1.0 x 0.8 cm right upper lobe subpleural irregular nodular opacity was not clearly identified on CT from April 9, 2020.”

This is the size of the previous nodule that was removed with my right lower lobe.  They never mentioned this spot to me in October when I was there?

I’m a nervous wreck.  I made it 18 months with no issues.  This has me concerned because it’s now in the upper right.  Locations says:  “subpleural inferior lateral”

report goes on to say “possible neoplasm”.

What would be the course of action if it grows in the 4 months?  Another VATs?  Can they remove my upper and just leave the middle lobe without a lower / upper lobe?   I did nit have adjuvant chemo after my VATs and I wish I did now.  It was not offered since my lymph nodes were clear.  The size of this new one seems big to me? Would they just do chemo?   So many questions.

anyone here have lower right lobectomy and they have a recurrence in upper lobe?  

[LexieCat]

Hi, Steph,

I've been in your shoes, only my second cancer was discovered three years, almost exactly, from my lobectomy. 

If it turns out to be cancer, the diagnostic drill will most likely be similar to what you went through before. There will more than likely be a PET-CT, biopsy (if possible), and testing for biomarkers. The treatment will depend, again, on the stage. I wasn't excited about having more lung removed, and my oncologist said if it came to that, I might be a candidate for Cyberknife (precision radiation). Unfortunately, in my case, I not only had a few lymph nodes that were cancerous, but there was also a very small (7 mm) bone met on my sacrum, which made it Stage IV. 

So I was put on a course of the triplet (Carboplatin, Alimta, and Keytruda) for 4 cycles and am now on maintenance therapy of Alimta and Keytruda, which will continue indefinitely. The good news is I've had a terrific response to the chemo and immunotherapy and the side effects haven't been too bad.

BTW, in my case, nobody can say for sure whether it's actually a recurrence or an entirely new cancer, so don't beat yourself up for not having chemo the first go-round. I passed on it, too, and though I sometimes wonder whether it would have made any difference, several of my doctors say if it were them, they'd do the same thing. 

So don't worry (easier said than done, I know), but if it turns out to be cancer, there are still plenty of tools in the toolbox. If it's just the one nodule, you might have surgery or radiation. If you have an actionable mutation, you might be able to get targeted therapy. Otherwise, chemo and immunotherapy can be very effective. 

Hang in there, and keep us posted. I think if I were you, I might ask my oncologist for a PET-CT now, rather than waiting another four months. It can be hard to get those approved by insurance, but it's worth asking about, IMO.

 

[Tom Galli]

Steph,

Unfortunately, one of the things that makes lung cancer so dangerous is its high probability of recurrence after NED treatments. Here are two suggestions: First get an actual copy of all test reports and read them. We can help you understand what the language means. My reading of your quoted report suggests there was an opacity reported on your April 2020 scan and if this is correct, it should have been discussed a year ago.

Second, as Lexie suggests, there are many tools in the kit to address this reported nodule. If it were me, I'd choose precision radiation (CyberKnife or a similar type) and likely adjuvant chemo. At the minimum, I'd seek a consultation with a radiation oncologist in addition to your medical oncologist. I personally like the idea of "frying" the nodule and taking it off the table!

Stay the course.

Tom