lung nodule 6mm to 9mm

[NYC GUY]

Hi, I had a 6MM incidental find lung nodule, monitored yearly with no growth. On the 3rd year this past February it was 9MM. Pulmonologist said biopsy or remove. I made appt to follow up but visited a specialist from NYU meantime to get second opinion. This DR said biopsy or remove. I am 47, i was a more then 20-year smoker and my father had lung cancer in his 40's. My father had a lobectomy and survived; he is now 80 years old. 

The second DR told me He advises removing instead of biopsy since its growing it should be removed anyway. I scheduled the removal in April, I have a PET scan scheduled this week. 

Can someone weigh in on this please, 

DR said he would remove it and test it while i am in operating room, if it came back as cancer, he would remove more i guess to clean it out and then close me up. If not, cancer, then just close me up. 

[Tom Galli]

NYC Guy,

Welcome here.

The metastatic concern level increases markedly when pulmonary nodules change size or shape. At this juncture, one's only choice is how to biopsy. Your doctors are suggesting a surgical biopsy but there is another alternative--a needle biopsy. This avoids surgery and a 9mm nodule provides a large enough target to obtain a valid tissue sample for the pathologist's histological (microscope) examination. The PET scan may help you choose because if the scan shows high standard uptake value (SUV) results, malignancy can be presumed. But sometimes small nodules don't give reliable results. Here is information about the PET scan and SUV. 

If the PET scan does not validate malignancy, I'd explore a needle biopsy before agreeing to surgery.

Stay the course.

Tom

[edivebuddy]

I personally would not delay with a rescan or a separate biopsy.  Even though not 100% odds are high of it being malignant.   Stage 1a lung cancer stops at 10 mm  your at 9 now. While it's not known how fast it's growing, every day you wait is a day closer to 1b.  While that's still very wet early it's not 1a. 1a systemic (chemotherapy, immunotherapy, targeted treatment) are not even offered.  While because of your history they would most likely recommend it if you were 1b.

This is the very reason they no longer wait for 10 mm to do a biopsy and now do it at   8 mm 

Good luck to you.  ROSE may come back benign.

[Livin Life]

just want to send support, NYC!  I'm new here and in a similar position.  Rescan in early July.....

[NYC GUY]

Pet scan came back with:: 

right lower lobe/lung base nodule with no appreciable uptake may represent an adenocarcinoma spectrum nodule. Notably, metabolic activity of small pulmonary lesions in this region may not be well evaluated due to diaphragmatic motion artifacts. 
 

I asked what the Dr said and they said they still advise removal and biopsy. Does this sound right from this indication above off my PET? 

[BridgetO]

I had a small, slow-growing nodule in my lower right lobe that didn't show any uptake on the PET.  Because of its location, it couldn't be biopsied without surgery. I had a lobectomy and the noduleturned out to be an adenocarcinoma. My decision to go with the surgery was influenced by my having had two prior non-lung cancers and this thing could have been a metastasis, although the docs all agreed that it was most likely a primary lung cancer due to its appearance on the CTs.

[edivebuddy]

Unfortunately a PET sucks at seeing early cancers.   AIS and MIA lung cancers normally show way less than an SUV of 2 . I'd continue to follow the doctor's advise. Continued good luck to you. AIS and MIA Lung cancers have a 100% 5 year survival.  AIS. Has a 100% 10 year survival if treated.

[Tom Galli]

NYC Guy,

You are in the small nodule, unreliable PET result zone.

Now you have two choices: a CT scan 2 to 3 months from now to evaluate change in size and or shape, or surgery to obtain a biopsy. Depending on where the nodule is, anatomically, the surgeon may remove the entire lower lobe.

I have no suggestion for how you might choose.

Stay the course.

Tom

[Livin Life]

These are tough decisions!  It is important whatever you decide you are comfortable with it... wishing you the best as you decide.  

[TJM]

Hello. I had a 1.2 cm round nodule in my RLL discovered in 2006. Had annual scans for 5 years and then forgot about it.

Fast forward to 2020 (early) and that nodule had grown to the size of a lime. Upon reviewing my past surveillance scans I found that it had indeed been growing very slowly, but growing. No alarms were set off. Also the SUV uptake wasn't high but wasn't  nothing at 1.8

My message is to not forget about it if you go the surveillance route. I ended up with 3 nodes involved and staged 3. Had a RLL VATs, chemo and radiation. Turned out to be Large cell NET (rare for LC) so the stats were scarce. They treated it as if it was small cell. I feel lucky to have had surgery because if it was known to be large cell protocol for surgery is sketchy.

I would have it removed. I wish I had in 2006 (was given the option but doc suggesr a PET scan instead). Suffice it to say I was not a happy camper and made them very aware of that fact.

Best of luck. Probably ok to go either way...if you keep cognizant it is there.

 

[Karen_L]

I'm always envious when surgery is an option for someone. It offers such a measurable outcome.

For myself, starting into year 4 of this nonsense, I will will act aggressively and decisively the moment there is a change in the status of my scans. YMMV-- we all have different approaches and priorities. Best of luck. 

[NYC GUY]

Hey all, just wanted to follow up. Had surgery Monday. As diagnosed it was adenocarcinoma. Dr removed a wedge of my lobe and said cleared margins. He also removed lymph nodes. Feeling lucky for the incidental find and choosing the surgical biopsy . Waiting on lymph node results. I have a Follow up may 9th. Thanks for the support. 

[LouT]

Good to hear.  Early diagnosis is a real benefit to success.

Lou

[Livin Life]

Hope nodes are clear and surgery is curative for you!!  Appreciate your update and will wait to hear on your final path.....  Hang in there - this waiting is hard too...