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