Not Diagnosed ~ In the testing stage

[DRock]

Hi Everyone,

I am a 54 year old female, thyroid cancer survivor (2014).  Thyroid was removed, one dose of radiation treatment, been cancer free since.

I have heart disease a (Hypertrophic Cardiomyopathy) and Multiple Sclerosis.  Only history of cancer that I’m aware of is my mom passed away suddenly 25 years ago.  She died of lung cancer, was 49 years old.

At the end of August, I had a head/neck CT scan for a different health issue.  The CT scan of my neck found the following:

- Two irregular nodular opacities in the right upper lobe (lung)

- One is 12mm, the second is 16mm and they are adjacent to one another

Because these were found inadvertently, the radiologist recommended a CT scan of my chest in 3-4 weeks.  I am waiting for an appointment.

****I am not looking for medical advice.  I know that they only people that can give me that are my doctors*****

I’m only trying to understand the little bit of information that I have and some of the research that I have done.

Question:

Is it true that nodules located in the right upper lung are more likely to be cancer?  If so, what is the reasoning?

Nodular opacities - is that the same as “ground glass opacity/nodule” 

Size:  12mm and 16mm are those considered small?  The internet says that “Nodules greater than 10 mm in diameter should be biopsied or removed due to the 80 percent probability that they are malignant.” …is this a somewhat accurate statement?

I’m interested in people’s experiences, advice, sharing.  Regardless of whether these are benign or malignant, I will deal with it like everything else in my life.  Positively, optimistic, head on with a smile on my face 😊 

Thank you for reading,

Carrie 🇨🇦 

PS - Being a cancer survivor and having spent some time researching, reading and learning via these types of sites, I must say that this site is the best one that I have come across.  The information has been excellent and the people replying to questions, posting questions or sharing their stories have done so with such kindness and support.

[LouT]

DRock,

Sorry you need to be here, but glad you found us.  I'll try to handle your questions best as I can.

1.  I've never heard that the location of lung nodules was a predictor for malignancy or being benign.  Most lung nodules (~60%) are benign and require watching over time.

2. My nodule was 11x13mm and it was not considered large, but enough to be a problem.  Smaller nodules can often be difficult to get a tissue biopsy from and that can slow down the diagnostic process.  The more important trait is if the module is stable or growing.  Benign nodules rarely grow although they can sometimes appear and even disappear over time.

3. We have a section in our Lung Cancer 101 series called "Diagnosing Lung Cancer" that will provide you with helpful information as you go through the diagnostic process.  Take a look at this page.

4. The first thing I want to do for you is share a blog that will be helpful; "10 Steps to Surviving Lung Cancer; by a Survivor" it will provide a lot of good advice for you and it can be found here.  This will be quite helpful if you are in fact diagnosed with Lung Cancer.

You seem to have a positive attitude and that will serve you well regardless of the outcome of your testing.  The good news I can share is that Lung Cancer is no longer the automatic death sentence it once was.  I was diagnosed in 2019, had surgery (lower-right lobectomy), and have been NED (No Evidence of Disease) ever since.  You'll find many survivors here and as you go through your journey we'll be here to support and help you.

Lou

 

[Tom Galli]

Carrie,

Welcome. We've lots of folks from Canada and BC in particular. 

On nodules and their location, I haven't read anything about an anatomical location and lung cancer nodules. Nodules are tricky. After nearly 18 years of survivorship, I have what I call phantom nodules. They show on one scan then disappear on the next. I track them on a spreadsheet to keep my sanity. Here is the place that explained pulmonary nodules and their multitude of causes the best. Note, most pulmonary nodules are not lung cancer, fortunately.

I conclude there is a visible difference on an image; nodular opacity is a circumscribed shadow while ground glass opacity appears white or frosted. Causes however are similar. Here are definitions:

• Nodular Opacity: "a solitary, round, circumscribed shadow found in the lung...causes include granuloma, primary or secondary carcinoma, benign tumor, vascular malformation."
• Ground Glass Opacity (GGO): a normally dark area of the lung now looks white or frosted. There are many causes including infection, fluid, blood, inflammation, scaring or cancer.

Nodules greater than 10mm should be biopsied or removed? I'm not sure I agree that size alone is the governing factor. Lung nodules are a relatively recent phenomena. They don't show on x-rays; CT technology was the discovery method. Here is a 2019 paper that focuses on approaches to and management of lung nodules. Note in particular the information in the "Nodule size" paragraph. This information is complied from a high-lung cancer-risk population and suggests nodules below 6mm are "acceptably low cancer risk" while a nodule >8mm represents risk. But nodules size alone is not the key indicator; it is change in nodule size, particularly increasing nodule size that is of concern. That is why many of us with nodules on scans often need to endure repetitive scans. I've had a multitude and waiting for results produced Scanziety!

I would say that a single scan showing two irregular adjacent opacities of 12mm and 16mm would yield exactly what your doctor suggests--a repeat scan.

I do hope your next scan shows no change in your nodules or that they simply disappear!

Stay the course.

Tom

 

[Minh]

One of my oncologists told me that for smokers or former smokers, it’s generally true that nodules in upper right lung lobe are more likely to be cancerous. The reason is when you smoke, the right lung will take in more smoke volume than the left lung because it’s bigger. And most of carcinogen smoke trapped in the lung would tend to float from bottom to the top of the lung. So over years of smoking, carcinogen particles tend to collect themselves on the top lobe of the right lung which likely lead to cancer. This is one of the reasons right lung cancer is slightly more prevalent than left lung cancer. Smoke usually floats from low to high location.

Again my oncologist told me that the shape and consolidation tumor ratio (CTR) is more important than size. If the nodule shape is spiculated and has more solid component, then it has high probability of being cancer. If the tumor has round shape and no solid component, it is less likely to be cancerous.

I had a 16mm nodule and he claimed it’s small. After the RLL lobectomy to remove this nodule, I still have 2 nodules with sizes of 5mm and 6mm which he said to wait and see. He won’t do anything until they consistently grow over 7mm. 

[Judy M2]

@Minh, your comments are very interesting. A couple of years ago as a result of a mammogram, I needed to get a biopsy done. The radiologist told me it was just a precaution because what showed up was round, and he said "cancer isn't round". Sure enough, what I had was a benign cyst. 

I've had a 5 mm nodule in my upper right lung for a couple of years and lately it's not showing up on scans anymore. My oncologist had also adopted the wait-and-see approach with it. 

@DRock, I hope this turns out to be nothing of concern. Glad you'll be watched closely so if there is any change, they'll catch is quickly. 

[DRock]

I couldn’t figure out how to reply to each of your messages so thank you all for reading and replying to mine, I really appreciate it.

Lou and Tom, thank you so much for all the information.

Lou, I am curious about something.  I understand that benign nodules rarely grow.  So when people are diagnosed with a nodule, say 16mm and it is benign, how did it get to that size.  I assumed that it started out smaller and grew to that size but based on that info, that obviously isn’t the case.  Does it just appear at that size?

Mihn and Judy, thank you both your replying as well.  Interesting info Mihn and Judy, I too hope that it turns out to be nothing.  Everything crossed 🤞 

[LouT]

DRock,

Of course the nodules are first formed, often from an infection or as a result of an irritant to the lungs.  Cleveland Clinic has some very good information on lung nodules and you can find it here.  While I've read that lung nodules are benign 60% of the time this article claims such at 90%.  Regardless, although a nodule can "magically" appear and disappear benign ones rarely continue to grow once formed.  In my case a needle CT Guided Needle Biopsy wasn't possible so I had to have surgery.  Prior to the surgery I asked my surgeon what the chances were that my nodule was benign and he replied that it was only 10%.  He based his opinion on the fact that over a 3-month period my nodule had grown from 6mm x 11mm to 13mm x 18mm.  I hope this helps.

Lou

[DRock]

Thanks Lou, it was helpful 🙂

Carrie