Introduction - dealing with uncertainty

[Schnib]

Hello all,

First of all, let me say reading through the comments in this forum has been a God send.

Unfortunately I'm here due to uncertainty with my father. He is a breast cancer survivor of 5 years, having been discharged from oncology last year. Recently he has been having chest pain which had been put down to a pulled muscle in the chest. However, after no improvement in the chest pain, had an x-ray which revealed a nodule on the lower right (suspected to be on the lung). Nodule is estimated to be 13mm-19mm long. CT scan is booked and from my understanding and previous experience on the breast cancer journey, nothing much more can be deduced until CT results are back.

I'm trying to remain positive; nodule isn't small but it also hasn't been classed as a mass. However, it's very much on my mind that this could be a new cancer or a secondary cancer as a result of recurrence of breast cancer. Trying to be positive that nodules can be caused by a number of other reasons but also aware that the previous cancer and the pain symptom could be negative factors.

I know you are all living through your own battles so thought I'd say hi and see whether anyone has experience with a similar situation?

[LexieCat]

HI, Schnib, and welcome!

I think you and your dad may have to wait for a biopsy to figure out exactly what's going on. If this turns out to be a metastasis from his breast cancer, then it will be treated as breast cancer, not lung cancer. They are different diseases and treated in different ways. The CT scan will give them a better look, but it won't tell them the type of cancer. The size does sound somewhat suspicious for cancer, and I believe a solitary nodule is somewhat more likely to be lung cancer than metastasis (note I'm not a medical professional--just been dealing with this for a while). If it turns out to be lung cancer (as opposed to breast cancer), we can be more helpful in terms of explaining what's going on and what you/he can expect in terms of treatment. If it turns out to be lung cancer with just the one nodule, and there are no signs of spread (typically determined with a PET-CT scan), then treatment might be just a relatively simple surgery. 

Chest pain like what you're describing would be an unusual symptom of lung cancer. It could be, of course, that the pain is a pulled muscle or something and the nodule is just an incidental find. A lot of people have their lung cancer discovered when they are being diagnosed/treated for something else.

Keep us posted

[Schnib]

Thank you Lexie Cat. Completely appreciate that we don't know what we're dealing with yet and that breast cancer isn't the reason why people are on this forum. Also, I get it that this forum isn't full of medical professionals; it just seems a good community to be a part of

RE the size and it being 'suspicious for cancer' do you mean suspiciously large enough to potentially be a cancer?

RE the symptoms - the only symptoms he has that I'm aware of is the chest pain I've already mentioned and fatigue. Both can potentially be explained though - pulled muscle in the chest and tiredness because he does a manual labouring job and has been told his breast cancer meds can cause fatigue, particularly after being on them for a number of years. Oh and weight loss too as he has gone off junk food and beer so, again, there's an explanation.

I don't want to be naïve and want to prepare myself for what could come but am still holding out that there is some hope.

[LexieCat]

Most lung nodules are something other than cancer--for example, scar tissue from a lung infection. But larger ones are, I believe, somewhat more likely to be cancer. 

Many lung cancers have no symptoms. I had none--my original cancer was found during a screening for lung cancer. I had surgery for that and then three years later a second lung cancer turned up during a routine post-surgery scan (unclear to docs whether it was a spread/recurrence from the first or a totally separate lung cancer). But I never had pain, shortness of breath, cough, or any of the "classic" lung cancer symptoms. I've now had chemo and immunotherapy, which has resulted in a great response.

The thing is, his nodule isn't huge, so if it's lung cancer and there's been no further spread, treatment might be pretty simple. And even if there has been spread, there are a number of very effective drugs and other treatments, depending on the exact type of lung cancer. 

So I can't speak to the breast cancer possibility, but there's definitely reason to be hopeful if it turns out to be lung cancer.

[Schnib]

Thank you for your kind words, especially when you have your own stuff to be dealing with. I'm glad to hear you've had a great response to your treatment. Back to the waiting game now while scans are concluded. If anyone else has any experience with a similar situation I'd love to hear it ☺️

[Jesse L.]

Welcome to the forum... To expand on what LexieCat was saying, her and I have quite a few similiarities. I had absolutely no issues whatsoever and went in for an annual CT last 12/15. Sure enough a suspicious nodule (1.8mm x 1.2mm) was noted in my RLL. A biopsy was done on 12/31 and it was determined to be adenocarcinoma. Note that something is not considered a mass untill it is 5cm or larger. In any case, I had a VATS lobectomy on my RLL on 2/25 to completely remove that nodule, but wouldn't you know it while they were in there they found two affected lymph nodes and removed them as well. Well, from initial diagnosis for an easily removable nodule stage 1a I went to a stage 3a because of the affected lymph nodes. Now this may seem to be getting worse from the get go, but all is not lost by a long shot. According to the American Cancer Society website, cancer that has minimally spread to lymph nodes is usually destroyed in those lymph nodes. However, the article also went on to state that there may be a few escapees that will get out and seek to set up shop elsewhere. For that reason I am now going through adjuvant chemotherapy to destroy any cancer cells that may possibly still be roaming around in my body. Some things to consider:

You absolutely need a biopsy to know what you're dealing with. Lung nodules happen for many different reason...in fact it has been determined that half of all people past 50 yrs. old have lung nodules and for sure not all are cancer.

Nodule size is no indication of whether something is cancer or not. That being stated better to catch it early...that leaves a lot more treatment options on the table for your medical team to consider.

While I am not a medical professional, I do know that unless a growth is obstructing an airway a person with it will not notice anything at all. I have been told that there are no (repeat no) nerves in our lungs. That's both an advantage and a disadvantage in that if you ever need surgery it's not that bad but there will also be nothing telling your body that something is wrong in the first place. That's why there are quite a few people who when they finally go in to get checked end up with a somewhat dire diagnosis. No matter what everyone should be getting an annual CT scan...if you have a pair of lungs you can get lung cancer...period.

Therefore, I believe most likely that any pain your Dad has is not associated at all with the lungs. It certainly could be the combination of things you stated though. 

In any case, whatever you have to deal with is just something you have to do; there is no alternative. My recommendation is to ask many, many questions, learn all you can, and with that knowledge be the best advocate you can for a healthy long term outcome. Sure you can learn from this website, but there's lots of information on the internet too. Whatever you do though be mindful of the dates in the articles on the internet touting life expectancies. Most of the statistics go by 5 yr. life expectancy and that ignores most of the targeted and immunotherapies just developed in the last few years.

All good things to you and stay in touch...we will support you!☺ 

[Tom Galli]

Schnib,

Welcome here. You've received good information from other members. Just two things to add: sometimes our US treatments, scans, and methods differ from those in the UK and here is my go to resource for explaining lung nodules.

Stay the course.

Tom

[Schnib]

Thanks again for the detailed responses.

@Jesse L. - I really hope your chemo is effective, better to be on the side of precaution of blitzing any potential escapees. Can I check I've understood you correctly - are you saying you don't believe the chest pain is associated with the lungs because of there being no nerves in the lungs to register the pain? I suppose it is possible though for a nodule to push outward into a space where there are nerves (such as a muscle)? Again, I am not medical so don't know the legitimacy of what I've just suggested.

@Tom Galli - yes, I appreciate the US and UK systems are very different. It's still great to have support from you folks though and to gain a perspective of what scans / treatments have looked like for you. As we all know cancer is non-discriminatory, be it that we are American or British! The article is very useful too, thanks 

[LexieCat]

There are certain types of lung tumors (particularly the ones they call "pancoast" tumors at the upper edge of the lung), that can press on nerves causing pain (usually to the arm/shoulder). Again, though, that's pretty unusual--pancoast tumors are relatively rare. Usually if lung cancer is causing actual pain, it's so far advanced that the pain is from metastases (e.g., in the bones). So given that your dad has what is apparently a single nodule of that size, I'd be very surprised if it had anything to do with his chest pain.

 

[Schnib]

@LexieCatThe location of his nodule is in the lower region. With you mentioning pancoast tumours being in the upper edge of the lung that potentially sends less likely? I think my biggest concern is not understanding the impact that the previous breast cancer may have and what the likelihood is of the lung nodule being a metastasis of a recurrence of it....I do appreciate your words of reassurance though, there are just so many variables at play!

[LexieCat]

Anything I, or anyone else here, says is just guessing/spitballing. I can talk about what I've experienced and to a lesser extent what others here have talked about in the almost four years I've been dealing with this. What I'm saying is that it's common for pancoast tumors to cause nerve pain. I personally have never heard of anyone having any other kind of pain as a result of the primary tumor/nodule. Could it happen? Don't know, I just haven't heard anyone talk about it, nor have I read about it. 

And I really don't know the odds of its being a met from the breast cancer vs. a totally separate cancer. His oncologist would be in a far better position to give an opinion on that.

I get your frustration. At this stage of the game it's like trying to read tea leaves to figure out what's going on. This is the part of the process that stresses most people out the most. Once we have a diagnosis and a treatment plan, most of us feel better because we can start doing something about it.

[Schnib]

I appreciate your honesty and I appreciate that you can only speak from your own experience. Apologies if it felt like I was putting pressure on you. I know that I can't take this forum as gospel as I haven't heard anything from the oncologist yet. However, it's invaluable to gain other insights and perspectives from people that are far more experienced with this than me and have been living with it. You're right, the waiting game stage is awful. I'm grateful for all of your support

[Jesse L.]

I know it's easy to speculate and much harder to wait for a definitive biopsy, but really that is needed in your case. It could be a mets or it could be a whole new growth or it may not be a cancer at all. Way too many variables at play... You just have to play the waiting game...no matter what it is fortunate the nodule is small. You caught it early and that's half the game. You just have to stay on it and get good answers from medical professionals as soon as you can. 

And it sure doesn't hurt to become educated as much as you can...the more you know the better health decisions you will make now and into the future. Be careful not to make it worse than it is though. It's an easy thing to do...just count your lucky stars for the advantages you have and deal with the legitimate things that come up... 

[Schnib]

I know, too many potential outcomes but all too easy to speculate. I think it's a fine balance between the old saying, "information is knowledge and knowledge is power" vs falling into the old Dr Google trap....I am trying to remain positive

[Judy M2]

All I can add is that I've never had any pain from lung cancer itself.  My left vocal cord became paralyzed and I lost my voice, which is what led to my diagnosis. After successful chemo and radiation treatments (and now targeted therapy), I still have a 6 mm nodule that seems stable but is being watched. It is too small for a PET scan to characterize. 

[Schnib]

Hi @Judy M2 thank you for your input. Great news for you about your nodule seeming to be stable now. Did the treatment shrink the nodule or was it always 6mm? Interested to know how that works

[Judy M2]

I honestly don't know whether treatments affected the nodule or not. They certainly tackled the cancerous 6 cm tumor in my LLL and all the lymph nodes pretty well.