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1.8 cm nodule


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Hi,

44 yo M here from the Central Valley in California. I’ve had asthma all my life, especially as a child so lung ailments aren’t anything new to me. About 3 weeks ago i woke up in the middle of the night feeling like i was choking and it was relieved by sitting up. At the time i figured it was my sleep apnea and maybe gerd so I dismissed it. However over the next few weeks it worsened with increasing chest tightness and shortness of breath. 

That finally got me to get a blood test done which was normal including the cbc (most likely because i took prednisone i had sitting around). I figured I probably had covid and was slowly improving and didn’t need further work up but i did ask my doctor to put in an order for a chest xray in case i didn’t get better. 
 

Fast forward 3-4 days later and I still haven’t gotten over it so i went in today for the xray and they called me back literally 10 minutes after i left the hospital saying i have right lower lobe pneumonia and a 1.8 cm nodule on the same side viewed via lateral xray. 
 

Most people would freak out but then i  remembered i had a ct scan done 5 years ago of my chest to rule out a PE and they had found a nodule then. Unfortunately i don’t know if it’s the same one since i never followed up and it was a different out of state hospital. 
 

Anyhow, i have a ct scan scheduled on the 20th and I’m hoping this nodule isn’t malignant though there is a 40% chance it could be, especially given the size. The one thing i have going in my favor is I’ve never smoked nor had an occupation which was near cancer causing chemicals. Hoping for the best and glad i found this community! It’s difficult to get support from even friends because they don’t quite understand how it feels to go through this and how isolating it feels. 

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Brian,

We completely understand how it feels but let's not jump to conclusions. The fact you had a nodule discovered 5 years ago gives me some comfort that what doctors are seeing is the 5-year old nodule. There are many reasons lung nodules form, and here is my go-to resource on pulmonary nodules. As you can see, most of them fortunately are not indicative of cancer. Speaking of lung cancer, the only way to diagnose our disease is with a tissue biopsy. That may be in your future so here is information about typical biopsies used in diagnosing lung cancer.

Let us collectively hope you've got a bad cause of asthma.

Stay the course.

Tom

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5 hours ago, Tom Galli said:

Brian,

We completely understand how it feels but let's not jump to conclusions. The fact you had a nodule discovered 5 years ago gives me some comfort that what doctors are seeing is the 5-year old nodule. There are many reasons lung nodules form, and here is my go-to resource on pulmonary nodules. As you can see, most of them fortunately are not indicative of cancer. Speaking of lung cancer, the only way to diagnose our disease is with a tissue biopsy. That may be in your future so here is information about typical biopsies used in diagnosing lung cancer.

Let us collectively hope you've got a bad cause of asthma.

Stay the course.

Tom

Hi Tom,

Thanks for the kind remarks. I'm hoping that's not the case either but I'm very worried regardless. I just got a hold of my old CT report from 2014 (turns out it was 7 years ago) and there were 2 small nodules in the same area (RLL) measuring 6 mm (ill defined margins) and 2 mm. My recent x-ray shows RLL nodule of 1.8 cm so that's extremely worrying to me. Hopefully not the same one but I guess I'll find out more when I have this new CT done on the 20th. My brother in law is a surgeon and I talked to him about it and his reasoning was that if it was the same nodule, it would have been much bigger than 1.8 cm by now and metastasized so it's likely not the prior two they found but a new one or not one at all. This waiting is definitely nerve racking. 

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Welcome Brian. So sorry for your predicament. I would be concerned as well, especially since you have seen growth. Hopefully a CT/PET scan will reveal it is just one nodule.

Yours is about the same size as mine back in 2005 that we monitored for 6 years then stopped. Forward to Dec 2019 and it had grown to roughly 4cm round with lymph node involvement. Turned out it's a rare form..Large Cell. Hoping yours is vanilla LC (no such thing) and Surgery is an option (not to jump the gun) if it turns out to be LC.

You have found the right place! So many treatment options now.

Peace

Tom

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7 minutes ago, TJM said:

Welcome Brian. So sorry for your predicament. I would be concerned as well, especially since you have seen growth. Hopefully a CT/PET scan will reveal it is just one nodule.

Yours is about the same size as mine back in 2005 that we monitored for 6 years then stopped. Forward to Dec 2019 and it had grown to roughly 4cm round with lymph node involvement. Turned out it's a rare form..Large Cell. Hoping yours is vanilla LC (no such thing) and Surgery is an option (not to jump the gun) if it turns out to be LC.

You have found the right place! So many treatment options now.

Peace

Tom

Hi Tom,

Wow 14 years for it to grow is definitely an odd one. What stage were you at and how are you doing now? I’m mainly afraid of losing the ability to take care of myself as I’m alone and slowly declining would be hard to do. 

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4 minutes ago, BrianK said:

Hi Tom,

Wow 14 years for it to grow is definitely an odd one. What stage were you at and how are you doing now? I’m mainly afraid of losing the ability to take care of myself as I’m alone and slowly declining would be hard to do. 

I agree it's very puzzling. But going over my records I think they indicated slow growth years ago. Regardless....Large cell is suppose to be a fast grower?

I'm doing ok but not as well as I hoped. Lobectomy RLL followed by adjunctive Chemo the adjunctive radiation (if this is ever suggested get smart about it. I would not make the same decision now). Also had a PE in my left lung.

Currently NED. I can do normal stuff but not close to pre cancer yet. Patience patience patience. Next scan in about 6 weeks.

Peace

Tom

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Hi Brian,

Welcome here.  I'm glad that you found us.  So, you are really still at the point of determining if your nodule is part of the 60% that are benign (usually caused by inflammation or pneumonia, etc.).  At this point a CT Scan only show the nodule, as well as any growth if it was a nodule previously discovered.  As Tom said, it will likely take a biopsy to determine if the nodule is a malignancy or not and we do hope that you'll post here once you get that result.  But stay strong...you're still in a diagnostic stage and even if the nodule tuned out to be malignant it does not mean a death sentence.  You'll find solid support here and plenty of firsthand experience from people who are survivors.

Lou

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Is it normal for the pulmonary nodule to be evaluated via CT WITHOUT contrast? I have a family friend who is a pulmonologist saying that CT w/contrast WITHOUT PE protocol is better but my provider (Kaiser) is insisting they will do a CT without to prevent complications from the dye. 

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I've had CT scans with and without contrast. Never had a reaction to the dye. If you think you're allergic to it, I don't think they have a choice but to avoid the contrast. I think a PET/CT scan is better for imaging the 1.8 cm nodule, but it is possible the PET won't show SUV/uptake, which could be considered an inconclusive result. In that case, your doctors would just watch the nodule by regular scans. 

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So update: CT scan done and fortunately my brother in laws brother who works at Kaiser (radiation oncologist) had immediate access to my CT scan. He noticed the same nodule that was spotted in 2014 and commented that it looks nearly identical. My brother in law is a general surgeon and he seemed to think the nodule is probably old scarring. No lymphadenopathy anywhere or any other pathology according to them so they think i likely won’t need a follow up CT. 
 

Also have a family friend who is a pulmonologist that will be going over both CT scans in depth but for now i sent him both CT images of the nodules and he seemed to think they were nearly identical as well.
 

So thank god it seems like good news and although I still feel a bit paranoid as this whole ordeal felt like my world was ending and I still don't have the official report from Kaiser yet. I wish you all the very best, you’re good people and i hope you all emerge NED. 

 

EDIT: Kaiser just sent in their evaluation and now I can FINALLY relax and breath a sigh of relief although I still have that granuloma and atelectasis to worry about (pneumonia is still lingering). 

CTResults2021.png.0a11cea428f7f0548b9a5b7df1bdc776.png

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Good news!  Like most nodules it is not of concern...So now you can turn your attention to those things that will help you breath better at night (perhaps a wedge pillow?), fully recover from that pneumonia and put LC out of your mind.

Lou

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6 hours ago, LouT said:

Good news!  Like most nodules it is not of concern...So now you can turn your attention to those things that will help you breath better at night (perhaps a wedge pillow?), fully recover from that pneumonia and put LC out of your mind.

Lou

Thanks Lou! I guess I’m a natural worrier because I started googling trying to figure out why i have atelectasis and it keeps talking about tumors or surgery as the principal causes. I didn’t have any surgery so now I’m worried that maybe the CT missed something. I have had pain coming from that area despite taking antibiotics and my sister (who is a nurse) keeps saying that’s normal for pneumonia. But everything i read suggests that atelectasis causes pneumonia not the other way around. I do as noted before have sleep apnea, gerd and history of asthma.  I guess if i don’t get better i might ask for a bronchoscopy. 

Did any of you have intermittent sharp back pain at all? Also, did any of you have atelectasis? 

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@BrianK my pulmonologist explained that actelectasis is commonly reported due to being supine during the CT. It’s reported on most of my scans. So I wouldn’t worry. No abnormalities were reported on your CT 👍

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Fantastic! Boy you have really good friends for this! Sounds like your golden to me. But keep an eye on it. I had a nodule found in 2005 and followed thru 2011ish when we changed providers. 18 months ago it was the size of a lime! Other than that.....go live.

For the record I have KP and only get CT with contrast or a PET. They actually call em CAT/ PET scans?

Peace

Tom

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