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New Nodule on CT Scan


RH1970

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Hi All,

I was diagnosed in Sept with NSCLC, T1N2M0, Stage IIIb, EGFR+.  I had concurrent Chemo/rads in Nov/Dec.  My first scan in Jan showed a partial remission with just a slight SUV uptake under a PET scan at the original tumor site, which was written off as inflammation.  Also at that time, a liquid biopsy showed no trace of EGFR mutation in the blood stream.  I started Tagrisso as consolidation/maintenance.  My second scan in April showed NED!  I was so happy!

But my most recent 3 month CT scan (July) now shows a new small nodule ~5mm near the original radiation treatment field.  My Radiation Oncologist says it is within 2cm of the radiation field, but definitely separate from it.  My team agrees that it is too small to biopsy or PET scan.  They don't know if it is a recurrence or just the result of scar tissue, inflammation, etc.. surfacing from the radiation treatment.  I'm very worried about this result.  Of course, I'm hoping that whatever it is, it's benign.  I expected to continue on Tagrisso for longer than 6 months, and indeed my Medical Oncologist says that ,statistically, the Tagrisso should still be working.

I go back for another scan in 1 month to see if the nodule has changed and possibly PET.

Has anyone here had a similar experience?  Could this indeed be benign growth?  My mind is racing, already plotting courses for treating a recurrence.

Thanks so much for any input.

-Rick

 

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5 mm is VERY small. You do want to follow up on it, but even if it's a recurrence/progression, you are catching it early. And there is a good chance it's nothing to worry about.

Try to relax--you can't do anything about it till there is more information, so no good in getting ahead of yourself. 

 

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Hi Rick,

Many of my friends in targeted therapy who had radiation do have scans very similar to yours.  What the radiologists do not have a great deal of experience in is ironically interpreting these results.  Both targeted therapy and radiation can produce scar tissue.  The PET is the easiest way forward if your insurance pays for it.  The data is on your side, the Tagrisso is most likely still effective.   Over time scar tissue will become better differentiated on the scans. So hold onto your hope, we’re still in uncharted territory with these new therapies.  Doctors need more time and experience.  Hang in there. 
 

Michelle

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I also have a 6 mm nodule in my upper right lung but I'm considered NED. After enduring chemo and radiation and now on an EGFR targeted therapy (Tagrisso), I have to believe that all of the treatments have been effective. I don't worry about this nodule but my oncologist does watch it for changes. It is too small to be characterized on a PET scan (every 3 months). 

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Thank you for the encouragement all.

I'm trying very hard not to let this consume my thoughts.

Judy, if you don't mind me asking, how long have you been monitoring the nodule?  Did it arise after your treatment?

Thanks again.

-Rick

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Rick, I don't exactly remember when the nodule was first mentioned, but I think it was found after chemo and radiation were completed. It wasn't picked up on my initial CT scan when I was diagnosed in October 2019. It's probably been a year now that it's being monitored. My next PET scan is at the end of this month. 

I really see Michelle's point about radiologists needing to see more of us on targeted therapy. I hadn't thought about it before but it makes sense. Even some oncologists don't have much experience with targeted therapies yet. 

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