Lung Nodule

[Arisa]

Hello , Today my mom's CT scan came back and said nodule has grown from 6mm from 7mm after a year. Doctor said it's solid and smooth. It's on right upper lung. He give us two option 1) wait and re scan after 6 months. 2) needle biopsy. 

My mom have been monitoring for 2 years .Nodule was at 4 mm (2020)- 6 mm (2021) - 7 mm (2022)

She had TB years ago and got treated

Which would be a better option ? 

Thanks. 

 

[LouT]

Arisa,

Welcome to our forum.  So, your mom has a nodule that has grown, but is still very small.  At this point your doctor may decide to do some additional testing.  Perhaps a PET scan to see if any of the nodule "lights up" indicating it may be cancerous and if there are any other areas of concern throughout your mom's body. But, at the end of the day, a biopsy will need to be performed as that is really the gold standard of testing nodules.  If for any reason a needle biopsy is not possible a "liquid biopsy" via a blood test may be able to be performed.  One way or another more testing is needed so the doctors can properly determine if the nodule is cancerous or not and if there might be any spread to other areas.  With all the diagnostics done your doctor will then present your mom with options ranging from surgery alone to many other forms of treatment for the cancer.  Once you have all the test results you can sit down with your doctor and really discuss the best options.  After you do that please share here and you'll surely find people who have had the same or similar treatments and they will be able to share their experiences with you.

Meanwhile one of our members wrote a great piece called, "10 Steps to Surviving Lung Cancer; by a Survivor" and it can be found here.

Lou

[Tom Galli]

Arisa,

Welcome here!

Before I comment on options, I want to complement you and your mom on diagnostics tracking her nodule. That is, in all cases, the right thing to do.

Mom's TB complicates an answer about options. TB can often produce lung nodules and even these can change (or not) year over year. In fact, your mom's 1mm progression is so small it might be lost in the accuracy range of the CT equipment. Consider two things--7mm is the size of a typical camera on a modern cell phone and this makes it a hard target for successful needle biopsy (to Lou's point), and small nodules if metastatic often do reliably produce SUV uptake so a PET scan can be problematic. 

I'd ask a thoracic surgeon, interventional pulmonologist, or interventional radiologist about the possibility of a successful guided transthoracic needle biopsy for a definitive diagnosis. Here is some information about needle biopsies. And here is information about pulmonary nodules. If her practitioners decline to perform a biopsy, keep on tracking things with a CT.

One more thing. I've survived 18 years after diagnosis and my yearly monitoring scans still show nodules. I call them my "phantom" nodules because they appear and disappear randomly. To retain my sanity, I use the diagnosing radiologists report about location and chart them on a spreadsheet. So far, nothing new. Just a waxing and waning of nodules scan after scan. Why? Who knows!

Stay the course.

Tom

[Arisa]

Thanks for the responses.

My mom never smoke and has no health issue. Is smooth nudle indicate that's not cancer ? . Are there any risk if we decide to do biopsy ? . 

[LouT]

Arisa,

As Tom told you having any kind of lung disease (e.g., TB) can create nodules.  But under normal conditions 60% are not cancerous.  They may just decide to watch this nodule to see what happens.  Tom sent some information on biopsies so please discuss them with your mother and/or her doctor.  Right now there is very Little growth (6mm to 7mm could actually be an artifact in the scan) over a year so this is not a rush situation.  Needle biopsies are difficult on very small nodules.  Side effects from some biopsies can occur, but rarely.  If the needle biopsy is through the chest wall or back there is a small chance of a pneumothorax, your doctor should discuss these risks and their probability of occurring.  But I believe you need to  focus on what the medical team determines is the best next step for your mom. 

BTW, while most people with LC (Lung Cancer) have a history of smoking a sizable number with LC were "never smokers".  

Lou

[Karen_L]

Hi Arisa, 

What I've read is that medical professionals don't get worried until the nodules reach a certain size, perhaps one cm?  You might want to ask your mother's team what their criteria is for further action. 

[Arisa]

On 3/5/2022 at 7:20 AM, LouT said:

 

Talked to the doctor, he recommend rescan in 6 months to see if there are any change. I am worry that 6 months seem to long . Nodule is too small to biopsy.  

[LouT]

Arisa,

In one year the nodule grew only 1mm...that is amazingly slow and small...I just believe he's weighing this all out and is making a sound decision.

Lou

[LoriF]

I had a chest CT completed 5-18-2022.  According to the report, the radiologist noted "multiple scattered up to 7mm semisolid pulmonary nodules" as well as "scattered less than 3mm solid pulmonary nodules".  When I met with my pulmonologist on 5-25-2022, he stated I had "submillimeter nodules" and not to worry.   I inquired about the discrepancies in the findings, however have not yet heard back from the doctor.  Curious for an explanation regarding the differences in assessment of the scan?

I also completed a CT Angiogram (calcium score test) on 2-22-2022 to rule out any coronary disease.  The results came back normal including my lungs.  Would this CT scan be able to pick up the nodules if they were present back in February?  

Both tests were given due to shortness of breath, chest pains, and sporadic increases in HR for the past year and a half.  I am a former smoker (1.5 - 2 packs a day for 20 years, last year smoking was 2013).  Maternal aunt and paternal uncle both passed of lung cancer.  I am otherwise healthy 41 yr old female.  Any insight would be greatly appreciated.  Thank you!

[Tom Galli]

Lori,

Welcome here.

Sadly, I am very acquainted with pulmonary nodules. First and foremost, most are not lung cancer. Here is my go-to-resource about pulmonary nodules.

I'm only scanned yearly now but I have "phantom" nodules. They wax and wane scan after scan and the only way I retain sanity is to map them on a spreadsheet using the radiologist report description. I also always get a paper copy of all test results including radiologist interpretations of scans. I keep these copies as reference and thereby add precision and understanding to bolster my declining memory.

Some folks post the actual language of the radiologist interpretation of scans on this forum so we can help you understand the meaning. We are not doctors but have acquired a lot of knowledge about the obtuse language in CT and PET scan reports. 

To your question, would a CT Angiogram for coronary disease be able to pick up nodules if present on a previous scan? Maybe. Anatomically, I would think the scan might capture the left lung, particularly the upper lobe. If your nodules are in the right lung or left lower lobe, then perhaps they wouldn't show.

Most important, know that pulmonary nodules are not conclusively indicators for lung cancer. Only a tissue biopsy can confirm our disease. There are other plausible explanations for shortness of breath, chest pain and heart rate swings. I hope this helps with the insight.

Stay the course.

Tom

[LoriF]

Tom, 

Thank you for the kind welcome and the sound advice.  I will continue to document each of the findings as time progresses.  I just heard back from my pulmonologist and was advised to get another CT in 3 months to check for growth.  Thank you for taking the time to respond and sharing your insight!  It's greatly appreciated!!

Lori 

[Arisa]

Hi everyone I have a update on my mom lung nodule from last time. Doctor recommended to rescan in 6 months and nodule didn't change size still at 7mm . And doctor recommended recan in 1 year , this time it's now at 10mm . I am very scared and confused. Now waiting for her doctor to call us for farther discussion but I am very stressed.

 

[Arisa]

So nodule is growing 3mm in one and half year , is that fast growth rate?

[LouT]

Arisa,

You'll really need to see what steps the doctor believes you should take now.  It is possible for benign nodules to grow and even shrink over time. The following is from an article by the Cleveland Clinic, regarding benign nodules that can be found here:

Compared to malignant tumors, benign lung tumors:

• Aren’t cancerous, so won’t spread to other parts of the body.
• Grow slowly, or might even stop growing or shrink.
• Aren’t usually life-threatening.
• Usually do not need to be removed.
• Can expand and push against nearby tissues but will not invade, destroy, or replace other tissues.

If the doctors are concerned they will perform additional tests (i.e., PET Scan, biopsy, etc).  The biopsy can be done in a number of ways, but is considered the definitive test as to whether a growth is cancerous or not.  At that point a decision can be made as to any next steps.  At this point please stay focused on the fact that most nodules are not cancerous.  If you find out it is then there are effective treatments as lung cancer it not the automatic death sentence it once was.  Please keep us updated on your conversation with the doctor.

Lou

[LilyMir]

Did they tell you how the nodule looks like? It is not good that it grew but it is not a confirmation of cancer, only a biopsy would confirm that, or at least a PET scan can give some idea of cellular type. From your description it seems like slower growth but 40% growth is still significant so they have to confirm what it is soon. My tumour doubled (on CT) in 4 years (radiologist missed it the first time but error was exposed after second scan) but it was an aggressive type of cancer somehow and tumour was in fact much bigger than imaged suggested once my lobe was removed and sent to pathology. The key for curative treatment is early intervention so don't let them dismiss it until it has grown much.  

[Arisa]

My mom had TB years ago and treated, so she has multiple nodules but one has grown in size and has been monitored since 2019. Nodule is solid rounded circumscribed. We'll talk to doctor on Sept 25 th.

[LilyMir]

Round is good, better than spiculated but hope the doctors can give you a definite answer soon. I am sure the uncertainty is very stressful. Best of luck! 

[Arisa]

Hi everyone, here to update on my mom's lung nodules. My mom did PET Scan two months ago and her doctor said no uptake on the scan , don't show any active lesions and recommend recan in 1 year. 

[LouT]

Arisa,

Thank you for the update and it is good news.  Your mom's doctor's seemed to have taken the correct and careful approach.  My hope is for good scans going forward as well.

Lou

[Chuck K]

Arisa

I know you are relieved time for celebration

Chuck

 

 

 

[NYC GUY]

I have a lung nodule that was an incidental find at 6MM. was scanning every year for 3 years and it didn't grow until this February it is now 9 MM. My doctor said we should remove it or biopsy it. I felt might just be better to remove. I got a second opinion and doctor at NYU said same thing. I am in my 40/s former smoker, my father had lung cancer in his 40's. He survived after a lobectomy and is now 80 years old. 

Do you think removal is better or should i be taking a PET scan or biopsy before moving forward with removal.  DR said he would remove it and test it while i am in operating room and if cancer clean out more, if not close me up. 

[Karen_L]

@NYC GUY, you may want to re-post this as its own topic-- it will likely generate more responses. 

I'm always envious of people who have the option for surgery. With surgery, you get rid of the nasty thing and you get a biopsy. My tumor and lymph node locations sent me down the road of chemo and radiation, and now, a targeted therapy.  

If you are concerned, it's best to find a second opinion, ideally, from a major cancer center. You're lucky to be near several with the federal NCI designation. You can learn more about why the NCI designation can be helpful here. 

Please consider re-posting this in order to get more feedback. And, keep us posted.

[edivebuddy]

@NYC GUY 

I personally would get a vats fine needle biopsy with a rapid in site evaluation ROSE.  That way a positive finding gets you a resection right then and there.  An early resection is your best chance for a cure.    Good luck to you and sorry you're even faced with this decision.